Here’s why councils should get a share of the government’s NHS “birthday present”

Happy birthday? What exactly is so happy about it? Image: Getty.

Every day, a new story emerges about the spiralling financial crisis in local government. If it isn’t a new council announcing mammoth cuts to simply stay afloat, it’s new data revealing how a vital local service is facing meltdown.

The government, however, seems uninterested. Extra funding is going in only one direction – towards the NHS in the form of the £20.5bn “birthday present” announced by the Prime Minister in June.

One day, students of public finance will study this as an example of policy-making at its most irrational. The £20.5bn was announced as a response to the rapidly rising demand, which is stretching NHS services to snapping point. But if councils are left to fall apart that demand will only rise further and faster.

This is because councils do the things that keep people from bothering the NHS in the first place. They make sure the elderly and people with disabilities are cared for. Councils keep roads, town centres and businesses safe and clean. Their public health teams educate local communities about how to stay well. They expend a great effort on steering troubled children away from drugs, self-harm and mental illness.

Maybe more fundamentally, councils are tasked with providing the housing and local business investment that gives people the decent homes and jobs that all research shows is vital to better physical and mental health.


So far, the government has avoided confrontation with the absurdity of its position by claiming that the problems facing councils are all the result of local mismanagement. Northamptonshire, the first council to effectively declare bankruptcy in decades, has been subjected to a convoluted inquiry and structural re-organisation in an effort to pin the blame on local leaders.

But as the number of councils declaring themselves to be in severe financial straits has grown over the last few weeks, the government’s line is looking increasingly detached from reality. The conclusion that the real cause of the crisis is the 50 per cent cut in government funding councils have endured since 2010 is becoming unavoidable.

No doubt the Treasury’s next move will be to shift money around within the overall budget for councils to bail out those facing immediate difficulties. There is an obvious opportunity to do this given a review on how council funding is allocated will report very soon.

The government may buy some short-term respite by shifting funds to struggling councils. But if that comes at the expense of withdrawing even more funds from other councils then the problems will only re-emerge elsewhere.

The chancellor could avoid these undignified and self-defeating manoeuvres easily: spread the £20.5bn of love directed at the NHS more widely. If that money is genuinely to be used as a response to rising demand then sharing it with local government makes far greater sense than blowing it all on the health service.

How much would need to be shared? The Local Government Association has estimated that councils need an extra £7.8bn just to keep services at their current rather threadbare level over coming years. But there is more to it than that.

Such significant funding shared between the NHS and councils could, if positioned right, enable a major shift towards a system built around preventing people getting ill in the first place rather than being treated once they do. A great partnership between the two biggest providers of public services in the country to keep people healthy and out of hospital: the benefits to the economy, the public finances and simple well-being could be huge.

Adam Lent is director of the New Local Government Network. This article previously appeared on our sister site, the New Statesman

 
 
 
 

Air pollution in London is now so bad it’s affecting lung development

Cough, splutter. Image: Getty.

Air pollution is known to contribute to early deaths from respiratory and cardiovascular disease. There is also mounting evidence to show that breathing polluted air increases the risk of dementia. Children are vulnerable, too: exposure to air pollution has been associated with babies being born underweight, as well as poorer cognitive development and lung function during childhood.

Cities including London are looking to tackle the social, economic and environmental costs of air pollution by improving urban air quality using low emission zones. In these zones, the most polluting vehicles are restricted from entering, or drivers are penalised to encourage them to take up lower emission technologies. London’s low emission zone was rolled out in four stages from February 2008 to January 2012, affecting mainly heavy and light goods vehicles, such as delivery trucks and vans.

But our new research, involving more than 2,000 children in four of London’s inner-city boroughs, reveals that while these measures are beginning to improve air quality, they do not yet protect children from the harmful effects of air pollution. It is the most detailed assessment of how a low emission zone has performed to date.

Young lungs

Our study focused mainly on the boroughs of Tower Hamlets and Hackney, but also included primary schools in the City of London and Greenwich. All of these areas experienced high levels of air pollution from traffic, and exceeded the annual EU limit for nitrogen dioxide (NO₂). What’s more, they have a very young demographic and are among the UK’s most deprived areas.

Between 2008-9 and 2013-14, we measured changes to air pollution concentrations in London, while also conducting a detailed examination of children’s lung function and respiratory symptoms in these areas.

Every year for five years, we measured the lung function in separate groups of 400 children, aged eight to nine years old. We then considered these measurements alongside the children’s estimated exposure to air pollution, which took into account where they lived, and the periods they spent at home and at school.

Our findings confirmed that long-term exposure to urban air pollution is related to smaller lung volumes among children. The average exposure for all children over the five years of our study was 40.7 micrograms of NO₂ per cubic metre of air, which was equivalent to a reduction in lung volume of approximately 5 per cent.

Changes of this magnitude would not be of immediate clinical significance; the children would be unaware of them and they would not affect their daily lives. But our results show that children’s lungs are not developing as well as they could. This is important, because failure to attain optimal lung growth by adulthood often leads to poor health in later life.

Over the course of the study, we also observed some evidence of a reduction in rhinitis (a constant runny nose). But we found no reduction in asthma symptoms, nor in the proportion of children with underdeveloped lungs.


Air pollution falls

While the introduction of the low emission zone did relatively little to improve children’s respiratory health, we did find positive signs that it was beginning to reduce pollution. Using data from the London Air Quality Network – which monitors air pollution – we detected small reductions in concentrations of NO₂, although overall levels of the pollutant remained very high in the areas we looked at.

The maximum reduction in NO₂ concentrations we detected amounted to seven micrograms per cubic metre over the five years of our study, or roughly 1.4 micrograms per cubic metre each year. For context, the EU limit for NO₂ concentrations is 40 micrograms per cubic metre. Background levels of NO₂ for inner city London, where our study was located, decreased from 50 micrograms to 45 micrograms per cubic metre, over five years. NO₂ concentrations by the roadside experienced a greater reduction, from 75 micrograms to 68 micrograms per cubic metre, over the course of our study.

By the end of our study in 2013-14, large areas of central London still weren’t compliant with EU air quality standards – and won’t be for some time at this rate of change.

We didn’t detect significant reductions in the level of particulate matter over the course of our study. But this could be because a much larger proportion of particulate matter pollution comes from tyre and brake wear, rather than tail pipe emissions, as well as other sources, so small changes due to the low emission zone would have been hard to quantify.

The route forward

Evidence from elsewhere shows that improving air quality can help ensure children’s lungs develop normally. In California, the long-running Children’s Health Study found that driving down pollution does reduce the proportion of children with clinically small lungs – though it’s pertinent to note that NO₂ concentrations in their study in the mid-1990s were already lower than those in London today.

Our findings should encourage local and national governments to take more ambitious actions to improve air quality, and ultimately public health. The ultra-low emission zone, which will be introduced in central London on 8 April 2019, seems a positive move towards this end.

The scheme, which will be expanded to the boundaries set by the North and South circular roads in October 2021, targets most vehicles in London – not just a small fraction of the fleet. The low emission zone seems to be the right treatment – now it’s time to increase the dose.

The Conversation

Ian Mudway, Lecturer in Respiratory Toxicology, King's College London and Chris Griffiths, Professor of Primary Care, Queen Mary University of London.

This article is republished from The Conversation under a Creative Commons license. Read the original article.