District councils’ fundamental role in determining the health of their communities makes them “indispensable strategic partners” in integrated care systems (ICSs).
That is the conclusion of a report produced by the King’s Fund for the District Councils’ Network which is being launched at the Local Government Association Conference on Tuesday, 4 July.
The report, Driving Better Health Outcomes Through Integrated Care Systems: The role of district councils, notes that district council services – including housing, planning, economic development, welfare, leisure and environmental health – influence some of the most significant determinants of health.
“Around 80% of the variation observed in population health outcomes is attributable to wider factors such as these, rather than to the quality of health care services,” the report says. “This makes district councils indispensable strategic partners in integrated care systems, whose involvement is essential if systems are to deliver population health improvements.”
The report notes ICSs constitute an opportunity to bring together the NHS, voluntary sector and local government to take action on the wider determinants of health, and to help shift the focus from treating illness towards preventing it.
“For this opportunity to be realised in full, district councils, with their ability to act as convenors in local places, need to be active partners in ICSs,” it says.
“District councils can help bring about a shift to prevention in the health system, pushing resources higher upstream.”
The report notes how district councils operate on a highly localised scale – with an average population of 117,000, compared to 917,000 for a county council.
“District councils are smaller than many of the other bodies that make up ICSs, and this can bring significant advantages. NHS leaders interviewed in our research often brought up district councils’ ability to move quickly and offer strategic leadership in challenging situations as one of the main advantages that comes from working with them.”
The report cites numerous case studies of examples of district councils which are already undertaking significant preventative work (see below), adding: “In some ICSs, this is being effectively harnessed. This work now needs to be universally integrated across all ICSs to maximise its benefit.
“ICS leaders interviewed in our case study sites argued that district councils are indispensable partners not only due to their power to influence the wider determinants of health, but also because of their ability to act quickly and flexibly, and their detailed knowledge of local communities.”
The report outlines five principles for success in fully utilising district councils within ICSs:
- Create effective local partnership structures
- Align agendas across levels in the ICS
- Embed district council leadership throughout the system
- Invest in relationships
- Build shared purpose and collective accountability.
Matthew Taylor, Chief Executive of the NHS Confederation, said:
“In the year that the NHS celebrates its seventy-fifth anniversary, it is time to recognise that for too long responsibility for the health of the population has been placed exclusively at the door of the NHS. Tragically, the decades’ long trend of rising healthy life expectancy is plateauing and for some groups declining. To address the health of the population we need a health strategy not just policies for the NHS.
“This shift requires several actions, but at the core it demands greater collaboration between organisations and across professional boundaries. Integrated care systems and the place bodies they oversee – both of which are represented by the NHS Confederation – offer the scope for new ways of working.
“This report commissioned by our partners in the District Councils’ Network from the King’s Fund highlights how district council leaders are ready to use their positions as representatives of local communities and providers of vital services to play a growing part in meeting our collective ambition for a healthier nation.”
DCN’s health spokesperson, Cllr Hannah Dalton, the leader of Epsom & Ewell Borough Council, said:
“Prevention, in the form of a focus on population health, needs to be our shared goal. We want to prevent illness or stop it at the first opportunity rather than allow it to progress, worsening wellbeing and adding to the NHS’s workload. And we want to build places which promote happy, healthy lives.
“For 40% of the English population, district councils are the lead bodies in bringing this about. We are the most localised principal authorities, have unique proximity to our communities and run the specific services that have the most significant impact on the determinants of health.
“Our planners shape the places in which we live, building communities with plenty of green spaces which promote active lifestyles; while our economic development staff promote seek to overcome the joblessness and deprivation which are linked to ill health. Our welfare teams help people avoid poverty, reaching out to support the people our local insight tells us are in danger of falling into crisis, for instance by facing homelessness. Our leisure centres support our populations to be physically active and offer specific services designed to help people manage long-term conditions. District housing teams ensure that people live in safe, pleasant environments conducive to health and environmental health teams are key to ensuring public safety. We specialise in prevention.
“The importance of districts’ work has been truly apparent in recent years as we worked to limit the impact of Covid-19 and have supported our local communities during the cost-of-living crisis, working with them to alleviate food and fuel poverty.
“In some parts of the country, districts’ full value is being utilised by ICSs. But there is no reason why existing best practice should not be utilised in all places. After all, we all share the same objectives: creating healthier, happier communities; ensuring an efficient and effective care system and – crucially – reducing the pressure on the NHS.
“The DCN looks forward to working with all our partners across the health system to bring about the revolution we all seek.”
Sally Warren, Director of Policy at the King’s Fund, said:
“The need for shifting to a more preventative approach to health has never been clearer. By taking action on the wider determinants of health, integrated care systems can improve the health and wellbeing of the population and reduce the stark inequalities that exist between different communities. District councils are key allies in doing so. Our report highlights the need for district councils to be at the core of ICSs and provides practical advice about how to make the most of their valuable assets and expertise.
“In some systems, district councils are already deeply embedded within the ICS but there is a very varied picture nationally. In order to make the most of the opportunities that exist, district councils need to find shared purpose with neighbouring councils and their NHS partners and to work collectively towards these common goals.”
Supporting people on waiting lists in Norfolk and Waveney
District councils have led a project to improve the social situations of people on waiting lists for NHS treatment to manage their conditions so they do not exacerbate their health problems.
Under the Waiting Well project, districts have hosted multi-agency teams which contact people on orthopaedic waiting lists to see if they require assistance. Overall, 17% have unmet needs identified.
Support offered has included minor alterations to people’s homes and using social prescribers to connect them with specialist support in relation to welfare rights, relationship difficulties, social isolation or housing problems.
Responding to the cost-of-living crisis in Lincolnshire
District councils have jointly led the multi-agency local response to the cost-of-living crisis, taking advantage of their existing connections to the most vulnerable people.
Much of the focus of the work has been on guiding people through the various types of support available to them and the eligibility criteria for them. The aim is to improve financial resilience.
The project has also seen local services more fully mapped, with many integrated and duplication reduced.
Facilitating hospital discharge in Leicester, Leicestershire and Rutland
In Leicester, Leicestershire and Rutland, there is a focus on how multi-agency working to help people stay out of hospital and to support hospital discharge.
The Lightbulb Project hosted by Blaby District council has brought together partners to meet health needs within homes, for instance by installing equipment such as shower chairs or grab rails and offering energy advice to help them keep warm in winter.
The service also offers a range of grants to support hospital discharge and to cover the cost of improving an individual’s home to support their health needs.
The work has also seen housing specialists located in hospitals to pick up housing issues, including homelessness, that could delay discharge.