Paradise Regained and Paradise Lost?

The transfer in 2013 of significant public health responsibilities and funding for the over fives was, rightly, heralded as one of the best local government-related decisions of the last Parliament (although, to be honest, there weren’t that many to choose from). And since that time we’ve been working hard to negotiate the follow-on 0 – 5 healthy child programme, included within it the Coalition Agreement priority of an enhanced Health Visitor resource, personally mandated by the PM.

At an otherwise pretty grim time for councils, we celebrated the “coming home” of responsibilities that had, more than 150 years ago, first defined local government as being principally about the health and wellbeing of our citizens and their communities. Indeed, we even took in our stride the otherwise anathema-like criterion of the money being subject to a ring-fence.

And we lauded this progressive change not just for its potential to enable all our functions to be redefined and reworked in the light of these new “health of the public” duties, but we loved the unexpected and increasingly rare opportunity to salvage something of our commitment to prevention and early intervention which was being undermined by the swingeing reductions being made to other key sources of “early help” revenue (notably the DfE’s “hot knife through butter” approach to the EIG).

So, the recent announcement by the Chancellor that £200m is to be swiped in-year from our grants, just a few months before the 0 – 5 transfer, has left us – and apparently the Department of Health and Public Health England – deeply troubled. The sense of disbelief and, amongst the more melodramatic, outrage wasn’t just because we thought we might have balanced our books in 2015-16; no, it was because we picked up a rumour that the cut was to be made both deliberately against non-NHS activity and also specifically against this grant. Local government, and only local government, must take the hit. Whether or not the latter is true, it is clear that the former is accurate – protection for the NHS is to be ensured.

Or is it?

As we work our way through the likely implications locally with our health colleagues (possibly £6.4m for Birmingham, by-the-by) – who are equally bemused and angered – what is clear is that pretty much all of the 2015-16 allocations are tied up contractually. And large numbers of those contracts are – you guessed it – with the NHS, notably Community and Mental Health providers.

So, this cut has three consequences attached to it: it will, as seemingly intended, permanently reduce the DH’s DEL as it pertains to the public health grant and, consequently, further impair councils’ ability to invest in upstream interventions. But it will also put more pressure on the NHS at a time when it least needs it.

Why would the Government want to do this? Well, we know that deficit reduction is the fig leaf for an appetite to shrink local government, so perhaps there is no real surprise in yet another cut – although, clearly, the rules of the funding game are that there are no rules and, if this is the case, we should expect further in-year reductions to play havoc with our attempts to plan and set budgets.

But what councils and their partners really don’t get is why it makes sense to anyone to introduce this kind of cut when it clearly undermines the otherwise ferocious determination to protect the NHS. Maybe, along with much else that we are seeing in the early legislative programme of the new government (for example, in the Housing Bill), decisions are being implemented that were never intended to get this far. Obviously, it is bizarre that anyone would bring forward ideas that they wouldn’t really want to put into practice in the first place; but this is not as strange as then seeing them through anyway. Let’s hope that this is just an early phase of cognitive dissonance and that, as Parliament progresses, there will be no more cutting off of noses to spite faces.

For now, however, it does seem that a paradise only recently regained is to be a paradise lost.

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Posted on June 30, 2015, in Articles, Blog. Bookmark the permalink. 2 Comments.

  1. Alan Wenban-Smith

    DoH has form on this kind of thing. The Memorandum of Understanding on devolution of health functions to Manchester was (until now) the most recent: after stating the ‘ambition’ for ‘full devolution of funding and decision-making for health and social care’ it goes on to make this subject to no fewer than 17 ‘Principles. Each of these principles represents a line of control back to Whitehall.

    This has been a constant theme under Government of all complexions. Alan Milburn replaced Health Authorities (which were big enough to make real local decisions) by Primary Care Trusts which weren’t. This also was done in the name of localisation, so the present move by Sir Humphrey should not perhaps come as a surprise.

    The real test of bona fides is whether DoH dismantles the relevant parts of its Whitehall machinery, relocates it in the region it is supposed to serve and subjects it to local democratic control. I am not holding my breath waiting!

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