Herts county council green paper prevention response final

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
Advancing our Health Together
The Prevention Green Paper
Cllr Tim Hutchings
Executive Member, Public Health and Prevention
October 2019
Hertfordshire County Council’s Response

www.hertfordshire.gov.uk
OUR VISION, COMMITMENT
AND EXPERIENCE

Our Contribution to the Government’s Vision
The Government’s leadership in shifting the conversation, including through this Green
Paper, towards a more preventative approach to health and wellbeing is a positive step
forward.
The County Council has a track record of delivering on prevention and is committed to
playing its part.
To make ‘prevention better than cure’ a reality for individuals and communities requires
significant progress across four areas:
1. Taking a social determinants approach
2. Embedding wellbeing across the Public Sector
3. Investing in sustainable, long-term funding for public health
4. Partnership as Second Nature

A Social Determinants Approach
• Our health and wellbeing is overwhelmingly shaped by social, economic and
environmental factors and this evidence should be fully reflected in the
Government’s prevention agenda.
• This means
– going beyond a conversation about health which is focussed on hospitals,
services and treatment.
– It is essential that the Government focusses on population level policies which
address the root causes of poor health as these will make the biggest
difference for the largest number of people.
• As a County Council we can offer:
– A track record of multi-agency partnerships in taking this approach across a
population of 1.2m people
– Will, experience and skills

Embedding Wellbeing across the Public Sector
• Given Social Determinants are so crucial, ensuring that every part of the Public
Sector assesses what it can do to improve the health of the population and prevent
ill-health (mental and physical) is crucial.
• This means we need to be better at joining up across local areas and between
national and local government.
• Health should be a first order priority for Central and Local Government and all
Public Sector Organisations.
• As a County Council we can offer:
– Experience of doing this across the lifecourse, joining services up to improve
health
– Working across boundaries
– Delivering prevention services in partnership where the whole is greater than
each agency can achieve individually

Sustainable funding for Public Health
• Investing in sustainable, long-term funding for public health is vital to
Government achieving its ambitions
• investment is needed across all the determinants of health.
• In respect of public health services specifically, The Kings Fund and Health
Foundation identified that at least £1bn extra per year is required.
• The Government will need to work with the public health community to properly cost
new commitments arising from the Prevention Green Paper.
• Considering spending through the social determinants lens should lead to significant
new money for education, housing, transport and much more besides.

Partnership as Second Nature
• Strengthening collaboration and partnerships is essential if we are to achieve
a healthier population
• It is only through strong partnerships that integrated service pathways and good
outcomes can be achieved – the delivery of the NHS Long Term plan and proposals
in the Green Paper depends on collaboration between the NHS and local
government.
• The NHS cannot do it alone.
• Links must be reinforced at every level.
• As a County Council we have wide and strong reach into our communities and
partners, and these will prove to be significant assets in implementing the Green
Paper.

Vision into Action
• The County Council has decades of experience and a long track record of
partnership, innovation, service transformation and integration with other agencies.
Our Public Health service has added to that in the seven years since it became part
of the County Council.
• We are also experienced in using a range of mainstream non public health services
(HR, Catering in Schools, Social Care, Childrens Services, Environment, Trading
Standards, Fire and District Councils) to improve and protect the Health of the
Population
• We have experience central government and the NHS do not. Government making a
reality of partnership, co-commissioning and place based approaches will make its
ambitions a reality more quickly and more sustainably.

OUR RESPONSE TO THE
SPECIFIC CONSULTATION
QUESTIONS

• The Government should adopt a whole system approach to health inequality and
promote place-based approaches.
• Government should use the experience and track record of bringing their
communities together at local level to do this through Health and Wellbeing Boards
• The Government should reintroduce binding national targets to reduce child
poverty.
• The Government should make tackling the social determinates of health and
building wellbeing into policy decision making and funding allocation a cross-
government priority, supported by a new ‘health index’ and better utilisation of
existing ONS wellbeing statistics.
• Government should review policies on partnership and commissioning to require
local agencies to work together more effectively
Which health and social care policies should be reviewed to
improve the health of: people living in poorer communities, or
excluded groups?

