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Bringing the power home: can councils handle it?

It’s hard to miss the headlines informing us that obese people could have their benefits cut unless they start exercising. This is bound to spark considerable debate over why only overweight people are being punished and not smokers or drug addicts or why overweight people should be allowed to put a strain on the healthcare system. But it’s not this debate that I’m interested in.  Instead it’s the role that local councils are now taking in public health.

In a recent report released by City of Westminster council, entitled ‘A Dose of Localism: The Role of Councils in Public Health’, it is claimed “Relocalisation of council tax benefit and housing benefit combined with new technologies provide an opportunity for councils to embed financial incentives for behaviours that promote public health”. Since April 2011, 25 of the 91 PCT’s have introduced restrictions on treatment for obese people. For example Hertfordshire PCT has introduced a ban on knee or hip surgery for anyone with a BMI over 30. Whereas in Bedfordshire the criteria is slightly less stringent with access to hip and knee replacements being denied to patients with a BMI of 35 or over.

The discriminatory nature of these new legislations will certainly cause some controversy and outrage and there is even a growing suspicion that some PCTs are now blocking access to surgery for the obese simply to help achieve ever greater efficiency savings and withhold benefit payments. Furthermore we can’t deny that this switch to giving control over to local councils has come at a difficult time when councils are already struggling to provide the resources that people need.

However there could be a light at the end of the tunnel. The first recommendation outlined in Westminster council’s study is the innovative role that councils now play in public health. By linking welfare measures to behaviours that promote public health they are doing just that. But how can this move benefit us financially? The NHS constitution states that the NHS must provide comprehensive services available to all irrespective of age, gender, race, or even BMI. It has a duty to each and every individual that it serves and must respect their human rights. Furthermore the constitution states that the NHS must reflect the needs and preferences of its patients.

These restrictions however do not apply to local councils. The changes will see GP’s being given the power to prescribe activity at leisure centers. If a GP chooses to prescribe a free dose in the gym instead of costly weight management surgery then they will be perfectly entitled to do so. The relationship that people have with their GP is closer than the relationship that they have with their local council, and GPs have a closer relationship with local councils than they do with the NHS as a whole. So by giving GPs the power to decide and by giving councils the power to provide, the care that the patient receives should be more tailored to them and their lifestyle than had they simply used governmental NHS services.

But the benefits of this move don’t stop there.  In 2008 a Government commissioned review recognised that the most crucial indicators of public health are the responsibility of public authorities and not the NHS. This is because individual health is influenced by social determinants such as income, education and the local environment. With councils having control over how their resources are allocated they will be forced to connect with their occupants, to learn about them and to understand them and their needs. All this is made easier with new technologies such as the suggested smart cards that record leisure center usage.

Councils may be struggling to allocate diminished funding, however with this innovative approach councils can allocate what they do have in the most beneficial and resourceful way. So long as patients, GPs and councils keep a close relationship we could see significant improvements to the nation’s health and the public’s purse.

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