Public Health in two-tier local government areas: some tips from experience

One of the issues causing concern among Directors of Public Health in England is how, when and if Public Health transfers to Local Government, you configure public health to work in two-tier areas. By that I mean areas where you have both County Councils and District Councils. (All major Councils in Wales and Scotland are unitary, though both Wales and Scotland have a layer of Community Councils underneath the major Councils. So what I say here applies only to England -including Cornwall  and the Isles of Scilly.)

The model of Public Health in Local Government has been written for unitary or all-purpose authorites, and there have been a number of constitutional fudges over the last ten years or so which have put “top-tier” authorities (unitaries or Counties) in charge of some things. The phrase “top-tier” can sometimes feel patronising to District Authorities. But there are ways of making Public Health in two-tier Local Government areas work.

This blog is written from the perspective of someone who has worked in Public Health in the NHS, and has had a range of public health and Public Health roles in and around Local Government. I love Local Government and am passionate about its role, history, potential and significance.

I have worked in a number of two-tier areas, either as an employee or a Consultant, and the key is to understand the respective powers, duties, issues and concerns of each Council, the politics between them and how you can play them in to achieve your objectives. Ok, much more simple than it is, but in eleven years working across multi-tier areas in one capacity or another it has never failed me.

So, here are the things which have worked for me:

Firstly, understand that Local Authorities essentially fall into three Categories 

  •  Principal Councils are those which undertake major functions like Housing or Social Care. In London and many places these are all-purpose unitary councils. But England has a long tradition of two-tier local govermThese are Counties and Districts in County areas. The phrase “two-tier” essentially means you have two types of Authority. Counties cover a whole County such as Warwickshire or Dorset. Districts or Boroughs within the County cover a part of the County, such as Dorchester.
  • Local councils are parish or town councils which are very local. More about these later. In some ways calling an area two-tier is a misnomer when there are Parish councils around. Parish Councils can be significant for public health.
  • Specific purpose authorities are those like the North York Moors National Park Authority, and in some places specific Joint Fire Authorities, which usually exist in places where the Fire Service covers a number of local authorities, such as Tyne and Wear.

Secondly, understand what powers you might want to work with. Principal Authorities in two-tier areas have the following division of functions:

County Councils

  • Social Care for Adults
  • Childrens Care
  • Schools
  • Adult and Child Safeguarding
  • Health and Wellbeing Partnerships (proposed)
  • Category 1 Responder for Civil Contingencies Act
  • Waste disposal
  • Crime and Disorder Reduction Partnerships
  • Consumer Protection and Trading Standards
  • Strategic Planning
  • Libraries
  • Transport
  • Animal Licensing

District Councils (may also be called Borough Councils) 

  • Planning Control and local planning
  • Housing
  • Environmental Health
  • Waste collection
  • Building Regulation
  • Appointment of Proper Officers for Public Health Act purposes
  • Appointment of Proper Officers for Section 47 National Assistance Act
  • Disease Notification
  • Category 1 Responder for Civil Contingencies Act

All councils have different powers on similar issues

  • Leisure services and Culture have duties and powers across Districts, Counties and even Parishes
  • Roads and highways (Counties, Districts and Parishes all have different functions)

Parish Councils (sometimes called Town Councils)

Parish Councils vary enormously in size and functions. We might be tempted to think of the Vicar of Dibley when we look at Parish Councils but some of these very local bodies do struggle while others have functions and budgets not far off several million, often undertaking functions on behalf of their District and County sisters. You can find a really useful guide to the surprising powers of Parish Councils here http://www.townforum.org.uk/servicesstructure/parishcouncilguide2007.pdf. You can also find two very useful quick reads, The Role of Parish Councils http://www.camlink.org.uk/wiki/The_role_of_the_Parish_Council and the National Association of Local Councils, which is the Parish and Town Council answer to the Local Government Association http://www.nalc.gov.uk/Default.aspx

There are a whole host of things which Parish Councils can do you might not know about:

  • The provision of community facilities ranging from allotments to bars, laundrettes and even mortuaries, cycle parks, swimming pools and green spaces.
  • Undertaking functions on behalf of other councils
  • The right to raise a local precept for their parish through council tax collection

But equally importantly, they can help you engage local communities with policy changes, the Joint Strategic Needs Assessment, etc.

What’s in a name?

You  will find some councils in Counties may be called Districts or Boroughs. There is little difference, really just ceremonial and historical. Boroughs are districts which have been granted the title of Borough and can have a Mayor. Technically their councillors can be addressed as Burgesses not Councillors. Districts have a Chairman, not a Mayor.

Parish Councils and Town Councils essentially have the same functions they just exist in a rural or less rural area, or around a market town or historic town respectively.