• Evidence shows that the current NHS Health Check programme is able to have a
positive impact on improving population health and reducing inequalities. However,
to improve uptake of health checks, a more focused and targeted approach should
be adopted, which focuses on those identified as being at increased risk of CVD or
other long-term conditions, and those living in deprived areas.
• In addition, the referral and sign-posting aspect of the NHS Health Check could be
improved. Local authorities and voluntary and community sector organisations
already deliver a wide range of services and interventions to support the
communities’ physical and mental health. We would support increased sign posting
and referral to these local services would also support the commitment in the NHS
Long Term Plan to expand social prescribing initiatives to all local areas.
• Greater use of behavioural sciences across all CVD and cancer prevention will
improve outcomes, motivation and adherence in patients.
• Recommendations: The NHS Health Checks programme should be more
focused and targeted to improve uptake, particularly focusing on those
identified as being at higher risk of CVD and other long-term conditions and
those living in deprived areas.
Do you have any ideas for how the NHS Health Checks
programme could be improved?

• The tobacco industry should be made to pay for the damage it does, on the ‘polluter
pays’ principle using to raise funds to help pay for the recurring costs of
implementing the evidence-based comprehensive approach to tobacco control.
• The proposal is strongly supported by over 120 health-related organisations. It is
also supported by members of the public. A YouGov poll with over 12,000
respondents asked if the public would support a requirement for tobacco
manufacturers to pay a levy or license fee to Government for measure to help
smokers quit and prevent young people from taking up smoking. The net support for
this statement was 71%.
• The levy should be structured as a charge on each tobacco manufacturer, designed
to deliver a fixed sum annually to the DHSC (using the Health Act 2006) to be used
to fund high impact, evidence-based measures to encourage smokers to quit, and
discourage youth uptake.
What ideas should the government consider to raise funds for
helping people stop smoking?

• The funds should be put towards stop smoking services and more broadly for
measures which will reduce prevalence including delivery of national and regional
public education campaigns and work at regional level including on illicit tobacco. In
line with WHO Framework Convention on Tobacco Control Article 5.3, this should
include no partnership with the tobacco industry.
• Recommendation: A ‘polluter pays’ approach using mechanisms set out in the
Health Act 2006 should be legislated for. This would require tobacco
manufacturers to fund stop smoking services and the costs of tobacco
control.
• All central and local government premises should go smoke-free
• Government should work with us to make support more readily available for families
through pre and post natal activities
What ideas should the government consider to raise funds for
helping people stop smoking?

• In Hertfordshire we have a multi agency partnership and have achieved UNICEF
accreditation. We integrate breastfeeding work into our Family Centre Services and
Health Visitors.
• A public health campaign, in line with the UNICEF’s call to action on infant feeding, is
required to change the culture of breastfeeding so that women feel socially
supported to breastfeed. This includes raising awareness around the need to support
women in the workplace, ensuring they have the facilities and the time to breastfeed
or express breast milk.
• We welcome the aspirations within the NHS Long-Term Plan to further develop
maternal services to support mother to breastfeed, however this needs to be linked
to existing voluntary sector and local authority community services.
How can we do more to support mothers to breastfeed?

• The reduction in local government funding for public health and the ongoing
reduction in capacity in the health visitor workforce are significant barriers to the
effective delivery of these interventions.
• The Government should commit to adequate resourcing to preserve universal
health visiting services.
• The Government to ensure familiarity with breastfeeding is included as part of
statutory personal, health and social education in schools.
How can we do more to support mothers to breastfeed?

• To achieve the Government’s target of reducing childhood obesity by half by 2030,
there needs to be sustained action to create environments that promote health
options, whilst addressing the conditions that lead to poor health.
• The Green Paper is an opportunity for the Government to recommit to the
implementation of policies outlined in the first two chapters of the childhood obesity
plan. We would like to see the Government go further to progress and expand
successful evidence-based policies. Further action is needed to significantly reduce
children’s exposure to junk food advertising, in particular, the extension of the
proposed 9pm watershed to all audio-visual advertising, including radio, cinema and
digital out of home adverts. The Government across should also act to restrict
sponsorship by high fat, salt and sugar brands of sports and leisure activities.
How can we better support families with children aged 0 to 5
years to eat well?

