DH criticised for keeping directors in the dark

Social services directors have criticised the Department of
Health for shutting them out of plans to restructure the NHS
despite their significant implications for councils,
writes Mithran Samuel.

Association of Directors of Social Services leaders said they
were given no prior briefings on proposals, published in late July,
to slash the number of primary care trusts, affecting their
relationships with councils.

President Tony Hunter said: “We have forums in place where
these sorts of issues can be discussed because sometimes they have
unintended consequences as is the case with this

He cited the likelihood that smaller PCTs would be merged,
despite the fact that many share the same boundaries as, and have
strong links with, councils.

Hunter added: “They may have joint posts and pooled
budgets in place, which would need unravelling [as a

The problem stems from the tensions between two objectives in
the DH’s Commissioning a patient-led NHS plan: making 15 per
cent savings from restructuring trusts, and improving co-ordination
between social services and PCTs by aligning boundaries.

While mergers in the shires, where there are typically many PCTs
to each county council, could lead to alignment, this is not the
case elsewhere, where smaller trusts and councils already

Jeff Jerome, chair of the ADSS disabilities committee, said:
“It would have been good to have some kind of discussion
beforehand to put a local government perspective on it because I
don’t think it’s there in the proposals.”

He also attacked the rapid timetable for reform. Strategic
health authorities, which manage the performance of PCTs, have been
given until 15 October to put forward proposals for restructuring

A DH spokesperson said Commissioning a patient-led NHS contained
nothing new in policy terms. All if it drew on last June’s
NHS Improvement Plan and its successor, Creating a patient-led NHS,
published in March, both of which had been consulted on, she

However, Hunter said: “There are real implementation
issues which we feel haven’t received the full intention that
they need.”

He hoped the matter would be discussed at next month’s
meeting of the social care forum, the DH’s new outlet for
consulting the sector.

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