One in six English councils would lose their shared boundaries with local primary care trusts, putting social care and health partnerships at risk, under final recommendations to government from NHS bosses.
The proportion of councils sharing a boundary with a single PCT would rise from 44 per cent to almost 78 per cent, in line with Department of Health calls for reforms to improve partnership working, under the strategic health authority (SHA) plans submitted this month.
But SHAs rejected alternative proposals that would have resulted in coterminosity in almost every area, while shared boundary arrangements in 25 councils will be broken up by the drive to enlarge PCTs.
In most of these cases, SHAs decided that coterminous PCTs would be too small to fulfil the other conditions for reform set by the DH, notably strengthening commissioning and making 15 per cent savings in each area.
The changes could devastate partnerships; 13 of the 25 areas to lose coterminosity have local area agreements, which depend on close partnerships between councils and PCTs and are seen by the DH as a crucial vehicle for delivering its health and social care white paper.
Ann Baxter, corporate director for children, education and social care at Stockton-on-Tees Council, one of the 13, blamed the decisions on the 15 per cent savings target.
“It distorts the issue,” she said. “Given the white paper was clearly supportive of coterminous arrangements, there’s a certain irony about proposals to remove them.”
Another affected area is Northumberland, whose care trust faces an uncertain future because of plans to merge it with Newcastle and North Tyneside PCTs. A care trust spokesperson said discussions over the future of its role in commissioning adult social care were in their early stages.
The absence of coterminosity across the board also raises question marks over the DH’s call for joint appointments of public health directors between councils and PCTs.
If the SHA proposals are accepted by the DH, this would result in the number of PCTs being slashed from 303 to 128, 100 of which would share boundaries with councils.
The DH said it would shortly announce a decision on PCT reconfiguration. The new trusts will come into being in October.