The government will press ahead with its overhaul of the NHS but has responded to concerns that it will disrupt joint working between health and social care by strengthening proposed partnership arrangements.
Its plan to scrap primary care trusts and transfer their commissioning responsibilities to consortia of GP practices has prompted significant concerns from unions and social care leaders that existing joint arrangements between councils and PCTs could be put at risk.
However, responding to the consultation on its NHS White Paper, the Department of Health said today that it would implement its reforms through a Health and Social Care Bill, due in January.
But it made a number of amendments to its White Paper plans, including the strengthening of arrangements for joint working on care between councils and GP consortia.
As proposed in the White Paper, the bill will oblige councils to set up health and well-being boards to co-ordinate health and social care commissioning, which GP consortia would be obliged to join.
It said councils and consortia would be under a duty to publish health and well-being strategies to provide the overarching framework for NHS, social care and public health commissioning plans.
But it rejected proposals put forward by the Local Government Association that health and well-being boards would be able to sign off on consortia commissioning plans. The DH said the proposals would give councils power over NHS expenditure without responsibility for it.
The DH also dropped much-criticised plans for health and well-being boards to subsume councils’ existing responsibilities to scrutinise health services. Instead, their scrutiny powers will be kept separate from boards, and extended to cover all NHS-funded services.
As part of the transition to the new system in 2013, councils and GP consortia would be expected to decide whether to continue with existing pooled budgets and joint working arrangements between local authorities and PCTs. Any arrangements that are not addressed as part of the transition will be continued by default, under the legislation.
The DH confirmed that GP practices would be free to determine the boundaries of consortia, meaning there is no guarantee that these will coincide with the boundaries of local authorities.
Currently, most councils share boundaries with their local PCT, which many see as important in promoting joint working.
However, the DH said: “The government considers that consortia will be most effective if they are not forced to conform with and stick to a prescriptive geographical model. Instead, the intention is to permit communities of GPs to form organisations that best work locally, and for those organisations to adapt and flex over time – spreading, merging, shrinking, dissolving – according to success and failure.”
The Association of Directors of Adult Social Services and the Local Government Association both said that the DH had listened to their concerns in amending its original White Paper plans.
Adass president Richard Jones said: “The watchword for Adass for many years now has been integration, and the purposeful steps to closer integration between health and social care revealed in this paper, and reinforced by some of the financial measures set out recently, are highly encouraging.”
However, NHS leaders have raised concerns about the pressures on them to deliver the reforms while also managing the impact of a real-terms freeze in funding from 2011-15.
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