• Government should give local authorities powers to more easily introduce restrictions
on hot food takeaways and use CIL and Section 106 monies to ensure infrastructure
for healthy weight
• The sugar drinks industry levy (SDIL) should also be expanded to include milk based
sugary drinks.
• Schools should be given a duty to promote the health of their students .
• School Food Standards should be updated and loop-holes exempting academies
and free schools should be closed to ensure that all schools and early years settings
promote and facilitate health behaviour. Schools should also be encouraged to work
proactively with the National Child Measurement Programme and explore ways to
increase activity across the school day.
years to eat well? (Continued…)

• Furthermore, the Government should ensure that all healthcare professionals and
early years professionals are adequately supported to make every contact count to
discuss obesity and provide support to families. This should include support around
breastfeeding, appropriate formula feeding and weaning.
• Health visitors, in particular, play a key role in supporting families. They can monitor
child weight and use every opportunity to discuss the importance of a healthy weight
and physical activity with both parents, and signpost to relevant national resources
such as One You, Start4Life and Change4Life, and to relevant local community
activities. It is therefore vital that health visiting services are supported and
adequately funded.
years to eat well? (Continued..)

• Recommendation: The Government must commit to the implementation of the
policies outlined in chapters 1 and 2 of the childhood obesity plan. This
includes a comprehensive 9pm watershed on adverts for food and drinks high
in fat, sugar and salt (HFSS) on TV and online, restrictions on price and
location promotions of HFSS products in retail and out of home environments,
and mandatory calorie labelling in the out of home sector.
• The Government should commit to increased and continued investment in
public health budgets to ensure the continuation of provision of weight
management services and the National Child Measurement Programme
(NCMP) in England.
• In England, the loophole exempting academies and free schools from School
Food Standards should be closed. Nutritional standards should apply to all
schools.
• The Government should act to restrict sponsorship by high fat, salt and sugar
brands, particularly of sports and leisure activities.
years to eat well? (Continued.)

• Obesity cannot be prevented without structural, national level action to alter the
nutritional content of the food we eat and the environments in which we live. A policy
shift is needed away from individualised, specific interventions towards a structural
approach to tackling the wider determinants of health.
• A whole system approach is required, which necessitates joint working across
planning, transport, housing, business, education, health and the voluntary and
community sector.
• While we welcome the proposals in the Childhood Obesity Plan, further action is
required to tackle the environmental causes of obesity. This includes expanding
green spaces and encouraging active travel, promoting diverse high streets,
encouraging local food businesses to provide healthier choices, restricting the
proliferation of fast food takeaways and ensuring that healthier food and drink are
available in national government, local authority and NHS estates. These actions will
support healthier default choices through a better local environment.
How else can we help people reach and stay at a healthier
weight?

• The Government should clearly prioritise healthy and active environments as part of
the planning process and give local authorities and communities the flexibility to
respond to obesity challenges through licensing, planning, advertising and shaping
the local environment.
• The Government needs to use the Spending Review to deliver truly sustainable
funding for public health, so local authorities have the resources needed to take
action on obesity in their area and ensure there are no gaps in access to obesity
prevention and treatment services.
– the NPPF doesn’t do enough to enable this
– Public Health needs to be a statutory consultee for planning purposes on
appropriate developments
– Health Impact Assessments needs to be a statutory requirement
weight? (Contined…)

• Recommendation: The Government should commit to reducing obesity and
supporting everyone to be a healthy weight. The target to halve levels of
obesity in children and significantly closing the inequality gap by 2030 should
remain a cross-Government priority.
• Healthy weight pathways should be in every health and social care programme
as an essential part of keeping people healthy.
• Local authorities should have more place-shaping powers to enable them to
more effectively tackle the obesogenic environment; for example, health needs
to be included as a material planning consideration in England.
• Local authorities should have more place-shaping powers to enable them to
more effectively tackle the obesogenic environment; for example, health needs
to be included as a material planning consideration in England.
– the NPPF doesn’t do enough to enable this
– Public Health needs to be a statutory consultee for planning purposes on
appropriate developments
– Health Impact Assessments needs to be a statutory requirement
weight? (Cont)

