We humans are a discontented lot, constantly seeking release from the imprisonment of the present. Fashions ebb and flow; and if you wait long enough, what was already obsolete yesterday will surely become today’s ‘must-have’. Thus, as Shakespeare’s clown in Twelfth Night would have it, ‘... the whirligig of time brings in his revenges’.

The ghosts of former local authority medical officers of health, culled in the 1974 local government reorganisation, will have rattled their spectral stethoscopes when, on 12 July, the government published its NHS white paper.

For in addition to creating a new Public Health Service ‘to integrate and streamline existing health improvement and protection bodies’, the government also proposes that local authorities will, from April 2012, employ a director of public health (DPH) ‘jointly appointed with the Public Health Service’.

The local health improvement responsibilities of primary care trusts (PCTs) are to transfer to local authorities (PCTs having been earmarked for abolition by 2013) and the DPH ‘will be responsible for health improvement funds allocated according to relative population health need’.

The secretary of state, through the Public Health Service, is to set local authorities national objectives to improve population health outcomes. So, after a gap of 36 years, the white paper signals a return to local government of at least some local public health functions. Back to a healthier future?

The government also proposes in the forthcoming health bill to create a body called HealthWatch England. This is apparently to be a new independent consumer champion within the Care Quality Commission. Consequently, the current local involvement networks – LINKS (created not long ago under part 14 of the Local Government and Public Involvement in Health Act 2007) – are to metamorphose into ‘the local HealthWatch’.

The government intends to ‘enhance the role of local authorities in promoting choice and complaints advocacy, through the HealthWatch arrangements they commission’.

Local HealthWatch will be funded by and accountable to local authorities, which will be responsible for ensuring that local HealthWatch bodies are operating effectively, and for establishing better arrangements if they are not. Local HealthWatch is also to ‘provide a source of intelligence for national HealthWatch and be able to report concerns about the quality of providers, independently of the local authority’.

Well-being powersLocal authorities will also have strategic involvement in health commissioning in partnership with GP practice consortia.

Building on well-being powers in the Local Government Act 2000, new ‘health and wellbeing boards’ are to be established within local authorities to undertake ‘joining up the commissioning of local NHS services, social care and health improvement’. These boards (to be established by April 2012) will ‘allow local authorities to take a strategic approach and promote integration across health and adult social care, children’s services, including safeguarding, and the wider local authority agenda’.

So new local authority functions (to replace those currently discharged by health overview and scrutiny committees) will include responsibilities for: promoting integration and partnership working between the NHS, social care, public health and other local services; and leading joint strategic needs assessments.

The government stresses that local authorities’ new functions ‘will help unlock efficiencies across the NHS, social care and public health through stronger joint working’.

Radical change is of course necessary from time to time, to banish complacency and remind providers what they are there for. But it is, of course, people who make any system work.

All those concerned – government, managers and staff – will need truckloads of resilience, resolution and goodwill if the new craft is to fly. They will also need to pull together very positively if the better and more cost-effective health outcomes the country clearly needs are to be delivered.

The coalition government certainly isn’t hanging about and is making the most of its honeymoon period to plant its flags and chart its changes with all the energy of an Elizabethan explorer. In July the Department for Communities and Local Government (CLG) issued its Draft Structural Reform Plan. Best be careful as you take the lid off of this particular concoction, for it’s very volatile. And if, as it seems, it’s been robustly shaken, it is equally designed to give a vigorous shaking to large swaths of the local governance infrastructure.

The government says that CLG is leading ‘a radical shift of power from Westminster to local people’ to ‘make local decisions a normal part of everyday life, giving people more say, choice and ownership of their local facilities and services’. The policy aim is to reduce the size of the state and re-energise and empower individuals, families, local communities and neighbourhoods so that ‘innovation and ideas will flow from local people and enterprises’.

For, in the government’s view, the ‘default is no longer Big Government but Big Society, where family and social responsibility plus civil liberties create a stronger society’. It believes that a ‘rebalanced and smaller state will improve people’s lives, encourage innovation to flourish and draw people together in civic pride’.

The coalition’s aim therefore is to refocus ‘central government by removing barriers that get in the way of localism and only doing the exceptional things where central government is better placed to act’.

Strategic priorities have been set in five areas to make localism and the Big Society ‘part of everyday life’. These are: decentralising power as far as possible; meeting people’s housing aspirations; putting communities in charge of planning; increasing accountability; and letting people see how their money is being spent. For each of these the government has set out specific actions, with start and end dates, and progress milestones.

The Decentralisation and Localism Bill is expected to be passed by November 2011. Its provisions will include giving councils a general power of competence, empowering communities to save local facilities threatened with closure and giving communities the right to bid to take over local state-run services.

The bill will also introduce ‘measures to allow councils to return to the committee system, should they wish to’. And, unfortunately for those working within them, the Government Office for London and the regional development agencies (RDAs) have been placed on death row, with execution scheduled for April 2012; the jury is out over the other government offices. The government is pledging to work with ‘local authorities and business to promote shadow local enterprise partnerships to accelerate the transition of functions from RDAs’.

As for ‘increasing accountability’, the localism bill will also enable the largest 12 cities in England to have directly elected mayors from May 2012 ‘subject to confirmatory referenda and full scrutiny by elected councillors’. The new administration is also getting on with abolishing the comprehensive area assessment (which it plans to do by October 2010), and cutting local government inspection while identifying ‘exceptional areas where central government needs to retain an oversight role’. The coalition’s intention by April 2011 is to have designed and implemented a new approach with fewer reporting burdens on local government and ‘greater transparency’ for local people.

CLG also charts actions to promote the ‘radical devolution of power and greater financial autonomy to local government and community groups’. Measures include: phasing out ringfencing government grants to local government; and freezing council tax in England ‘for at least one year’ from April 2011 to March 2012, with a view ‘in partnership with local authorities’ to freezing it for a further year. There will also be consideration of the most appropriate framework to incentivise local authorities ‘to support growth, including allowing [them] to reinvest the benefits of growth into local communities’.

Among a host of actions aimed at ‘letting people see how their money is being spent’ are: publication by December 2010 of all local authority performance data held by central government; and preparing local authorities for publication, in an open and standardised format, of items of spending, contracts and tenders above £500. In addition, job titles and salaries above Pay Band 1 for senior civil servants will be published.

Furthermore, from November 2010, the Code of Practice on Local Authority Publicity will be amended ‘to stop unfair competition by local authority newspapers’. There will also be a review in tandem with the Home Office of the Regulation of Investigatory Powers Act 2000, ‘to stop councils unnecessarily using surveillance powers’, and the prohibition of local authority use of powers unless signed off by a magistrate.

In addition, although all council officers are appointed by the council, by November 2011 councillors are to be given ‘the power to vote on large salary packages for unelected council officials’. Presumably this is to empower those councillors (often from minority groups) who are not part of a particular officer selection process.

Although crafted to fit the new age of austerity, these proposals do mark a distinct change of policy focus from the previous administration. Labour adopted a resolutely centralist stance, underpinned by a strong political inclination to look first at state infrastructure solutions to economic and social problems. The coalition is focused on reducing the role and power of the state in favour of individuals and communities.

Honeymoons tend to be happy and harmonious. But the resilience of marriages starts to become tested once reality kicks in and the flack starts to fly. And the flack should certainly be airborne following publication of the 20 October 2010 Comprehensive Spending Review.

Dr Nicholas Dobson is a senior consultant with Pannone specialising in local and public law, and is also communications officer for the Association of Council Secretaries and Solicitors