An ambitious public service reform programme has been launched by the Government with Local Government Reorganisation being carried out in tandem with NHSE abolition and ICB restructuring.

While all of this system change is going on, the NHS is, in turn, trying to deliver a radical shift to neighbourhood health under the 10-Year Health Plan.

So has the Government bitten off more than it can chew?

‘All of that's happening all at once, and it does require some fancy footwork,' the ADPH president noted.

‘The acid test will be where does what is known as neighbourhood health fit into a much bigger party.

‘Where does it fit into place shaping, redefining what places look like? Where does neighbourhood health fit into public service reform, which is how all services reshape themselves to become more preventive and neighbourhood health is part of that bigger party, rather than the other way round and that will take a bit of work.'

In order for neighbourhood health to flourish within the shifting local landscape, Fell said it would require all partners to ‘be agnostic to institutional and organisational boundaries to better co-ordinate a whole range of different services for to enable communities to thrive'.

This will entail a multi-departmental approach, including healthcare, debt and welfare advice, housing, schools and services, he noted.

‘All of that together is how we achieve better neighbourhoods that enable communities, families to thrive,' Fell argued.  

A very welcome move

The ADPH president highlighted combined and strategic integrated settlements as a key platform for implementing a cross-departmental approach to health.

‘Integrated settlements bring together the combined or strategic authorities' responsibility around economic policy, strategy, housing, transport and skills all into one place,' Fell noted.

‘In theory, all of that is the determinant of health. Add into that the potential where the geographies align with ICBs, such as in South Yorkshire, Greater Manchester, and the announcement for a Deputy Mayor/Health Commissioner/Chair of ICB, further enables that integration to happen at that strategic level and that can only be good. How we sort of capitalise on the potential there, I think, is yet to be determined, but in principle, it's a really interesting move and very welcome.'

Lack of alignment

On the downside, Fell noted a lack of alignment between local government devolution and the merging of ICBs into larger geographic areas.

‘As the ICB operating footprint becomes bigger, almost by definition, they'll become more and more distant from places,' he said.

‘Meanwhile, it's fair to say that most of the rest of local government organisation is very much focused on place.'

Given the increasing geographic size of ICBs, I asked Fell whether placed an even greater importance on neighbourhood health centres to act as local agents of healthcare delivery.

While agreeing in principle, the ADPH president said it was important neighbourhood health was focused around people and not buildings.

‘Centres and buildings do offer an amazing potential for physical, economic and social regeneration, but in terms of service delivery, I would organise around buildings of people rather than neighborhood health centres,' he argued.

The public health director said Health and Wellbeing Boards were the key vehicle for effectively integrating healthcare, local government and the voluntary sector to deliver neighbourhood health at a local level.

‘It's clear that the Government expects them to be on point for delivering on the neighbourhood health agenda,' he observed.

Public health

When assessing Government's overall progress on public health, Fell said there had been ‘amazing progress', particularly on the Tobacco and Vapes Bill, but was ‘still a lot to go at'.

He predicted obesity would be ‘new tobacco', given the Government's comparative lack of progress on the issue.

Fell argued tobacco legislation should be used as a template for other ‘lifestyle killers' such as alcohol and obesity.

He noted the need for England to follow Scotland and Wales are alcohol minimum unit pricing.

He also stressed the need for more regulation on supermarkets to change advertising policies, noting progress with the high fat sugar advertising ban on social media and other channels, while adding many loopholes remained to be closed.

The ADHP president also identified air quality as requiring further action, noting it was the cause of 5% deaths.

He also stressed more work was needed on combating inequalities through the Child Poverty Task Force, while acknowledging abolition of the two-child benefit cap would have a ‘massive impact'.

‘I think it's fair to say that there is plenty of positive progress, but there's an awful lot more to do,' Fell concluded.

‘The job will never be done. Well, it might be done, maybe eventually, but certainly not for a good few years.'