Wide ranging proposals for structural change have been published in the NHS White Paper Equity and Excellence: Liberating the NHS with the move from PCT to GP commissioning attracting most attention in the media.
However, the White paper also proposes major changes councils’ responsibilities in relation to health improvement and coordination of health and social care.
New roles and resources for local councils include:
- PCT health improvement functions will be transferred to local authorities in 2013
- Local councils will employ Directors of Public Health, jointly appointed with a new national Public Health Service
- A ring-fenced public health budget allocated to local councils to support the public health and improvement functions.
- New statutory arrangements within local authorities (“health and wellbeing boards”) to take on the function of joining up the commissioning of local NHS services, social care and health improvement. Local authorities will be responsible for promoting integration and partnership working across health, social care and other local services, leading joint strategic needs assessment and promoting collaboration on local commissioning plans, and building partnerships for service changes and priorities.
- All relevant NHS commissioners, directors of public health, adult social services and children’s services will be under duties of partnership.
- Local Health Watch, funded by and accountable to local authorities will replace current LINks to provide patient feedback, advocacy and support.
- Current Health Overview and Scrutiny Committees will be replaced by the new arrangements.
At a national level the role of the Department of Health role will be fundamentally changed, as an independent NHS Commissioning Board is established to lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice. The Department’s focus will be on improving public health, tackling health inequalities and reforming adult social care, with its NHS role much reduced.
The White Paper contains few specific proposals for social care, but signposts further work in this area: A vision for social care will be set out later this year, and a commission on funding long-term care will be established to report within a year, with a White Paper to follow in 2011. One notable exception is the proposal that the National Institute for Health and Clinical Excellence (NICE) should extend its remit to develop quality standards for social care, which would seem to imply a reduced role for SCIE (Social Care Institute for Excellence).
Directors of Adult Social Services have broadly welcomed the White Paper, noting that it “appears to be consistent with the idea of adult social care, public health and integrated health services sitting at the heart of local communities.” The fact that GP consortia will have a duty to work in partnership with local government is seen as a positive measure, but ADASS also note that it will be critically important to ensure that the changes don’t lead to a fragmentation of the ways in which public money is used to improve outcomes.
The Local Government Group welcomes the recognition that councils are the most appropriate local bodies to coordinate and lead on health improvement, and the additional resources to undertake the public health role. However it is critical of the imposition of a ring fence for this money as it is “completely at odds” with the place-based approach advocated by the LG Group. “Government must trust local councils to direct resources as they see fit and remove the ring-fence”. These comments are reiterated in relation to proposals for reducing management costs: “..further reductions in public spending must go hand-in-hand with a radical reform of the way public money is spent. It is important that this includes an end to ring-fencing of budgets in order to allow for efficiency savings through place-based budgeting”. The LG Group considers that health resources should be included in this approach, in order to join up health and social care and to invest in preventative and early intervention in order to reduce the need for health and social care.
But what will constitute ‘place’ or ‘locality’ in the new world of GP commissioning, and will this help or hinder partnerships and joint commissioning? Up till now successive restructurings of NHS bodies have moved health and social care locality boundaries closer together. The White Paper acknowledges the need for GP consortia to have “sufficient geographical focus (…) to commission services jointly with local authorities”, but with 500 GP consortia on the horizon, and patients not being restricted to register with a local GP, how easy will it be in practice to plan jointly for local populations? And how can the commitment to partnership working be safe guarded during another period of major NHS restructuring?
Commissioning led by health practitioners is still in early stages of development and many commentators point to lack of GP expertise (and sometimes interest) in this area. Would it be too much to expect, before taking on the potentially biggest change in the NHS history, that the government might heed the Local Goverment Group recommendation “to ‘test-bed’ this model of commissioning before rolling it out nationally”?
Click here to view a copy of; Department of Health Equity and Excellence: Liberating the NHS
Click here to view a copy of; Local Government Group Briefing – Health White Paper: “Equity and excellence: Liberating the NHS” 13th_July_2010_
Click here to view a copy of; NHS White Paper: ADASS welcomes new responsibilities for local government and social care