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How district councils can help unlock better health outcomes

Luca Tiratelli - District Councils
By Luca Tiratelli Researcher, The King's Fund
19 July 2023



A seemingly endless stream of statistics tells us that most health outcomes are determined well before an individual engages with health and care services. District councils have more extensive links to local communities than most ICB partners, and integrated care systems (ICSs) can make good use of this. In theory, the constitution of ICSs recognises and addresses this, bringing together organisations beyond solely health and care services.

Local government is central to the work of ICSs. This has been widely recognised by upper-tier authorities because of their role in social care provision. However, the role of lower-tier authorities – district councils – has been somewhat overlooked as ICSs have developed. A new report from The King’s Fund, published this month, aims to rectify this.

About 40% of people in England live in areas where local government is split into two tiers – county and district councils. In these areas, districts hold significant powers. They provide services such as housing, planning, economic development, welfare, leisure and the environment – factors often referred to as the ‘wider determinants of health’. As a result, district councils need to be seen as crucial partners in improving the health of local populations, particularly through work focused on prevention.

As well as the services they are responsible for, districts have other characteristics that can be immensely valuable to systems. They operate at a smaller geographic scale than most other statutory organisations in ICSs, which brings certain advantages. Our report describes how districts are able to act quickly and flexibly in response to crises, as they did during the COVID-19 pandemic, which helps them meet the needs of their populations more effectively.

The potential of district councils

Districts also have a closeness to and understanding of their communities that other statutory organisations in ICSs aren’t able to match. Employing the knowledge of district councils can help ICSs better understand the needs of their communities and prove valuable when involving individuals and communities in activities such as designing or redesigning services.

However, at present, there is a very mixed picture of district council involvement in ICSs. And not every ICs is reaping the rewards that working with district councils can offer. Our work concluded that if ICSs want to work effectively with district councils to deliver real improvements in health outcomes for their communities, then ICS leaders need to take action.

They need to create opportunities within systems for districts to take the lead in areas where they have expertise, both in terms of decision-making and service delivery. Enabling districts to take on such roles helps bind them into the architecture of systems and, crucially, helps them share accountability for delivering interventions and outcomes. Our report argues that this is absolutely critical when it comes to deepening integration and breaking down the barriers that currently exist between organisations.

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However, achieving this level of integration requires certain other factors to be in place.

Working together

Organisations need to build cross-organisational relationships. Sometimes effective relationships can feel like good fortune, resulting from things that are difficult to control, such as how personalities gel or how long key staff have been with an organisation. However, while these things help, people can actively build relationships if they have time to invest in doing so. Shared priorities and goals form the lynchpins of productive co-working, even if human connection takes longer to build.

At a more technical level, infrastructure also needs to allow for closer working, for example, creating agreements around data sharing. Our research revealed issues around data sharing, often caused more by a lack of trust and inadequate processes than by any real legal or technical barriers. Nonetheless, a lack of shared data can prevent important work from happening.

Taking action to work more closely with district councils can help ICSs achieve two critical things. First, they can move beyond simple co-working and achieve genuine integration between organisations – pooling the resources, tools and perspectives of local actors and transforming them into a singular force.  

Second – and most importantly from the perspective of tangible outcomes for communities – ICSs can embed prevention at the heart of their mission and purpose, and harness the capabilities of districts. Much of the work of district councils is inherently preventive. Working with them as an integral part of an ICS brings an inherent focus and knowledge to goals and work around prevention and population health systems that ICSs leaders should embrace.

District councils are already delivering interventions that impact population health in their areas. ICSs need to embrace them to ensure that the work that they’re doing is joined-up and that the best outcomes are realised for local people.


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