Next week sees the launch of a new public health service from the IDeA. But its roots lie in the past as well as the future, says Andrew Cozens. With a past firmly rooted in innovation, the precursors of modern-day local government – the pioneering local corporations of the 19th century – fostered the emergence of many public services that we recognise today. Local leaders, such as Joseph Chamberlain in Birmingham, generated social change and community cohesion, transforming the city in the 1890s to become ‘the best governed city in the world’. In Victorian Britain, local leadership aimed to establish a cleaner, healthier local environment through co-operation with the private and voluntary sectors, and better local amenities in an era of rapid social and economic change. Today, the Government’s public service reform agenda aims to once again make public services more relevant to local people. This process began with the modernisation and improvement of local government under the Local Government Act 2000 and 2001’s Strong local leadership – quality public services White Paper. Against this background of local government reform, the increased potential of the role of local government in health improvement was identified. In 2003, following the 2002 spending review, the Local Government Association (LGA) and the Government agreed a ‘shared priority’ service area of ‘promoting healthier communities and narrowing health inequalities’. This recognised the role of local government in tackling the ‘powerful determinants’ of health and health inequalities in the local community, such as income, housing, education, employment and the physical environment. Today, the Government’s aim is to devolve power to neighbourhoods and create a more patient-focused NHS. In line with this remit, the public health White Paper Choosing health: making healthy choices easier in November 2004, reinforced the principles of patient choice, of resources following patient choice and of greater autonomy for local professionals. It established a shared set of priorities for action: l reducing the number of people who smoke l reducing obesity and improving diet and nutrition l increasing exercise l encouraging and supporting sensible drinking l improving sexual health l improving mental health. The Our health, our care, our say White Paper calls on local authorities to examine and establish the new role of director of adult services, who will share joint responsibility with the director of public health to undertake strategic assessment of the health and social care needs of the community, and support commissioning, assessing the quality of services provided. It brings the infrastructures of local government and the NHS closer, with the reorganisation of PCT boundaries to correspond with top-tier council boundaries and aligns their budgets in order to encourage greater engagement of PCTS in LSPs and the use of LAAs to both improve health and tackle health inequalities in local communities by 2007/08. The White Paper calls for the development of personal health and social care plans integrated by 2008, establishing joint teams/networks. Moreover, it upholds the use of health overview and scrutiny committees to monitor and challenge progress on developing the strategic needs of communities. The Department of Health (D0H) acknowledges the new role that local authorities have to play and has established the healthy communities programme, a new national service area for local government, to be launched on 12 June. A two-year initiative, funded by the DoH, the programme will be managed by the Improvement and Development Agency (IDeA) for local government and will run until March 2008. The programme aims to support and build the capacity of local authorities working within their communities to: l tackle local health inequalities l provide leadership to promote wellbeing l foster a joined-up approach to health improvement across local government itself, and through LSPs and LAAs, including PCTs and senior NHS representatives. Although this is a new area of work for the IDeA, the agency will be able to draw on its established areas of expertise and the existing teams focusing on the: l children’s services sector l adult social care l voluntary and community sector l sustainable communities. The programme will build on the success of the shared priorities programme, the Beacon council scheme, and utilise the IDeA’s successful, established approaches and products. Following the success of the peer review process in improving services in local government, a ‘healthier communities’ peer review process will be developed. An intensive organisational ‘health check’ and action plan for local authorities will be established against a benchmark of an ‘ideal authority’, giving access to advice and guidance on improvement. Peer review teams will consist of local authority, health and other relevant identified partners led by an IDeA review manager. A new module will be developed within the existing leadership academy programme to include the role of elected members in leading the health improvement agenda – for lead members and leaders for health with a key focus on the community leadership and health scrutiny roles. A network of peer experts/service advisers will act as mentors to local authorities or individuals within local authorities who have a specific role, to help mainstream public health and develop programmes and initiatives as an essential, corporate and strategic activity . The term golden thread is often used to stress the fundamental link that should exist between health, housing, social services, leisure, planning and finance. This peer-led approach is focused on self-help. Building on current programmes within the IDeA, including the performance and management-information programme and work in supporting the development of LAAs, the programme will look at developing systems and processes to gather accurate information and data to inform service planning, priority setting, monitoring success and to advance successful partnerships. The IDeA will have a strategic, support and co-ordinating role, operating in partnership with local authorities, local health professionals and professional organisations, relevant national bodies and consultancies to both develop and deliver the programme on the ground. One of the challenges is to identify the key individuals in local authority areas – in some cases the lead person on public health works at the health authority and in other cases in the local authority – and, depending on where they sit, they could be in a different department. n Andrew Cozens is IDeA strategic advisor for children, adults and health services.