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Council services in Barnsley
Critics say that 'street-scene' services will lose out as cash is diverted to social care. Photograph: Don McPhee for the Guardian
Critics say that 'street-scene' services will lose out as cash is diverted to social care. Photograph: Don McPhee for the Guardian

Public health will cost local government

This article is more than 11 years old
Peter Hetherington
Handing control of public health to local government sounds like a positive move, but how much of the NHS budget will go with it?

We ask an awful lot of local government. From repairing roads, to collecting dustbins, maintaining parks, libraries and swimming pools, overseeing housing and planning – and, increasingly, looking after the vulnerable in early years and old age. That's just for starters.

Soon, larger councils, having lost control of education, will be handed responsibility for public health, after a gap of 40 years. While, on the surface, this is an exciting move, signalling at least some democratic control over the NHS with the creation of health and wellbeing boards, the funding remains unclear. How much of the NHS budget will a cash-strapped Department of Health be prepared to cede to councils?

For cynics, the transfer of public health and other funding for welfare programmes merely marks a default option, leaving local government to pick up the social consequences of the government's austerity programme – "passing the buck without the bucks", in the words of one senior figure.

After more than two years of a Conservative-led government, you might have thought that this transfer marked a co-ordinated move towards addressing the party's once-vaunted commitment to that vague concept of "localism". You would be wrong.

Sir Merrick Cockell, Tory chair of the Local Government Association – meeting for its annual conference in Birmingham this week – is clearly frustrated by resistance in sections of the cabinet to meaningful localism, whatever the apparent commitment of David Cameron. Cockell believes that transferring functions from Whitehall to town halls could save billions of pounds by avoiding duplication. But Whitehall has fallen back on the ultimate fudge: more pilot schemes.

Communities and local government secretary Eric Pickles has only managed to authorise four "showcase" councils in the north-west of England, Essex and west London, which will team up with other public agencies to pool funds. Cockell rightly argues that it is time to move beyond these endless pilots to full-scale devolution. He cites one example, repeated across the public sector, of 33 separate ventures to get young people into work. Far better, he thinks, to let councils co-ordinate joined-up schemes, perhaps through a new network of local enterprise partnerships, into a single programme.

With English local government alone having endured cuts of £3.5bn since 2010-11, Cockell warned this week of a looming financial crunch facing councils as ministers dither over funding adult care and children's services. Unless the government acts swiftly, he estimates councils will face an eye-watering additional social care bill of £12bn by 2030. "We are heading in a direction that none of us can sustain or cope with," he warns. The consequences are all too clear: diminishing support for "street-scene" services closest to the heart of many electors – clean and well-maintained roads, parks, shopping areas, for instance – as cash is diverted to social care.

Cockell laments that while the government is adept at passing many problems to councils, "it doesn't give us powers to tailor solutions to address those problems". He is not alone in his criticism. Talking to former deputy prime minister (and one-time local government supremo) Lord Heseltine recently, I was struck by his perceptive analysis of the crisis facing many town halls. Recalling the buccaneering spirit of late 19th- and earlier 20th-century civic pioneers, he observed: "You've now got socially orientated authorities with councillors principally preoccupied with looking after increasingly large numbers of people. We've lost a lot of the spark, dynamism, and discretion [from Whitehall] that was characteristic of the original success."

Absolutely. But where does the blame lie?

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