How local government's relationship with the NHS is changing

In April 2013 local authorities took over responsibility for public health, which includes healthy eating. Photograph: Ben Stansall/AFP/Getty Images

Although, arguably, local government has contributed more to the health of the nation over the last century than the NHS itself, the relationship between these two public service silos has often been troubled.

The currency of power and responsibilities has been one-way traffic: in 1974, large swathes of health provision that had remained with local government, including public health, moved across to the NHS as part of a huge reorganisation of both services. As medical journal the Lancet put it, running health services was "too important to be left to the local citizenry".

However, in 2013 the tide has turned. The government's NHS reforms see public health returned to its home in local government and local authorities are given a new leadership role through the creation of health and wellbeing boards, charged with promoting integrated services and setting local strategies for health and wellbeing. So will 2013 be a watershed moment in the relationship between the NHS and local government ?

Our latest research is encouraging. Relationships between councils and clinical commissioning groups are generally good, and getting better. The new health and wellbeing boards are investing time in developing relationships and joint strategies are in place. But these are early days and three key questions remain.

The first is how far councils will support NHS partners in driving through essential changes in how local services are delivered.

Our hospitals cannot do everything, everywhere, all of the time. Controversial local proposals expose deep cultural differences between the two services. Local politics is coloured by the evidence of local public feeling rather than randomised trials. This makes it hard for local politicians to lead public opinion rather than follow it. And tougher still when the case for change is not well made and seems to be about saving money not lives. The culture of local accountability of councillors through elections is a source of mistrust and suspicion among NHS managers – though they are well-used to the no-less-political interventions of Westminster politicians.

The second is about money and whether austerity will either provide the burning platform for change or stress test local relationships to destruction. This will play out differently; places with tradition of good local relationships have a better chance of weathering the financial storm. It raises questions about whether the architecture of local public services is sustainable. Do the one million people of the shire county I was working in recently really need 25 different public bodies to deliver their health and social care services?

The pattern of clinical commissioning groups and district councils does not look sustainable but the politics of local government boundaries are tricky and there's no appetite for more reorganisation.

The third issue is whether local authorities and the NHS can achieve a breakthrough in offering the kind of well-coordinated, integrated care that almost everyone agrees is vital . Unless they can deliver more of this on a daily basis with services driven by the clock not the calendar, hospitals and the care system will fall over. Local partnerships alone will not be enough. Though the recently announced £3.8bn integration fund will help, there are some deep-seated fault lines in national policy for health and social care and the King's Fund has established the Barker commission to consider a different way of establishing our entitlement to these services and how this could be funded. The commission has put out a call for evidence, and we welcome contributions.

Our research indicates that although the new boards have set themselves some laudable objectives for local health improvement, it is far from clear whether they have begun to grapple with these three big challenges of money, cultures and ways of working. Local government and the NHS are on a new journey but there is a long way to go.

Richard Humphries is assistant director of policy at the King's Fund.

• Want your say? Email sarah.marsh@theguardian.com to suggest contributions to the network.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

How local government's relationship with the NHS is changing

In April 2013 local authorities took over responsibility for public health, which includes healthy eating. Photograph: Ben Stansall/AFP/Getty Images

Although, arguably, local government has contributed more to the health of the nation over the last century than the NHS itself, the relationship between these two public service silos has often been troubled.

The currency of power and responsibilities has been one-way traffic: in 1974, large swathes of health provision that had remained with local government, including public health, moved across to the NHS as part of a huge reorganisation of both services. As medical journal the Lancet put it, running health services was "too important to be left to the local citizenry".

However, in 2013 the tide has turned. The government's NHS reforms see public health returned to its home in local government and local authorities are given a new leadership role through the creation of health and wellbeing boards, charged with promoting integrated services and setting local strategies for health and wellbeing. So will 2013 be a watershed moment in the relationship between the NHS and local government ?

Our latest research is encouraging. Relationships between councils and clinical commissioning groups are generally good, and getting better. The new health and wellbeing boards are investing time in developing relationships and joint strategies are in place. But these are early days and three key questions remain.

The first is how far councils will support NHS partners in driving through essential changes in how local services are delivered.

Our hospitals cannot do everything, everywhere, all of the time. Controversial local proposals expose deep cultural differences between the two services. Local politics is coloured by the evidence of local public feeling rather than randomised trials. This makes it hard for local politicians to lead public opinion rather than follow it. And tougher still when the case for change is not well made and seems to be about saving money not lives. The culture of local accountability of councillors through elections is a source of mistrust and suspicion among NHS managers – though they are well-used to the no-less-political interventions of Westminster politicians.

The second is about money and whether austerity will either provide the burning platform for change or stress test local relationships to destruction. This will play out differently; places with tradition of good local relationships have a better chance of weathering the financial storm. It raises questions about whether the architecture of local public services is sustainable. Do the one million people of the shire county I was working in recently really need 25 different public bodies to deliver their health and social care services?

The pattern of clinical commissioning groups and district councils does not look sustainable but the politics of local government boundaries are tricky and there's no appetite for more reorganisation.

