Local Government
Communities and local government is responsible for national policy on local government in England. Local government makes a difference to everybody’s lives, delivering essential services and making communities better places to live. Each region in England has a Regional Assembly; part of their role is to represent the voice of the regions in Whitewall and Europeans institutions. They are responsible for integrating regional strategy development to local levels. There are 468 local councils in England and Wales and over 11,000 towns, parish and community councils and there are 410 local authorities. Local government in England and Wales is organised in 2 contrasting ways. In Wales and some parts of England there is a single tier all purpose council. The remainder have a 2 tiered system with district and county councils.
Europe
The public elect members to work in the European Union and to provide representation for local and regional government at a European level, they contribute to development of EU initiatives with governance implications for local and regional authorities. Polices in England can be affected by European Legislation and other activities.
Government can attempt to address social issues by Acts of Parliament for example;
- Disability Discrimination 1995
- Sex Discrimination Act 1986
- Children Act 1989
- Equal Opportunities Commission
- Health and Safety at Work Act 1974
- Mental Health Act 1983
- NHS Community Care Act 1990
- Data Protection Act 1998
- Human Rights Northern Ireland Act 1998
- Children (Northern Ireland) order 1995
- HPSS Quality Improvement and Regulation NI Order 2003
A major report on Equality and Inequality in Health and Social care in NI, a statistical overview (DHSSPS 2004) began to look at 2 areas of information relating to New Targeting of Social Need and an overview of the impact of the “Troubles”. The report indicates that as the new TSN and statutory equality duties become more mainstream that the identification of different needs of various social groups will become universal practice in determining social needs. The impact of the ‘Troubles’ on the health and wellbeing of the population, highlighted that people in high violence areas reported more symptoms of physical illness. Depressive disorders were over 3 times as common in females exposed to violence than males and anxiety disorders were all most twice as common. Victims of the Enniskillen bomb were more likely to have poor mental health. People in poor areas were more likely to be effected by the troubles and Catholics were more likely than Protestants to report adverse effects of the Northern Ireland conflict-related violence on their own lives and their families. The effects of the troubles on young people’s psychological wellbeing was unclear and the long term effects and understanding of this area is poor.
Findings regarding stress, mental health and suicide found that women reported more worries than men and this had increase compared to last year. Young and middle aged people reported more worry and stress than the elderly. More people with dependant children were worried and stressed compared to those without and the unemployed experienced more stress than employed people.
Women were more likely than men to have potential psychological disorders and the age group of people 45-50 years were at highest risk. More Catholics than Protestants were likely to have a potential psychological disturbance. Partly skilled people were more likely to have possible mental health problems than manual workers and people with dependant children were more prone to psychological morbidity (depression) than those without children.
The majority of suicides were males and deaths were more common in young people (25-34 years) the largest numbers were in single males of this age group but were lower in the divorced and widowed compared to married and single people.
Some areas which focused on health and social well being found that females live longer than males, 75 years and 80 years respectively. Cancer affected slightly more females than males but death rates were higher in males and the incidence of cancer increases with age. People in lower socio-economic groups had a higher incidence of cancer and poor survival rates than those in higher socio-economic groups. There were higher rates of cancer in deprived areas of Belfast and Derry.
Heart disease is more common in older people, (men 65-74 years and women over 75) over 4% of males compared to 2% of women have had a heart attack. Stroke statistics showed 2% of males compared to 1% of women have had a stroke and that non-manual and partly skilled workers were least likely to have a stroke compared to professionals, skilled, and unskilled workers.
The statistics discussed are only some areas reviewed by this report other areas looked at were diabetes, asthma, mental health, mother and child health, body weight, long standing illness, disability, carers, learning disability, smoking, alcohol use, drug abuse, physical activity, sexual behaviour and sexual health.
Findings found that women made more use of health and social care services than men. That access times for all types of facilities are longer in rural areas and that access in relation to travel in deprived areas when need is taken in to consideration travel times to all health and social services except for maternity units, opticians, day centres and nursing homes are longer in deprived areas.
In deprived areas there is a 70% worse teenage birth rate, 59% worse lung cancer rate and 2% worse uptake in immunisation against diphtheria, polio and tetanus.
Young people leaving care are more likely to be unemployed, more boys than girls were put on the child protection register and more boys were placed in care.
The elderly were in contact with social services more frequently and the majority of delayed discharges were for this group.
Hospital inpatient stays more likely in deprived areas and more females than males were inpatients. The Southern Health and Social Services Board had the longest waiting lists for people awaiting admission to hospital for day cases and inpatient procedures while the NHSSB had the longest waiting lists for a first outpatient appointment.
This report looks at disparities related to health and social wellbeing and highlights that it is a worldwide problem. Mc Whirter in 2002 noted a lack of research in this area in Northern Ireland.
