LGA and NHS Confederation debate health commissioning

London Councils and the Local Government Association have both called for councils to take some responsibility for commissioning non-acute NHS care budgets, a function carried out by primary care trusts.

The local government bodies both claim the reform would improve efficiency, help integrate health and social care and boost the accountability of the NHS to local people.

However, NHS leaders have rejected this argument, and said primary care trusts should retain responsibility for commissioning all health services.

Community Care asked the LGA and the NHS Confederation’s Primary Care Trust Network to outline their positions.


David Stout, director of the Primary Care Trust Network at the NHS Confederation

All complex problems have a simple solution that doesn’t work. This is one of those solutions. Patients do not care where the funding comes from to provide health services. What they do want to know is that the planning and delivery of these services, from hospital treatment to services at home, is led by local clinicians not local politicians.

Patients want care that means they move as seamlessly as possible from hospital settings to community ones or their homes. Imposing a barrier to define what is and is not acute care is absurd and would do nothing to improve patient outcomes.

Primary care trusts have the skills and mandate to plan all health services across a local community. Local authorities are vital partners in this work and some councils have made joint senior appointments with PCTs to recognise this. Rather than laying claim to budgets, we need to work on the real issues – such as properly integrating health and social care – so that the system works properly in patients’ best interests.


Andrew Cozens,

Local Government Association group strategic lead on adult social care and well-being London Councils’ proposals are consistent with the current debate about commissioning health and social care and the scope for greater efficiency in how they are organised and delivered.

Many Total Place pilots, which are looking at integrating public services and funding locally, have examined issues straddling health and care in children’s and adult services. They have all highlighted the complex interplay of large amounts of national and local funding streams with confused accountability and governance arrangements.

They show the limitations of trying to fix issues affecting the quality of life of a community just by tweaking service responses. Planning for an ageing population, drug abuse or childhood obesity needs local leadership and ownership.

There are obvious quick wins through single points of access, co-location and shared back and front-office services. But the real prize is in the clarity of purpose and consistency that devolved commissioning of all these budgets to local authority-level would bring.

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