The third issue is whether local authorities and the NHS can achieve a breakthrough in offering the kind of well-coordinated, integrated care that almost everyone agrees is vital . Unless they can deliver more of this on a daily basis with services driven by the clock not the calendar, hospitals and the care system will fall over. Local partnerships alone will not be enough. Though the recently announced £3.8bn integration fund will help, there are some deep-seated fault lines in national policy for health and social care and the King's Fund has established the Barker commission to consider a different way of establishing our entitlement to these services and how this could be funded. The commission has put out a call for evidence, and we welcome contributions.

Our research indicates that although the new boards have set themselves some laudable objectives for local health improvement, it is far from clear whether they have begun to grapple with these three big challenges of money, cultures and ways of working. Local government and the NHS are on a new journey but there is a long way to go.

Richard Humphries is assistant director of policy at the King's Fund.

• Want your say? Email sarah.marsh@theguardian.com to suggest contributions to the network.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

The relationship between proteinases and asthma

Main Category: Respiratory / Asthma
Article Date: 18 Aug 2013 - 0:00 PDT Current ratings for:
The relationship between proteinases and asthma

Dr. David Corry compares the allergic response to a computer.

"The core of a computer is its CPU (central processing unit) or chip. We are looking for the chip that drives allergic disease," said the professor of medicine, chief of the section of immunology, allergy and rheumatology in Baylor College of Medicine's department of medicine and director of the Biology of Inflammation Center at BCM. In a report that appears online in the journal Science, he and colleagues at BCM describe an important component of that chip - a molecule called toll-like receptor 4 that plays a key role in prompting the innate or immediate response that drives allergic disease and asthma.

Asthma is part of a battle that takes place as the immune system marshals its forces to fight off an invading organism-or what mimics such invaders. The ensuing fight takes a significant toll on the human airway and lungs, often generating a violent and itself potentially deadly reaction - asthma.

In 2002, Corry and his colleagues found that proteinases, enzymes that chop up other proteins, are important in initiating the adaptive immune response that prompts generation of the critical T-cells and B-cells that populate the adaptive immune system. The adaptive immune system specifically targets allergens, and Corry knew that the more immediate innate immune system also played an important role in asthma and allergy.

"If you take many proteinases and give them to mice, they will induce an allergic disease that resembles asthma," he said.

With that key finding in the adaptive immune system, the researchers turned their attention to the puzzle presented by the innate immune system.

"What is the relationship between proteinases and asthma?" he said. Other work in the field pointed to another immune molecule called toll-like receptor 4 that was believed to play a role in activating T-helper type 2 (Th2) cells.

Instead, he and his colleagues found that the proteinases carve up a protein known as fibrinogen, leaving behind fragments that signal through the crucial toll-like receptor 4 to activate the cells of the innate immune system - the macrophages of the airway and airway epithelia.

"Toll-like receptor 4 is not required for the Th2 response itself," said Corry. "But, the Th2 response is proteinase dependent."

"When the macrophages are activated by fibrinogen cleavage products in culture, you get beautiful activation," said Corry.

In the airway, the same fibrinogen fragments that are part of the blood clotting process can cause clotting that is a barrier to breathing, said Corry.

In his studies, he used proteinase-producing fungi as the environmental trigger for asthma. Laboratory mice that lacked toll-like receptor 4 did not mount a robust allergic airway disease when challenged by proteinase, viable fungi or other triggers but did have a normal Th2 immunity.

"Why do our bodies do this?" said Corry. The answer is both simple and complicated. The system developed to allow organisms to survive infection with deadly organisms such as fungi. How it achieves that is complicated. In this "survival mode," the immune system generates symptoms that can themselves create disease.

Against the insidious onslaught of organisms such as fungi, which can kill if left unchecked, asthma may be a better alternative, said Corry.

"If you don't fight fungi off, they will get you," he said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our respiratory / asthma section for the latest news on this subject.

Funding for this work came from the U.S. National Institutes of Health (Grants HL75243, AI057696 and AI070973 and CA125123) and the C.N. and Mary V. Papadopoulos Charitable Fund from the Biology of Inflammation Center.

Corry holds the Cullen Trust for Health Care Endowed Chair in Immunology.

Cleavage of Fibrinogen by Proteinases Elicits Allergic Responses Through Toll-Like Receptor 4

Others who took part in this research include Valentine Ongeri Millien, Wen Lu, Joanne Shaw, Xiaoyi Yuan, Garbo Mak, M.D., Luz Roberts, Li-Zhen Song J. Morgan Knight, Chad J. Creighton, Amber Luong, and Farrah Kheradmand, all of BCM. Kheradmand and Corry are also with the Michael E. DeBakey Veterans Affairs Medical Center in Houston; Shaw and Creighton are also with the Dan L. Duncan Cancer Center at BCM.

Science 16 August 2013: Vol. 341 no. 6147 pp. 792-796; DOI: 10.1126/science.1240342

Baylor College of Medicine

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