3. How does the Welsh Government promote effective partnership between local government and public health bodies in Wales? OAQ54647

The Well-being of Future Generations (Wales) Act 2015 and Social Services and Well-being (Wales) Act 2014 require public bodies, including local government and health boards, to think and act differently, putting collaboration at the heart of how they work. This includes, but extends far beyond, their work on public services boards.

Thank you. Although Public Health Wales provides specialist public health support to the 22 local authorities in Wales, responsibility for public health in Wales is shared amongst all the NHS bodies, with leadership provided by Public Health Wales. In contrast, in England, the main statutory duties for public health were proffered on local authorities in 2013, with responsibility in local authorities for improving health of the local population and for public health services, including no sexual health services and services aimed at reducing drug and alcohol misuse. I recently had a meeting with executive members and officers of a local authority in Wales, who told me that in England, as a consequence, there'd been a better focus and scrutiny for the same resources. A subsequent report to the launch of this in England by the independent health and social care charity and think tank, King's Fund, said, 

'The transfer of public health functions and staff...to local authorities has gone, in most cases, remarkably smoothly, with directors of public health confident of better health outcomes in the future and reporting positive experiences of working in local authorities.'

Without prejudging this, what consideration or what review role does the Welsh Government have in considering, on a neutral basis, on a non-judgmental basis, what works best in an outcome-related manner and looking at whether the systems across the border are delivering better, as was alleged to me?   

Public health is actually in my colleague Vaughan Gething's portfolio and not mine. So, much of what you've just talked about is in Vaughan Gething's portfolio but, in general, we've been using the regional partnership boards to achieve the same result, because it's not just about transferring functions from one part of the public sector to the other; it's about getting the whole public sector to work together in harmony to deliver a set of mutually agreed outcomes and a shared vision. So, it's a relatively new system. We've had some reports done into it.

We're about, in the local government Bill, to put a different regional working arrangement in place, which local authorities and health authorities and public health and other public bodies will be able to take advantage of, if they want to, on a not-one-size-fits-all basis. So, if a local authority you're talking to thinks that's a better route, they will have a vehicle to do that. But, at the moment, we've been looking at getting the regional partnership boards to work. It's a relatively new arrangement in Wales. So far, so good. But we are taking account of where they are at the moment, and actually my colleague Vaughan Gething and I are taking an interest in how that works and whether the way that we fund that and the way that we support that might need to change in view of the learning, as we come through the, I think, second year of functioning. 

Yes, thank you, Minister. I hear what you say about regional partnership boards, but, just to develop the argument a bit, with the range of what makes people ill in the first place—the so-called determinants of ill health, as you'll be aware—they already fall within the ambit of local government: bad housing and environmental health, education particularly and public transport. They're already under the control of local authorities. So, it would make sense, really, to try and strengthen the public health aspects of local authorities, because they already do a lot of that, to actually move across a fair amount directly to local authorities, rather than to regional partnership boards. I don't know how you think about that. 

We're not actually in the game of moving functions from one to the other. You can make an argument that social care should be in health, or the whole thing should be together in one body or whatever. Generally speaking, I'm a proponent of the view that it's not the structure that matters but the working arrangements and the culture. So, we're going down the regional partnership board route because we want all of the public services to work well together. So, he's absolutely right, but you could also add having a decent job and decent primary healthcare, and all the rest of it, into that.

So, the regional partnership boards have the range of public services sitting on them. They have shared budget arrangements, and they have a shared vision and purpose. As I say, we're about to give them a new vehicle if they want to use that. It's not compulsory; they can use it if they want to. We haven't gone for a one-size-fits-all, because the culture is different across Wales, and so, in some places, they will want to have slightly different arrangements. But, together with Vaughan, I have been looking very closely at how the regional partnership boards have been developing, how we fund them and how the partners work together. You'll know that we've recently made housing a statutory member of the board for the very reason that you outlined.