Future Arrangements for the provision of Public Health across West Berkshire, Wokingham and Reading (EX3900)
Purpose: To consider options and recommendations concerning the future management of Public Health across Berkshire West.
· The current arrangement between the six unitary authorities across Berkshire be dissolved and move to a shared arrangement between West Berkshire Council, Reading Borough Council and Wokingham Borough Council (Berkshire West).
· A shared Director of Public Health (DPH) role be created for Berkshire West which will lead the public health system, working closely with the local authorities and in partnership with the Berkshire West Integrated Care Partnership. There will also be a shared Hub Team providing health intelligence, health protection and commissioning support to public health teams in each local authority. The establishment of these functions would be delegated to the Chief Executive.
This decision is not subject to call in as:
· a delay in implementing the decision could compromise the Council's position.
therefore it will be implemented immediately.
The Executive considered a report (Agenda Item 12) which set out options and recommendations concerning the future management of Public Health across Berkshire West.
Councillor Howard Woollaston stated that the set up in Berkshire had shifted from the original vision which had relied on a collective responsibility between local authorities. The system had become unbalanced and it had been difficult to recruit to public health leadership positions. With the development of Integrated Care Systems demands on public health were increasing and the Director post was particularly stretched, covering 6 local authorities, 2 CCGs and 2 ICSs. Imbalances in the System had arisen as authorities had invested in different programmes and staffing structures.
In 2019 the Berkshire Chief Executives requested a review. They considered the effectiveness of the current model, the changing context and opportunities for public health, current costs, and alternate models. They recommended dissolving the current arrangement and moving to two hub and spoke arrangements across three borough geographies which was unique across the whole of the UK. By doing this arrangement it would improve the health of the population and reduce inequalities to improve outcomes for residents and reduce demand for services. There was a financial implication of £75k-£100k per annum which would be met from the 2020/21 increase in the ring fenced Public Health Grant.
Councillor Graham Bridgman noted that at the Locality Integration Board there was a clear desire to build and improve the relationship and this arrangement should be encouraged in order to promote the health agenda in Berkshire West.
Councillor Alan Macro understood the reasons for recommending this and although the budget was ring-fenced this would create pressures elsewhere. However, it would provide a better service for the residents of West Berkshire and on that basis he was happy to support it.
· the current arrangement between the six unitary authorities across Berkshire be dissolved and a shared arrangement between West Berkshire Council, Reading Borough Council and Wokingham Borough Council (Berkshire West) be set up.
· a shared Director of Public Health (DPH) role for Berkshire West be created to lead the public health system, working closely with the local authorities and in partnership with the Berkshire West Integrated Care Partnership. A shared Hub Team providing health intelligence, health protection and commissioning support to public health teams in each local authority be created.
· the establishment of these functions be delegated to the Chief Executive.
Reason for the decision: Although the current arrangements for Public Health have served West Berkshire well, in recent years the underlying structure has become unsustainable.
Other options considered: 6.1 A range of other options have been considered by the six Chief Executives and other partners. These include variations based around enhancing the current position, to creating a single Public Health Team within each Unitary Authority, each with its own DPH. At the end of the day there needs to be a balance between cost and effectiveness. Some Public Health functions are better delivered at scale and creating a local function would undoubtedly bring with it higher costs and concerns around resilience. A shared function over the larger geography reduces cost and improves resilience but in the Berkshire setting has created significant concerns around effectiveness. The option set out here is a compromise between all of these and one which currently has the support of all partners. It also provides an alignment with the Berkshire West Integrated Care Partnership.