NW Directors of Public Health

Master Class

Friday 18th February 2011

10 – 2pm

Everything you wanted to know about local government but were afraid to ask…..

NW Directors of Public HealthMaster Class

Trevor Hopkins

Principal ConsultantLocal Government Improvement & Development

How big is local government?• Total Local Government spend per year?

• £116 Billion• Assets?

• £16 Billion • How Many Councils in England?

• 375 (22 in Wales & 32 in Scotland)• How Many Councillors?

• 18,500 • How Many Employees?

• 2.3 million – LG is one of our largest employers

• People registered to vote in Local elections?• 40 million

How is local government funded?

Three main sources of income:

• Government Grants– 54% - about £56 Billion in 2009 - 10

• Council Tax– 25% - about £25 Billion

• Redistributed Business Rate– 19% - about £19.5 Billion

Councils also receive income from returns on borrowing and investments, interest and capital receipts, sales, fees and charges and rents.

HistoryA

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1834-5 1888 1948 1972 19801875 1929 1962Poor Law Amendment Act and Municipal Corporations Act

Between 1832 and 1875 the number of central government inspectorates increased from 0 to 20

Regularised the role of

Local Government Act

Local Government Act

Growth in local autonomy and size of central grants

Local Government Act

Loss of water services

More central control over funding, loss of local control over hospitals and municipal gas and electricity works

Residual Poor Law functions transferred to local authorities

Local Government Act

Loss of ancillary health services and sewers

Privatisation gradually erodes accountability and local control

1997+

Centralisation limits adaptive capacity of local government

Wellbeing Powers

The 21st Century – a new role?• Labour Government – partnership working, Local Area

Agreements, Sustainable Community Strategies, Area Based Programmes, attempts to ‘close the gap’ especially in child poverty and health……but top-down control, huge industry of inspection, performance targets,

• Conservative/Liberal Democrat Coalition – have dismantled most of the previous administration’s structures. Wants: “a fundamental shift of power from Westminster to people”. Local councils, communities and neighbourhood schemes will be given more power to determine local issues by a “radical devolution of power”.

Legal Framework• Local Councils and their powers are enshrined in Primary

Legislation• Central Government influences Local Government through - Guidance

- Funding- Secondary- Regulations- By agreement

• But it can’t just tell LAs to do something unless it has been given the powers to doso through legislation.

Different types of Councils

Types of Councils - What’s in a name ?• Parish• Town• District• Borough• County• City• Metropolitan• Unitary • London Borough• City of London Corporation• Greater London Authority

Third Tier

Second Tier

Top Tier

Two Tier

Two Tier

Single Tier

Unitary Councils • Were created in 1990s when some

Counties and Districts were abolished.

Metropolitan Districts• 36 Were created in large cities in

partial reorganisation in 1986 when the Metropolitan Boroughs were abolished

London Boroughs • All 33 were created in 1965

Two-tier - County

County Council• Initially 1888, reorganised in 1929,

1974,1996/8 and 2008 and 2009

District & Borough Councils• Initially 1894 reorganised in 1929, 1974

and late 1990s

Greater London Authority• Created by the GLA Act of 1999 and

formally established in 2000. The GLA Act of 2007 introduced additional and enhanced powers for the Mayor of London and the London Assembly

Two-tier - Regional

Greater London Authority

• In 2000 Mayor for London took on transport, some waste, environment and economic development responsibilities

• 2006 added housing strategy, large scale strategic planning applications strengthened waste and climate change role.

What do they do?

Council servicesCouncils provide three types of service to their communities:

• Statutory services – such as refuse collection – that councils must provide• Regulatory services – such as pub licensing – that councils must provide• Discretionary services – such as

tourism that councils may choose to provide.

Typical Council Services• Education • Adult Social Care• Services for children & families• Safeguarding children and adults • Social housing • Roads, highways and transportation • Planning and regulatory services• Environmental services and health• Trading standards • Leisure, culture and sports• Libraries • Fire and rescue

How are decisions made? Councils may be structured in three different ways:

• A Leader and a Cabinet

• Councillors elect a Leader who then appoints a Cabinet

• An Executive Mayor and a Cabinet

• Public vote for a Mayor who then appoints a Cabinet

• A Council with a structure of Committees

• In areas with populations below 85,000 Councils may adapt the older Committee model where no distinction is made between cabinet Members and backbenchers.

How do local elections work?Councillors are elected for four-year terms. They are elected:

• ‘All up’• There is an election of the whole council every four years

• ‘By thirds’• One third of Councillors are elected once in every four years

• But…• In seven District Councils they are elected by halves

An individual is eligible to stand as a candidate for the council if they are over 18 years of age, a citizen of Britain, the Commonwealth or European Union and meet certain criteria.

It is not possible to stand for election to the council if you work for that council or another council in a politically restricted post, are bankrupt or have been in prison recently

Current political balance and recent election results

The balance of power in local government changes frequently due to regular elections and by-elections. Following the May 2010 local elections, the political parties’ representation in England and Wales was as follows:

Conservatives – controlled 201 councils and had 9,265 councillors

Labour – controlled 51 councils and had 4,487 councillors

Liberal Democrats – controlled 25 councils and had 3,772 councillors

others’ – controlled 9 councils and had 1,965 councillors

There was no overall control in 87 councils. A council is described as having no overall control if one party rules as a minority or with coalition agreement.

How does the council work?