A review of employment legislation, Standing Advisory Committee on Human Rights in June 1997 made recommendations on two government policies, Targeting Social Need (TSN) and Policy Appraisal and Fair Treatment (PAFT). As a result TSN was strengthened and relaunched as new TSN and PAFT was succeeded by new equality legislation as part of the Northern Ireland Act 1998. The new TSN and statutory obligations under section 75 complimented each other and the Equality Commission was formed to provide advice and monitor compliance with these new statutory equality duties. In Northern Ireland some ways the government has attempted to redress these issues are by giving more funds to mental health for suicide prevention and home treatment teams too reduce inpatient admissions. The Chest Heart and stroke association have been given funds too review after care provided for stroke victims, I have also noticed recently the government campaign to inform people about heart attacks, there are large billboard posters around the city asking people too ring 999 if they are having chest pain.
The way that Government targets areas for funding is set out in the following report, ‘Allocating resources to Health and Social Services Boards: proposal changes to the weighed capitation formula’ July 2004.
The DHSSPS provides a block grant of funds to each Board on a yearly basis based on a resource allocation formula. The aim of this is to allocate funds equality, demands for service can be greater than funds available, so the formula cannot ensure that all needs are met but helps to ensure as far as possible that the population have equal access to services that exist.
The formula takes in account the number of people in each Board, age, gender of the population and the differences in need for care. It also considers factors such as the difference in cost of providing care in urban and rural areas.
This type of capitation formula was first introduced in 1998/99 and there have been 3 reports in the years leading to 2004 in which the latest report was issued.
The report highlights that the key influences on need for health and social care resources across the 4 Boards are;
- The number of people living within their area.
- The age/gender of that population.
- The socio-economic profile of the population.
The report summarised the following areas were need weighing were to be applied it stated that different resources needed to be allocated to groups. The 9 groups looked at were acute services, maternity and child health, family and child care, elderly care, mental health, learning disability, physical and sensory disability, health promotion and disease protection and primary health and adult community.
The allocation of funds also considered equality impact assessment carried out by each Board under the Act.
The report highlighted that more funds were needed for mental health, family and child care, learning disability and physical and sensory disability.
Mental health resources were based on a survey undertaken after the third report on cost of beds for short stay and long stay when this information was put into the formula it highlighted more resources were needed.
The introduction of the Children Order NI 1995 and the effect of supply of services meant that more research for this area would need to be undertaken. As a result a costing model was adopted in the interim until a more robust model could be developed for costing.
For the first time a change in the distribution of funds for learning disability and physical and sensory disability was given.
This report on Inequalities in health and social care use: the implications for resource allocation in the HPSS (research and development office-Feb. 2003) states that Inequalities in health have been an ongoing problem in the UK, although the overall health of the nation has improved over the last 50 years. The gap between rich and poor people and rich and poor areas has widened. Inequalities in wealth, 2 reports by ‘The Black Committee’ 1980 and Sir Donald Acheson 1998 supported these views.
Through new targeting social need (TSN) the government aims to tackle social need and social exclusion in NI and policies focusing on problems of unemployment and tackling inequality in areas such as health, education and housing were introduced.
A literature review by this report made the following conclusion to this policy approach:
- Social Deprivation is linked to ill health.
- There is enough evidence to suggest that utilisation data may not always be adequate proxy for relative need.
The results of this report were used to assist the weighed capitation formula in the allocation of resources.
However we have to consider will the government be able to achieve their targets. A discussion paper from the Kings Fund ‘NHS Reform getting back on track’ October 2006. Status that in recent years the NHS has seen the most sustained period of rapid funding growth ever and by 2007/08 there will be a 40% increase in annual money allocated than 5 years ago. Despite this, the NHS is still in deficit. This failure to achieve could be blamed on weak policy in place to insure financial balance. It states that the financial crisis was not caused by “to much reform too quickly” but by “too little reform too late.” The report indicates that there are three key areas where improvements are needed if the government reforms are to be more fully achieved.
- Development of a stronger strategic commissioning regime
This may be achieved in Northern Ireland by the Review of Public Administration and the formation of a new Strategic Health Authority
- Improvements in the design of PBR tariffs (payment by results) although not yet in Northern Ireland it is important to keep this in mind as NI has a history of following what has been introduced in other parts of the UK.
- Clarification of the system- regulation and management rules.
This is not yet available in the UK but clarification is needed in 4 areas.
- Financing adjustments from the “old to new” NHS
- Regulation of providers
- Performance management of commissions and publicity funded providers
- Financing service reconfigurations
To conclude a stronger commissioning regime would help target funds to identified areas or need both locally and nationally. The “new” NHS can only work when there are rules and processes in place to regulate and manage health care providers and clear identification of who is responsible for ensuring these are followed is needed. The improvements to reform need reform instructions in place to ensure realisation of the goals.