• Our Stevenage Healthy Hub specialises in supporting people who have long term
conditions or other major health challenges including rehabilitation after accident
recover after injury
• Our Herts Sports Partnership has a range of programmes which help people
undertake strength and balance exercises from Falls Prevention to Strength for Over
65s to strength training for people with long term conditions
• We have a dedicated healthwalks programme for people with dementia to help them
retain balance skills
• Our Disabled Sports Hub enables disabled people to undertake strength and
balance training for health
• Strength and balance needs to be consistently a part of education for all children and
young people
• Enabling local authorities to levy more on Community Infrastructure Levy (CIL) and
Section 106 to build easily accessible strength and balance gyms indoor and outdoor
could make a major contribution to this ; or adapt existing fire service gyms for public
use.
Have you got examples or ideas that would help people to do
more strength and balance exercises?

• A whole system approach is needed which identifies opportunities for minimising risk
factors and enhancing protective factors through evidence-based interventions at
key life stages from preconception, during pregnancy, through childhood and
adolescence, working and family building years and into older old. Such an approach
requires cross-departmental action with multiagency partnership work with schools,
the NHS, the police, housing associations, voluntary and community sector
organisations and other key stakeholders to address the broader determinants of
good mental health.
• Local areas should to be supported to adopt a place-based approach which works
across the protective factors for mental health. These include high quality housing,
debt reduction, good employment, training and education, green spaces & physical
activity and increased social capital.
There are many factors affecting people’s mental health.
How can we support the things that are good for mental health and prevent the
things that are bad for mental health, in addition to the mental health actions in
the green paper?

• With half of all mental health illnesses established by the age of 14, schools should
be supported to take a whole system approach to improving mental health,
particularly interventions to tackle bullying and promote social and emotional
learning. Personal, Health, Social and Economic education (PSHE) should be made
mandatory in all schools to support the development of resilience in young people.
• Furthermore, the Government should support and encourage other employers to
adopt organisational approaches that promote mental health and wellbeing through
good management, policies and intervention to prevent stress, depression and
anxiety problems. Supporting people with long-term health conditions, including
mental health conditions, in and into work should be a priority.
the green paper? (Continued…)

• Recommendations: National bodies should prioritise support for mental health
prevention and early intervention
• All providers and commissioners/service planners should work together
locally to promote a whole systems and life course approach to mental health,
using a common agreement such as the Prevention Concordat for Better
Mental Health.
• Personal, Health, Social and Economic education (PSHE) should be made
mandatory in all schools to support the development of resilience in young
people.
• Government should provide funding to ensure that localities are able to invest
in community and asset-based activity to support wellbeing.
the green paper? (Continued.)

• We have experience of digital and online mental health programmes
– We used Do Something Different to support people with long term conditions and those
who are isolated to improve mental health as well as physical health.
– We commission online and digital programmes for children and young people for mental
health
– We have used digital self help technology for alcohol and drug issues related to poor
mental health
– We have experience of using films, chat and social media for young people in improving
their mental health but also in reducing stigma in talking about mental health issues
• We have worked with community groups, faith groups and self-organised groups to
address mental health issues for a range of diverse communities
• Our health hubs and partnership projects with District Councils and Voluntary Sector
organisations has seen projects on mental health run from non-mental health
premises
• We have run mindfulness for staff to reduce workplace sickness absence
• We have integrated mental and physical health first aid to reduce stigma on seeking
support at work
Have you got examples or ideas about using technology to
prevent mental ill-health, and promote good mental health and
wellbeing?

• We have experience of running sleep hygiene and better sleep sessions in the
workplace and for parents and schools. This is a very common problem experienced
by many people.
• National and local public health campaigns should promote the importance of sleep
for both mental and physical health..
• Schools, colleges and universities should take a whole school (or whole institution)
approach to mental health and encourage good sleep habits and greater knowledge
of mental health issues.
We recognise that sleep deprivation (not getting enough sleep) is
bad for your health in several ways. What would help people get
7 to 9 hours of sleep a night?

