Since the shift of public health from central government, local authority teams across England have seized new opportunities to make health everybody’s business. Optimism and innovation have bolstered the consensus that local authorities are best placed to serve community needs; and health and social care continue to climb the agenda in decisions around planning, housing, transport, welfare and education, all of which feed into the wider social determinants of health and wellbeing.
The final piece of this jigsaw is the transfer of commissioning of services for 0 - 5 year olds, to take place in England in October. Local authorities should now finally be able to join up commissioning around people at the local level, across a range of services, throughout the entire life course.
As is often the case, local funding is a potential stumbling block, and many of us are concerned that the £200m cut to the public health grant may stall progress as greater responsibilities are devolved. We have already seen evidence that stretched local commissioners are rationing services such as child and adolescent mental health, weight management, and smoking cessation. While it is encouraging that some key child services will be mandatory, there is a real risk that cuts could stifle the growth of innovative early interventions at the heart of community prevention efforts.
But the wins could be enormous. We have known for some time that the right environment and support for children and their parents during the early years makes a crucial difference to a child’s chances of good health for the rest of their lives – strongly impacting on nutrition, growth and physical development; as well as the ability to maintain positive relationships, develop skills, achieve in education and build emotional resilience. Placing commissioning roles in local authorities offers the chance to tackle, from all angles, the varying causes of long-term health inequalities that take root even before birth. This is vital if we are to achieve the ‘radical upgrade’ in public health and prevention so passionately called for across the sector.
Huge investment in health visitors and Family Nurse Partnerships (as part of the Healthy Child Programme) has brought this into focus on the national stage and its impact is already felt on the ground. A look to the inspirational work that has been achieved by local authorities under pressure provides real hope that they can exploit this last transition to embed the health and wellbeing of children as a priority for local services up and down the country.
the right environment and support for children and their parents during the early years makes a crucial difference to a child’s chances of good health for the rest of their lives
Shirley Cramer, Chief Executive, Royal Society forPublic Health