CASH-STRAPPED councils could face a new crisis sparked by controversial changes to the NHS, a leading academic warned yesterday.
David Hunter, professor of health policy and management at Durham University, said councils were enthusiastic about taking responsibility for improving public health from the NHS.
But Government spending cuts on councils risked undermining their ability to do the job, according to the expert who is based at the university’s Centre for Public Policy and Health.
And while up to £4bn could be transferred from the NHS for councils to spend on public health, Prof Hunter said it would not make up the “shortfall” in terms of wider cuts on budgets that affected public health.
He also warned of “tensions” between council and Whitehall, with local public health directors being responsible to both despite town halls taking the lead on improving local people’s health.
Prof Hunter spoke to The Journal about councils taking on improving public health after appearing before the Commons health committee, which is investigating the future of public health policy.
“Is this a good thing at a time when they are reducing budgets in other areas that affect public health such as transport and education?
“What is coming in from the NHS will not be enough to make up the shortfall that is going to come through the cuts.
“Many do feel excited by it, but many feel they have one hand tied behind their back.”
And there were risks of “tensions” between councils and the Department for Health over local directors of public health, he said.
“The accountability at the moment is dual accountability to the local authority either to the chief executive or some other senior manager and then to the centre, to the Secretary of State for Health for aspects of their role.
“That sets a precedent for local government to have a member of their senior staff officer group accountable to a minister. That would just not be acceptable because they would be seen as accountable to their locally elected members and the public.
“The might be seen as hosting someone who has divided loyalties,” said Prof Hunter.
He added: “I don’t think local government will find it easy to handle and it will put the local director of health in a difficult position.
“What if you run into trouble with the local chief executive or minister? Do you stay in job or not? It just creates huge tensions and uncertainties.”
Easington MP Grahame Morris, a Labour member of the Commons health committee, said: “I would argue it is going to make it very difficult for them.
“And what we are seeing here is that we don’t need a fragmented approach, which the Government’s new system might inadvertently bring about.
“We need to have an integrated approach between primary care and local government.”
What is coming in from the NHS will not make up the shortfall that is going to come through cuts