Some Top Tips for Public Health to Understand

Thirdly, think through these top tips to develop a strategy for influencing and working across:

  1. Bear with me here, I’m going to give you the essence of what Psychology has to say on expert-novice differences and tell you why it’s important to you. The key difference between an expert and a novice in a field, according to psychological research, is that experts not only know the subject (i.e. have domain-specific knowledge of issues like environmental health and housing) but they can relate that knowledge to other areas of knowledge (i.e. how housing and social care interact) and can create mental maps and landscapes of how to work within and across those. What that means for you is get to know the Councils, understand how you can knit things together to create an integrated approach to public health, and understand who can help you.  A friendly local government lawyer is usually a help; while having both a County and a District member as a mentor can help too, especially if the two get on well and will agree to mentor you in joint sessions.
  2. The Elected Member theme here is crucial.  County Members and District Members have both different portfolios (housing, social care) and common concerns (their local area and electorate.) Personally I think elected members are crucial to making public health work and building an effective relationship with them is key. They have a difficult, not very well remunerated and often thankless task which they have to fight to be able to discharge. But they are a rich resource of learning and collaboration. The top tips are to remember – they are elected, you are not; you need to understand with both Chief Officers and Members when to relate to whom; treating them with respect and keeping some clear boundaries between their role and yours and finally staying politically impartial are all important. This comes with practice, hence finding a mentor.
  3. Remember always that Local Government in England has been around for centuries, so historical anomalies are important and you should accept these. The fact that the Common Council of the City of London and the Common Council of the Isles of Scilly have some unique functions is just one of these anomalies, and the fact that the Common Sergeant of the Inner Temple is actually a Local Authority (is He the only Local Authority who goes to bed at night?) is another.  Localism has been around for centuries, and the quirks and quaintnesses of local authorities up and down the land is just one manifestation of this rich heritage.
  4. Even if the public health transition intended in the White Paper is ultimately significantly downplayed or changed, Local Government remains crucial to the achievement of better health for our population. Counties and Districts, and Parish Councils can all have roles and they all have powers and duties you will probably want to tap into.
  5. While you will want to work in a two-tier area with both Districts and Counties (e.g. work with environmental health on food hygiene and education on school health) you need to understand that minimising the role of Parishes could be counter-productive. Make sure you think about Parishes, they can often be very helpful.
  6. Think about options for working together before or even without whatever comes out of the NHS listening exercise. Understand that there are models around for collaboration in two-tier areas already. Despite the political differences and challenges, Councils in two-tier areas often have a history of working together. They may have joint boards constituted between them (e.g. Joint Drainage Boards) which can give you governance models. There is probably a countywide Community Safety Network whose models you can learn from.
  7. Professional bodies often work well across counties. Trading Standards (County) and Environmental Health (District) often come together in networks for regulatory affairs. How can you use these to help? Similarly the lawyers might meet. The Chief Execs almost certainly do and there may be a members’ liaison forum.
  8. Professional groups are important sources of good practice in Local Government. Think about this. Can you work with the local Chartered Institute of Housing branch to help include housing people? Equally, the Chartered Institute of Environmental Health is a crucial body. It has now opened its doors to people from all public health backgrounds, and a good vote of confidence if you really want to be embedded in local government might be to join, and gain value and possibly some respect from your local government peers. I have decided to do this and am putting together my application and portfolio. Let’s hope I make the grade!
  9. Understand that local government thinks it never lost some aspects of public health. The Local Better Regulation Board with the Chartered Institute of Public Health and the LACoRs [Local Authority Co-ordinators of Regulatory Services] put together an excellent paper on the contribution by these bodies to public health. Get and read a copy! http://www.lbro.org.uk/
  10.  Think about whether, in the transition, you might want to set up a Joint Public Health Board, through agreement between the Authorities. Members and Officers can be given appropriate delegated powers within schemes of delegation.  The Council’s Lawyers (sometimes in Counties called The County Secretary) should be someone you want to speak to.  You might even want to consider the use of Agency Powers under the Local Government Act 1972, where one Council can arrange for another to carry out some of its functions as an “agent” on the commissioning Council’s behalf.
  11. Most Counties have shared County Level strategies and will have learning from this experience you can tap into.
  12. Counties and Districts have their own networks within the Local Government Association. These can be rich sources of learning. There is a County or District somewhere that has grappled with the constitutional, administrative or configuration challenge you are facing, so network!
  13. Make sure you are a regular visitor to the Local Government Association Website www.lga.gov.uk and if your Council is a member of the Local Government Information Unit , a Local Government Think Tank, you could benefit from making sure you see their publications. www.lgiu.org.uk

I hope this helps. Working in single tier areas brings is own challenges, but working effectively in two-tier areas can really bring its own rewards.

Further Reading

You can get some basic readings on two-tier local government here

http://www.idea.gov.uk/idk/core/page.do?pageId=1121355

http://www.direct.gov.uk/en/Governmentcitizensandrights/UKgovernment/Localgovernment/DG_073310

Jim McManus (2011) Understanding Local Government – a guide for public health professionals. E Book. Forthcoming

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