By Janet Sillett
We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT).
Coalition Agreement 20 May 2010
Eight weeks, as they say, or should say, is clearly a long time in coalition politics. Equity and Excellence: liberating the NHS proposes, possibly, the biggest shake-up in the NHS since its inception, It does, indeed, promise a stronger voice for patients, but, alas, for PCTs, not through their boards, as PCTs are to go the way of the numerous other health bodies that have been formed and abolished in very short spaces of time.
There are, and will continue to be, heated debates about the merits of undertaking a massive restructuring whilst the financial pressures are increasing daily, about the acceleration of the mixed economy in health and in the programme for turning all trusts into foundation ones. Issues around democratic accountability aren’t going to go away either. But for local government, the key issue is what does the white paper mean for the future role of local government in promoting health and well-being in their communities?
Further consultations will follow, but we can see the broad direction now. The white paper recognises local government’s critical role; it proposes the transfer of responsibilities for health improvement to councils, with a ring-fenced public health budget; councils will have a co-ordinating role around health and social care integration.
The mood music is clearly positive. But, as usual, especially for pessimists as some of us have learnt to be, big questions remain: how will councils work in partnership with GP consortia; will the public health budget cover additional costs and how flexible can it be: will councils be given responsibilities but not the necessary powers and resources to carry them out?
For optimists – well, there are massive opportunities here for councils – local government’s expertise in commissioning can be ‘sold’ to the GPs and joint commissioning could actually be strengthened. Public health could become less of a cinderella service. Councils could become more equal partners with the mighty health service.
The white paper is very ambitious. Local government is well able to match that ambition. Planning for major change starts now.