Strategic health authorities have recommended plans that will see more than one in six English councils lose their existing shared boundaries with primary care trusts. On the surface the plans look constructive – the proportion of councils sharing a boundary with a single PCT would rise from 44 to almost 78 per cent.
The flipside is that 27 councils will have their boundary arrangements broken up by the push to enlarge PCTs, driven in part by the need to make savings in each area. But the proposal is at odds with the health and social care white paper. Thirteen of these councils have local area agreements, which are seen by the Department of Health as the key vehicle for delivering its white paper.
The situation in Wiltshire should sound a warning. Relations between the NHS and social care have reached a new low after health bosses recommended that the area’s reshaped PCT should not be coterminous with the council. Social care managers say this will cause difficulties with joint commissioning and the local area agreement – a view that is backed by the House of Commons health select committee.
Alternative proposals that would have resulted in coterminosity in almost every area were rejected by SHAs – so much for health wanting to work more closely with social care.