• Councillors decide policy & represent electorate

• All sit on the ‘Full Council’ • Split into two roles (except in

some cases)• Executive Councillors• Overview and Scrutiny Councillors• Officers are the paid employees,

they are professional advisorsand carry out the work.

Council

Scrutiny

Officers

CabinetOther

Committees

Role of Elected Members

Different Types of Mayors

Lord Mayors

Elected Mayors

Town Mayors

Borough Mayors

Mayor of London

The Lord Mayor of London

Council Chairmen/Chair

Problems and Opportunities – a council of all the talents?

• Despite pockets of excellence overwhelmingly standard picture

• Average age 58.3, 70.7% male (population 48%), ethnic minorities 4.1% (pop 9.5%), retired 35% (pop 22%)

• Only 11% of Council Leaders women

• 36% of all public appointments now women

• Direction of travel not encouraging number of councillors under 25 halved 1997 - 2001

Local government is different• Administration and delivery must be achieved

in a democratic context…• involving members• subject to politics and the electoral process• joint leadership has to be developed• requires active work by both Members and officers• Community leadership is about more than services,

referenda and partnerships• Regulatory and standards bodies,

statutory and strategic responsibilities

www.idea.gov.uk

Conduct of Local Government Members & Employees

• Code Of Local Government Conduct

• Local Authorities Standards Committees

• National Standards Board

The Local Government Group

• Local Government Association (LGA)

• Local Government Improvement & Development (LGI&D)

• Local Government Employers (LGE)

• Local Government Regulation (LGR)

• Local Government Leadership (LGL)

The LG Group priorities for 2010 - 11The Business Plan sets out five priorities:1. Reputation – building and maintaining the national and local reputation of

councils

2. Innovation and value for money – supporting councils to achieve greater local efficiency and effectiveness

3. Local democracy – ensuring that councils are at the forefront of greater local decision making on spending priorities and leading improvement work across the sector

4. Economy – supporting councils to lead their communities to prosperity in the economic recovery

5. Customer service – ensuring that the LG Group enhances the reputation of local government and delivers value for money

My two challenges:

• Local Government is different. Whose culture is going

to change the most – yours or theirs – and in what

ways?

• The ring-fenced budget has the potential to

marginalise public health in local government. How will

you advise the council to use yours?

Presentations

The opportunities and challenges of working in Local Government

Dr Mike Grady

Senior Fellow, Marmot Review TeamUniversity College, London

A new definition of public health and a new set of priorities?

31

• Fairness at the heart of all policies.

• Health inequalities result from social inequalities – requires action on all the social determinants; the causes of the causes

• Focusing solely on the most disadvantaged will not reduce inequalities sufficiently – action is needed across the social distribution.

32

Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003

33

A. Give every child the best start in lifeB. Enable all children, young people and adults to maximise

their capabilities and have control over their livesC. Create fair employment and good work for allD. Ensure healthy standard of living for allE. Create and develop healthy and sustainable places and

communitiesF. Strengthen the role and impact of ill health prevention

Fair Society: Healthy Lives: 6 Policy Objectives

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Per cent of children achieving a good level of development by local authority: England

35

Per cent not in education employment or training by local authority: England

36

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My two challenges:

• How do you shift the agenda to focus on early intervention on the social determinants of health?

• How do you exercise political astuteness and strategic influence within the health and wellbeing board to secure your public health outcomes?

Councillor Jonathan Owen

Deputy LeaderEast Riding of Yorkshire Unitary Council

Working with politicians – the new strategic leaders for public health

‘Dr Livingstone I presume?’

Opportunities

• Closer to the Community

• LA Resources

• LA Freedoms

• JSNA

• Ring fenced budgets

• Champion for the cause

Challenges

• Who’s the Boss

• Ring fenced budgets

• Elected member whims

• Scrutiny

• Priorities

Challenges

• Evidence

• Politics

• Timescale for outcomes

• Academic pride

• Two-tier Authorities

My two challenges:

1. Elected Members champion community &

people issues not the DPH.

2. Politicians will want to manage the DPH not

vice-versa – is this an issue?

Robin Stonebridge

Independent Consultant &PCT Non-executive Director

A new culture with new relationships and accountabilities

15th September 2010

• local councils founded on health and social issues

• then: big killers were infectious diseases

• now: big killers are heart disease, cancer and respiratory disease

• if councils are about improving ‘place’ then this needs to include health

Health is core business for councils

Plato’s Cave and Public Health......

Where does the DPH sit?

Public Health challenges moving forward.....

• Does public health exhibit the attributes of a discrete profession or the characteristics of a social movement?

• Can we develop a shared vision for public health based on local priorities and needs , with milestones for which practitioners are prepared to be locally accountable?

Group discussions

Discuss the implications for you of the opportunities and challenges and agree questions for the panel after lunch.

The Challenges• Local Government is different. Whose culture is going to change the most –

yours or theirs – and in what ways?

• The ring-fenced budget has the potential to marginalise public health in local government. How will you advise the council to use yours?

• How do you shift the agenda to focus on early intervention on the social determinants of health?

• How do you exercise political astuteness and strategic influence within the health and wellbeing board to secure your public health outcomes?

• Elected Members champion community/people issues not the DPH

• Politicians will want to manage the DPH not vice-versa – is this an issue?

• Does public health exhibit the attributes of a discrete profession or the characteristics of a social movement?

• Can we develop a shared vision for public health based on local priorities and needs , with milestones for which practitioners are prepared to be locally accountable?