It is vital that the private sector is incentivised to get involved in improving the nation's health in a way that works for local communities, say MEND.
As the Commission on Big Society's report, 'Powerful People, Responsible Society', points out, the concept of the Big Society has been wrongly defined by many as being synonymous with the promotion of the voluntary sector, hence accusations that it is merely a ploy by government to justify spending cuts. Rather, as the report quite rightly argues, the Big Society is about shifts in power and responsibility, and means that there is a role for the public, private and third sectors in solving our society's problems.
So how does this fit with the government's localism agenda?
Speaking from the perspective of a service provider, two issues emerge. Firstly, the push to get the private sector to take responsibility for society's problems will fail if private companies are seen as taking a top-down approach. Particularly in a time of spending cuts, where public health problems like obesity are set to cost the health service and the wider economy billions, it is vital that the private sector is incentivised to get involved in improving the nation's health in a way that works for local communities.
While the Responsibility Deal is a strong start, the private sector has a great deal more to offer in terms of resources and expertise. MEND has been able to leverage corporate funding into local communities to provide weight-management services through partnerships with Bupa, Morgan Stanley and Johnson & Johnson, amongst others. Local authorities should look positively upon engaging with local businesses and the wider private sector, and the government should encourage these types of partnerships. Rather than detracting from localism, companies have been able to work in partnership with local commissioning bodies to ensure that local people continue to hold the reins of power.
The second issue is around achieving economies of scale. Unfortunately, certain societal issues, such as obesity, which are widespread and require evidence-based solutions, cannot be left simply to borough-by-borough commissioning if we are to take the type of swift, effective action that is needed. As a result, while localism may be the ideal, in order for it to be realistic and successful, localism perhaps needs to come with a few caveats.
For instance, where possible, pan-city or regional commissioning of services such as weight management should be encouraged. Not only does this allow for significant savings, it also increases efficiency. Of course, the government acknowledges this approach is necessary for certain services, but not all that need it. The London Health Improvement Board has recently met, and listed childhood obesity as one of its three target areas where it believes a pan-London solution can and should work. In the end, who is to say what the size of a 'local' area should be? If there is a common need across a city or region, working together is not top-down – it can still be local by definition.
To conclude, while we would never dispute that local decision-making is best, this does not mean that local commissioners do not need the support of the private and third sectors, and central government. Certainly in the case of health, the Nicholson Challenge will only be met while maintaining a high standard of public services, if local bodies work in partnership with these sectors and with each other. Commissioning the same service ten times across a region when the common need is clear, makes no sense. As public health passes across to the domain of local authorities, we hope that they will be encouraged to proactively engage with different sectors and with each other, to make a tangible improvement to the nation's health.
Throughout recess, ePolitix.com will be focusing on a different policy theme each week. This week we are featuring articles with a focus on localism and the Big Society.