Context from the October 2011 Healthy Lives, Healthy People: A Call to Action on Obesity: [1]

Local authorities took on new responsibilities for public health from April 2013, and they have a lead role in implementing the obesity strategy where it has been identified as a local priority. 

• From 2013-14 the Department of Health has allocated ring-fenced public health grants to upper-tier and unitary local authorities to improve the health of their local populations (with the Authorities giving the Department an annual breakdown of how they have spent the grant, against a number of public health services, including discretionary services such as obesity programmes).​

• The Health and Social Care Act 2012 gives the Secretary of State power to publish guidance to which local authorities must have regard. The intention is to use this power to require local authorities to have regard to the Public Health Outcomes Framework. The new Public Health Outcomes Framework for England 2013–2016 includes two outcome indicators on excess weight prevalence in children and adults, to measure progress locally and nationally.​

• Each director of public health reports annually on the health of the local population. Guidance from the National Institute for Health and Clinical Excellence says that directors of public health should also establish local targets and indicators including short and immediate measures, alongside defining long-term goals.​

• The directors of public health can ensure that, depending on local needs, multiple agencies across the community are involved in tackling obesity. Action can also be aligned with other disease specific prevention strategies, such as initiatives to prevent type 2 diabetes. The director of public health will be able to work with local clinical commissioning groups to ensure a coherent approach to tackling obesity which spans both prevention and treatment.​

• The Department will set the public health outcomes framework and will incentivise achieving certain national priorities through the health premium incentive. However, there will be no centrally imposed targets, and no performance management of local authorities by the centre. Local authorities will determine their priorities, according to the needs of their population.​

• Health and wellbeing boards in every upper-tier local authority  provide a forum for councillors, the director of public health, the director of children’s services, the director of adult social services, representatives from clinical commissioning groups (CCGs) and local Healthwatch to assess local needs through Joint Strategic Needs Assessments. Health and wellbeing boards will develop Joint Health and Wellbeing Strategies based on those identified needs.​

• Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies will inform local commissioning plans for health, public health and social care; and could possibly be used to inform the commissioning of health-related services.

Local government is playing a lead role in driving health improvement and harnessing partners at local level with the freedom to determine the local approaches which work best for local people and for specific population groups facing the greatest challenges (with the Government monitoring  and rewarding progress against outcomes, and not process).

Local government is leading efforts to support individuals in achieving and maintaining a healthy weight, through:

• Harnessing its reach – excess weight has many causes, and at the same time the types of action that can help to prevent it can bring wider benefits. Local government is ideally placed to lead on developing comprehensive local strategies on overweight and obesity, involving core prevention and treatment measures. It is also well placed to harness the potential of a wide range of other instruments, including: synergies with sustainable transport plans; application of planning rules to benefit healthier lifestyles; use of green spaces and other opportunities for physical activity and sport; healthier catering provision in local authority and education premises; and bringing influence to bear on the local out-of-home catering sector.

• Bringing together a local coalition of partners – supporting health and wellbeing boards to operate effectively and a wide range of partners from the public, private and voluntary and community sectors so that tackling obesity is genuinely seen as ‘everybody’s business’.

• Commissioning a comprehensive and integrated range of interventions – the need is for a spectrum of interventions, from purely preventive, through brief advice on weight loss, through to weight management services and ultimately surgery, commissioned and provided in an integrated way which makes efficient use of different routes into support and different kinds of provision, backed by an agreed local pathway. The opportunity will be for local government to work seamlessly with local clinical commissioning groups and (where appropriate) the NHs Commissioning Board to build on excellent examples of good practice so that the best becomes the universal.