• Sleep should be covered in the school curriculum under Personal, Social, Health and
Economic (PHSE) education in schools.
• Employers have a legal duty to make sure reasonable measures are in place to
remove or control the risks of work activities, including hours worked and how they
are scheduled. The Health and Safety Executive should be held accountable for its
duty to enforce night work limits and health assessments for night shift workers.
• Employers who operate shift or long hours work should provide information to
employees on how to achieve healthy sleep and signpost them to effective online
self-help resources and health services.
We recognise that sleep deprivation (not getting enough sleep) is
bad for your health in several ways. What would help people get
7 to 9 hours of sleep a night?

• We have commissioned a range of services through pharmacy including brief advice
and intervention for alcohol problems, smoking and drug and alcohol problems.
• We are working to include pharmacies in our health hubs.
• We have commissioned a range of sexual health services through pharmacies
• We also have experience of working with pharmacies to deliver a series of “living
well” programmes
• We have delivered consultation and health behaviour change programmes for
pharmacists which help them in Medicines Use Reviews
• We feel with appropriate investment made available pharmacists could do much
more to improve health and reduce demand on our NHS
Have you got examples or ideas for services or advice that could
be delivered by community pharmacies to promote health?

• We have linked pharmacies to social prescribing programmes
• The roll out of minor ailments schemes could significantly help disadvantaged
communities
• Community pharmacists should work directly with the public and have
responsibilities including prescription drugs. They should further be trained to provide
advice and brief interventions on smoking, alcohol, mental health, physical activity
and falls prevention, healthy ageing, weight management.
• Services that could be provided through pharmacies include smoking cessation,
weight management, sexual and reproductive health (not just emergency hormonal
contraception), blood pressure testing and hypertension management.
• The potential expansion of community pharmacies could help to alleviate the
pressure on GP surgeries, avoid unnecessary A&E visits and increase access for
patients
Have you got examples or ideas for services or advice that could
be delivered by community pharmacies to promote health?

• Tooth decay remains a major problem. The evidence is clear. In its 2018 report, PHE
concluded, that “water fluoridation is an effective and safe public health measure to
reduce the frequency and severity of dental decay, and narrow differences in dental
health between more and less deprived children and young people”. Moreover, six
million people in England (1 in 10 of us) already drink fluoridated water. These areas
experience lower levels of dental disease than similar areas without fluoridation. For
5-year-olds living in the most deprived areas, the odds of tooth decay are reduced by
a third.
• The barriers for local authorities, and Directors of Public Health in particular, in
progressing with schemes are as follows:
– The financial savings mainly accrue to the NHS, with the revenue costs falling
on local authorities. The cost at around £1 per head of population are relatively
modest but, when multiplied to cover an entire population, can be significant
especially in the context of significant cuts to public health budgets. The NHS
is spending around £35 million per year treating children in hospital for touch
decay at a cost of around £850 per case. Yet we know that admissions can be
reduced by 68% in the most deprived communities (PHE, 2018). The NHS
should fund the recurrent costs of water fluoridation..
What should the role of water companies be in water fluoridation
schemes?

• There is considerable financial, administration and reputational burdens for local
authorities in pursuing an untried and untested route. The Cabinet Office should
explore how it can make the process quicker and simpler for local authorities.
• As with vaccinations, misinformation about what fluoridation entails and the impact
affects public support for schemes coming forward. Public Health England should
explore how it can communicate the evidence effectively in support of local
authorities seeking to deliver schemes.
• In respect of water companies, their role is clearly laid down in legislation and we
see no reason to amend this. However, delays to advice, technical expertise and
engineering reports can hamper local authority plans and the Government should
formally request that water companies communicate and act in a more urgent
manner.
schemes? (Continued…)

• Recommendations: Water fluoridation should be prioritised in areas of high
need where it is technically feasible.
• The NHS should recognise the substantial savings in surgical and staff time as
well as finance and cover the recurrent costs of water fluoridation.
• Addressing the financial disincentive, combined with renewed national
leadership, will help local authorities considering undertaking fluoridation
schemes – and encourage others to explore the option.
schemes? (Continued.)

