Cllr Louise Gittins, former chair of the LGA, led the panel discussion with health and social care secretary, James Murray; Lord Victor Adebowale, chair, NHS Alliance; and Professor Lisa McNally, director of public health, Worcestershire County Council.  

NHS barrier  

Speaking first, Lord Adebowale said the NHS was the biggest barrier to neighbourhood health.

‘The NHS is not a great partner,' he said.

‘We tend to arrive at communities wanting control, defined boundaries, detailed governance and we call that leadership. It isn't.

‘Leadership is the work and we are still learning to do it.'

Lord Adebowale said local government was ‘better at the things that make neighbourhood health work', including genuine partnership, being led by the community and ‘being brave not to impose one model on very different places'.

The NHS Alliance chair called on the Government to provide the ‘data and digital alignment to reach the communities with the worst outcomes' along with ‘aligned money so local leaders aren't swimming against the tide to do the right thing'.  

‘Neighbourhood health' not ‘neighbourhood healthcare'

Prof McNally warned of the danger of focusing on ‘neighbourhood health care' rather than ‘neighbourhood health'.

‘What I see [in the neighbourhood health framework] is NHS metrics around diagnostic pathways and around reducing demand, which is all really important, but that's not neighbourhood health, that's neighbourhood health care,' she argued.

Prof McNally said there was a risk of addressing only the 20% of health determined by clinical care factors at the expense of the 80% determined by social factors such as financial security, housing, education, employment, skills and access to a community full of socially supportive connections.

The public health director said there was a ‘once in a generation opportunity to empower local authorities and Health and Wellbeing Boards (HWBs) to build that total place model to improve health, and then just maybe we'll have something genuinely transformational'.

Devolved health

Health and social care secretary, James Murray, said: ‘The biggest challenge we face is how to make sure we have the right structures for local authorities to work with the local health service towards the common goal of making people healthier and having less need to go to the NHS and receive healthcare.'

Lord Adebowale said bringing democratic accountability was ‘absolutely welcome' through deputy mayors chairing ICBs, ‘providing it transfers power to communities and not just reallocates it between institutions.

He said local authorities ‘must have a seat at the ICB' where there was no mayor.

Prof McNally agreed, arguing the Health Bill's proposal to remove the statutory right for local government representatives on ICBs risked parity of esteem between the NHS and councils. The public health director said devolving health to strategic authorities risked losing ‘the local' in neighbourhood health.

‘Housing is health'

During the following Q&A, Cllr Helen Whitehead, deputy leader of Thanet District Council and cabinet member for housing, said unitary councils had the potential to bring a holistic approach to health by tying housing and health together.

Health secretary Murray agreed, adding central Government's housing and health department silos could be broken down at a local level through partnerships between coterminous ICBs and strategic authorities.

‘There's viewpoints and priorities that should come from local authorities, and, where appropriate, from the mayoral strategic authority, which has a broader view about planning and housing across the region,' Murray said.

‘Both of those are important to get housing on the agenda when we're talking about health.'

Lord Adebowale called for ‘consequences' for landlords who failed to provide decent housing.

Declaring an interest, he said modular housing could play a key role in addressing substandard residences.

A partnership approach

Looking ahead, Prof McNally said she was working with think-tank, New Local, on a list of difficult questions councillors could ask NHS colleagues about neighbourhood health such as: ‘Where's the community in this?' ‘Where's the neighbourhood in this?' ‘Where's housing?' ‘Where's social isolation?' ‘Where's the 80% that directs health outcomes, or are we just focusing on the 20% determined by social care?'

Lord Adebowale said NHS Alliance members would like to contribute to Prof McNally's project.

‘I think we need to signal that we're serious about this by helping councillors and council officials to actually ask those questions of each other, not just of the NHS,' he said.

Cllr Gittens signposted the LGA's launch of its Neighbourhood Health Hub last week, which brings together information and resources on neighbourhood health for councils and their partners.

In addition, Cllr Gittens revealed an autumn report will set out the LGA's vision for neighbourhood health.

Watch this space.