Are Local Authorities using their new responsibilities to shift the gravity of their spending towards preventive health?

 Some public health professionals initially struggled to understand different decision-making mechanisms after councils took over public health. What help do public health commissioners need in making better spending decisions asks researcher, Dr Silvia Scalabrini 

Last year’s changes in the organisation of public health have great ambition and represent a big shift in responsibility – from the NHS back to local authorities. So it is fascinating to understand what is actually happening in practice, in particular whether it is leading to a genuine shift at council level towards promoting preventive health agendas.

How, for example, is decision-making effected, given that it is now greatly influenced, at least in theory, by the views of democratically-accountable politicians and voters? And how are spending decisions on public health being made, now they compete for priority with, perhaps, education and social care whereas, in the past, competition might have been with the needs of the local district general hospital?

What types of evidence do the new decision-makers need to create policy around, for example, transport and housing, in the cause of better health – policy spheres over which the former NHS-based public health policy makers had much less potential influence. What help do these decision-makers, operating in a very different policy world, use and need, to make the most of their new responsibilities?

Our research, led by Durham University and in collaboration with other academic partners, focusses on understanding what has been happening to decision-making in public health since responsibility passed to local authorities in April 2013. We are aiming to identify the effective supports that can help public health commissioners who are involved in prioritising investment and disinvestment in services and who are making decisions to improve health and wellbeing and to tackle health inequalities. We have held workshops for local authorities on health economics tools that they might use – around cost effectiveness, options appraisal and benefits realisation – to help with spending decisions.

The research comprises semi-structured interviews with members of Health and Wellbeing Boards and other local stakeholders in three local authorities plus an online survey across the country involving all the HWBs to see if our findings are echoed elsewhere. The early interviews, done months after the changeover, highlight how some public health professionals were still digesting the changes and sometimes struggling to understand how the various cultures and decision-making arenas, formal and informal, worked. All of this took place against a backdrop of austerity and a severe squeeze on local authority budgets.

A key question we want to answer is whether or not there has indeed been a shift in spending in local authorities towards preventive health as a result of the transferred responsibilities and funding.  How is money actually being spent and what are the underlying principles informing investment decisions?

The picture we are getting at this stage of the study is that professionals and political leaders are just beginning to identify the best ways to tackle public health under the new arrangements. We hope our research is going to help our policy and practice partners understand how the changes are working, to identify good practice and highlight effective supports for local authorities as they meet the challenges of improving the health and wellbeing of their communities.

Dr Silvia Scalabrini is a Post-Doctoral Research Associate at the Centre for Public Policy and Health at Durham University. Her seminar presentation on 7th October 2014 at LSHTM is entitled ‘Shifting the Gravity of Spending? Exploring methods for supporting public health commissioners in priority-setting to improve population health and address health inequalities.’ It is part of a series of SPHR@L seminars.