• We need
– Evidence of MSK strength and disease prevention across the lifecourse,
especially evidence on prevention of disease. This should prioritise:
• Evidence from school,
• Evidence from workplace and
• Evidence from community settings
• Evidence of preventing MSK morbidity in older and frail people
– Evidence which underpins what local authorities can do
– Evidence of MSK health for people with long term conditions and people
recovering from Cancer
What would you like to see included in a call for evidence on
musculoskeletal (MSK) health?

• In homes and neighbourhoods
• The Government should address the foundational role of planning, housing and
place policies in the promotion of wellbeing and prevention of ill health across the life
course.
• Housing is an underpinning, foundational determinant of health across the life
course. The government needs to strengthen efforts to revitalise the social housing
sector and regulate the private sector more robustly, including rent controls.
• Healthier housing can both prevent hospital admissions and result in smoother
discharges, action on providing healthy and appropriate housing should form part of
local Sustainability and Transformation Partnership plans in England.
• The wider determinants of health need to be kept front and centre of any prevention
strategy – providing good jobs, secure neighbourhoods, healthy housing and
improving social connections will do more to address poor health and wellbeing
issues than anything that seeks to address these directly.
• Government should take action to reduce fuel poverty and ensure eco funding for
energy efficient, safe and warm homes continues beyond 2022
What could the government do to help people live more healthily:

• In homes and neighbourhoods (continued.)
• To support the development of strong and healthy communities, the Government
must invest in community infrastructure, this includes parks and green spaces,
village halls and community centres, libraries, and places of faith and spirituality.
• Recognising the value of these to individual and community wellbeing is an important
part of a whole-government approach to creating health. Equally important, however,
is the need to give local communities a meaningful role in shaping the places where
they live.
• Local government has an important part to play in facilitating co-production of its
services and its place-making by working in partnership with communities. However,
support from central government is needed to put in place an enabling policy
environment to support co-production and allow local authorities the flexibility to
respond to health issues through licensing, planning and shaping of the local
environment.
• Government should enable greater use of Community Infrastructure Levy and
Section 106 for health improvement. This should include outdoor gymns for adults
and children which address strength and balance in local communities.

• When going somewhere
• Make public transport and healthy self-propelled modes of transport much easier
and enable local authorities to deliver these
• Increase efforts to ensure electric and hybrid vehicles and charging points are
affordable and easy options
• Improve access for disabled people to public transport
• Help the delivery of sustainable and active travel infrastructure at lnational and ocal
level – recognising the multiple benefits this has for health priorities and outcomes in
relation to obesity, physical activity, mental health and air quality.

• In workplaces
• Policies which incentivise work and being in work, and get people with long term
mental and physical health issues back into work are crucial. Local Authorities have
significant experience of delivering work in this area
• Government should invest in successful work by local authorities in supporting
people into employment who would otherwise be workless
• Supporting Employment in furthering healthy working lives programmes to ensure
work-life balance and good mental and physical health in the workplace should be
priorities

• In communities
• Governmental action is needed to expand the levers available to local authorities to
facilitate the development of the health in all policies agenda. This is particularly
needed with regards to planning policy and could be strengthened by linking this
explicitly to the Chapter 8 of the National Planning Policy Framework
• The Government should set out a clear plan for achieving the WHO air quality
standards, including the role that councils should play and how that will be funded.
• As said above, the Government should address the foundational role of planning,
housing and place policies in the promotion of wellbeing and prevention of ill health
across the life course.

We cannot choose simply one as our highest priority.
• Support people with staying in work
• Support people with training to change careers in later life
• Support people with caring for a loved one
• Improve homes to meet the needs of older people
• Improve neighbourhoods to meet the needs of older people
• Other
– We would support all of these aims but our highest priority would be to
ask government to Reform the design of the social care funding system
– including additional investment, with a focus on prevention. This
should be a national priority to deliver the care and support older people
need and deserve.
What is your priority for making England the best country in the
world to grow old in, alongside the work of Public Health England
and national partner organisations?

