Chancellor George Osborne’s December announcement of pilots for health devolution in nine London boroughs is an encouraging start for greater local powers over health and social care in the city.
Some of the issues experienced across these nine boroughs (Hackney, Lewisham, Barnet, Camden, Enfield, Haringey, Islington, Barking and Dagenham, Havering, and Redbridge) highlight the wild health inequalities across the capital. In Barking and Dagenham, for example, women’s healthy life expectancy is nearly 16 years less than in Richmond, meaning that women in the east London borough can expect to start experiencing serious health problems by the time they turn 56.
It is important that we start tackling health these inequalities across London, as well as other inner city areas, and Whitehall handing power to local authorities, that know the needs of their residents, is a huge step in the right direction.
The aim to take decisions locally in order to better integrate health and social care and an emphasis on helping people before they reach crisis is to be applauded, but to fully achieve this the role of the community sector must not be ignored.
What is needed from the devolution agenda is a truly holistic approach to designing and delivering services by looking at the range of issues that affect people’s health and wellbeing – like money worries or housing problems – and involving communities and community organisations so real innovation can be achieved.
We’ve seen great success in this area through the Our Place programme, which Locality delivers on behalf of the Department for Communities and Local Government.
In Thamesmead in south east London, GP surgeries have been collaborating with voluntary sector organisations to tackle difficulties people face which can lead to poor health and mental wellbeing Through the Positive Steps Thamesmead initiative, for example, people are directed to organisations which can help them with debt advice, stress about housing, fuel poverty and other issues for which they were previously visiting their GP.
Before the initiative started Lakeside Medical Practice had reported that up to half of its patients were coming to appointments with non-medical needs. Since the programme launched in April it has helped more than 500 people access the service most appropriate to their needs, meaning that fewer people need to visit their doctor and that waiting times for GP appointments are reduced.
Staff in organisations providing services to Thamesmead residents were frustrated by how difficult it was for people to navigate different services but, by joining up these organisations, the Positive Steps scheme has ensured more people are now getting the help they really need.
The success of Positive Steps Thamesmead, and other Our Place initiatives, is down to public services being built around the needs of local people and communities.
Involving people in the design and delivery of services and delivering them locally means that services are more responsive to local and individual need and are more cost effective, something the nine boroughs should bear in mind as they embark on the health devolution pilot.
Only by involving communities, and the community organisations that serve them, in provision can we hope to develop effective, robust health services that really meet people’s needs.
Local, people-focused public services, which Locality is calling for in its Keep it Local campaign, give people what they need, when they need it. This will deliver services that work for the individual, the community and the taxpayer.
