The King’s Fund | June 2018 | The role of cities in improving population health: international insights
A new publication from The King’s Fund argues that Metro mayors and other city leaders should be empowered to take greater responsibility for improving the health of the nation’s cities (The King’s Fund). Overview
Cities are playing a growing role in population health improvement and have enormous potential to be health-generating places. However, they also face considerable challenges and need to be governed in a way that gives all citizens the opportunity to enjoy good health.
Drawing on international case studies, this report explores the role of cities in improving population health and the conditions needed for success. It is based on 50 interviews with leaders from 14 cities and includes an extended case study on London that examines the lessons the city might learn from elsewhere.
The King’s Fund research found that although there is wide variation between cities in terms of governance arrangements, powers and resources, there are also some common themes. One is that improving population health depends on co-ordinated action at multiple levels and ensuring that decisions in areas such as housing, employment and transport planning all have a positive impact on health. This city-wide co-ordination requires effective leadership, robust governance, and adequate investment in central programme management.
The role of political leadership is also critical. Elected mayors and other city leaders have soft powers beyond their formal responsibilities that they can use to drive pro-health policies. Significant improvements in population health are possible when city leaders are willing to invest their own political capital to advocate for change.
In England, debate about the role of cities is closely connected with the devolution agenda, with new ‘metropolitan mayors’ now covering one‑fifth of the country’s population. Policy-makers should explore the case for giving cities further fiscal and regulatory freedoms to enable them to tackle population health challenges more effectively. (Source: The King’s Fund)
An accompanying press release from The King’s Fund is available here
Plans to cut public health budgets by £85m this year ‘self-defeating’ | story via Kings Fund
Public health services such as sexual health clinics and services reducing harm from smoking, alcohol and drugs are to be cut by £85m this year by local authorities, despite having their budgets severely reduced in recent times, new research has found.
In findings released by the King’s Fund which analysed Department of Communities and Local Government data, it was revealed that councils in England were planning to spend £3.4bn on public health services in 2017-18.
However, on a like-for-like basis excluding the impact of changes to how budgets are calculated over different years, councils will only spend £2.52bn on public health in 2017-18 compared to £2.60bn last year.
Once inflation is factored in, the King’s Fund experts also discovered that public health spending is more than 5% less in 2017-18 than it was four years ago, in 2013-14.
The Kings Fund has published ‘What is social prescribing?’
Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services. But does it work? And how does it fit in with wider health and care policy?
Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.
Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.
There is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes. Studies have pointed to improvements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of depression and anxiety. For example, a study into a social prescribing project in Bristol found improvements in anxiety levels and in feelings about general health and quality of life. In general, social prescribing schemes appear to result in high levels of satisfaction from participants, primary care professionals and commissioners.
Although the National Institute for Health and Care Excellence does not provide guidance on social prescribing specifically, some of its guidelines relating to mental health include initiatives that could be described as social prescribing activities. There is also an increasing amount of guidance on social prescribing available for commissioners and others in the NHS and local government, as well a new Social Prescribing Network set up to provide support and share practice on social prescribing at a local and national level. In June 2016, NHS England appointed a national clinical champion for social prescribing to advocate for schemes and share lessons from successful social prescribing projects.
“It is now 2050. And as an independent policy technician at Cybersocial Systems, I’m looking back at the impact of the ‘obesity epidemic’ in the first years of the 21st century” | The King’s Fund
It seems odd now, but at the time there was serious scientific debate about what ‘caused’ obesity, the role of the state – should it be a nanny or get out of people’s lives – and the relative effectiveness of the state, businesses, communities and individuals to influence outcomes.
In England, things came to a head in 2017, a year after the government published its ‘childhood obesity plan’. This suffered from a weight of expectation, delay and the random play of being delivered under a change at the top of government. There was predictable outrage from the usual suspects in the public health lobby, but, more quietly at first, disappointment too from some major retailers. Among the public the realisation was starting to bite that the West could be witness to the first generation that would die earlier than its predecessors, not because of an external health threat, but because of obesity – an issue manufactured within society itself.
This report looks at the economic case for closer working between the housing and health sectors. It shows how housing associations provide a wide range of services that produce health benefits, which can reduce demand on the NHS and create social value. A number of case studies are included in the report.
The Kings Fund has published ‘Sustainability and transformation plans (STPs) explained’.
Sustainability and transformation plans (STPs) were announced in the NHS planning guidance published in December 2015. NHS organisations in different parts of the country have been asked to come together to develop ‘place-based plans’ for the future of health and care services in their area. Draft plans were submitted in June 2016, and final plans are expected to be completed in October. But what do STPs really mean? And what will they mean for the NHS?
What are STP’s STPs are five-year plans covering all areas of NHS spending in England. A total of 44 areas have been identified as the geographical ‘footprints’ on which the plans will be based, with an average population size of 1.2 million people (the smallest area covers a population size of 300,000 and the largest 2.8 million). A named individual has been chosen to lead the development of each STP. Most come from clinical commissioning groups (CCGs) and NHS trusts and foundation trusts, but a small number of STP leaders come from local government.
What do they mean for the NHS? STPs represent a shift in the way that the NHS in England plans its services. While the Health and Social Care Act 2012 sought to strengthen the role of competition within the health system, NHS organisations are now being told to collaborate rather than compete to respond to the challenges facing their local services. This new approach is being referred to as place-based planning.
Where next? STPs could provide a foundation for a new way of planning and providing health services based around the needs of local populations. While STPs are primarily being led by the NHS, developing credible plans will require the NHS to work in partnership with social care, public health and other local government services, as well as third sector organisations and the local community. There has been limited time for public involvement in the plans so far, so leaders must ensure that local people are actively involved in the planning process as STPs develop.
The task of developing a plan may be challenging for some areas; making it happen will be altogether more difficult. Changes to incentives and performance management in the NHS may be needed to overcome the barriers that get in the way.
The King’s Fund Blog | Published online: 19 August 2016
By David Buck – Senior Fellow, Public Health and Inequalities
In her first month as Prime Minister, Theresa May has signalled that she will focus on inequalities and life chances. Unlike the first woman to occupy Number 10, she may even be one for turning, as evidenced by the Hinkley Point reappraisal. Given this fresh thinking, I wonder whether the Prime Minister will be interested in the current situation with public health budgets.
After a welcome commitment to better funding of public health services in the early years of the coalition (it’s easy to forget that growth in the local government public health grant initially outpaced clinical commissioning group allocations) the ex-Chancellor first slammed the brakes on, then made a £200 million in-year reduction, and finally announced in the Spending Review a further real-terms cut averaging 3.9 per cent each year until 2020/21.
The King’s Fund and many others warned of the false economy of these cuts; the arguments are well rehearsed so I won’t repeat them here. What is worth underlining, though, is how local authorities are planning to cope with these cuts – the first tranche of data on this has now been released – buried though it is on the Department for Communities and Local Government’s website.
Figure 1 below shows the percentage changes in local authorities’ planned spending on public health services between 2015/16 and 2016/17 – a 9 per cent cut on a like-for-like basis(1).