• A Clear, joined up policy for healthy childhood which identifies priorities for every
agency so children reach adulthood emotionally, psychologically and physically
healthy as well as having good educational attainment
• Policies for a healthy public realm including planning and air quality
• Policies which make working lives as healthy as possible
What government policies (outside of health and social care) do
you think have the biggest impact on people's mental and
physical health?
Please describe a top 3

• Require all public sector agencies to develop a health and wellbeing in all policies
approach
• Government could mandate Health Impact Assessments where appropriate and give
councils more powers in planning process to make health a statutory consultation
• We could make stronger use of public sector assets to support our most vulnerable
individuals and communities.
– One example of this is a range of building for homes and places that
developers don’t want to build but which is desperately needed – mental health
housing provision for example;
• Require Local Economic Partnerships to make health a consideration in the Local
Industrial Strategies
How can we make better use of existing assets - across both the
public and private sectors - to promote the prevention agenda?

• Primacy of place should be the key principle that underpins joint working and
integration initiatives across local government and the NHS.
• For sustainable long-term health and social care developments there needs to be
better aligned between different parts of the system; health, care and prevention.
• Councils have a crucial role in providing community support and enabling people to
live healthy lives.
• The provision of social care and public health services through councils undoubtedly
helps to relieve pressures on the NHS. It is therefore essential that local government
is recognised as essential partners in the delivery of integrated care.
• Proposals for better joined-up commissioning of Sexual and Reproductive Health
services is welcome. This should build on existing good practice in integrating
services, such as through the Better Care Fund and in response to the move
towards Integrated Care Systems. Longer contracts should also be introduced to
enable better strategic planning and to lessen the burden that tendering currently
imposes.
What more can we do to help local authorities and NHS bodies
work well together?

• The Green Paper should recognise the essential role that Health and Wellbeing
Boards in supporting the prevention agenda. It is crucial that they are given the
necessary tools and policy levers to:
– Understand where the inequalities exist and ensure plans reflect how these will
be addressed
– Provide an approach that is holistic and person centred with actions to benefit
all but with a scale and intensity reflecting the level of disadvantage
– Tackle the social determinants of health, save money and create value
– Balance short term solutions and investment in long term strategic
improvements
What more can we do to help local authorities and NHS bodies
work well together? (Continued)

• Whilst local authorities have been successful in modernising services in recent
years, the storm of rising demand and falling funding has hindered these efforts. A
long-term strategy and investment package, building on what is working in local
areas, would represent a real step forward towards the high quality and integrated
commissioning models communities deserve.
• Supporting collaborative commissioning – now that the Department of Health
and Social Care has confirmed that current commissioning arrangements for sexual
health services will remain as they currently are, a renewed national drive is needed
to overcome the barriers holding back too many areas from working across
organisational and geographical borders. There are many excellent examples to
share
What are the top 3 things you’d like to see covered in a future
strategy on sexual and reproductive health?

• Promoting digital transformation – since the transfer of responsibilities for sexual
health services, many local areas have adopted innovative approaches to meeting
the needs of their populations. In Norfolk, an online screening services is available
for chlamydia, gonorrhoea, syphilis and HIV - people can simply order a kit and will
be delivered to their door in plain packaging.
• Tackling sexual health inequalities – many councils are putting reducing
inequalities at the heart of their sexual health strategies – and indeed integrating
efforts across other council run services (e.g. children’s).
What are the top 3 things you’d like to see covered in a future
strategy on sexual and reproductive health? (Continued.)

As we have said above, making ‘prevention better than cure’ a reality for individuals and
communities requires significant progress across four areas:
1. Taking a social determinants approach
2. Embedding wellbeing across the Public Sector
3. Investing in sustainable, long-term funding for public health
4. Partnership as Second Nature
• We believe this must be underpinned by ensuring place-based approaches and
investing in the capabilities of local authorities are also made core policy
commitments.
• Our experience shows that where there is proper policy focus on both systems
approaches and using behavioural sciences, there is an improvement in reach and
impact. This needs to have much greater recognition in policy.
What other areas (in addition to those set out in this green paper)
would you like future government policy on prevention to cover?

Tim Hutchings
Executive Member, Public Health and Prevention
Hertfordshire County Council
County Hall
Pegs Lane
HERTFORD
Hertfordshire SG13 8DE
Tim.Hutchings@hertfordshire.gov.uk

Herts county council green paper prevention response final

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Herts county council green paper prevention response final