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Primary care trusts, strategic health authorities and regional directors of health and social care will be at the heart of plans to devolve power and funding to local communities in the delivery and development of local services, according to a major department of health consultation paper, writes Jonathan Pearce.

"(PCTs) will be the lead NHS organisation for partnership working with local authorities and other partners," the paper says, proposing that they will receive 75 per cent of total NHS revenue allocation "to secure the provision of services by 2004".

The paper adds: "PCTs will work as part of local strategic partnerships to ensure co-ordination of planning and community engagement, integration of service delivery and input to the wider government agenda including Modernising Social Services, Sure Start, Community Safety, Quality Protects, Youth Offending Teams and Regeneration Initiatives."

At a recent Local Government Association conference, DoH permanent secretary and NHS chief executive Nigel Crisp trailed the paper's proposals.

"PCTs will be the real link for local authorities," said Crisp, explaining that decentralisation of control from government to frontline services would mean a "really powerful role for PCTs".

With 160 PCTs already in existence, a further 150 are due to become operational from April next year, while at the same time 30 strategic health authorities (SHAs) will replace the 95 existing health authorities, taking over responsibility for strategic leadership and performance management.

The plans to devolve power locally have already seen the department of health announce its restructuring around 12 directorates and a single top management team for health and social care.

The paper proposes that the eight NHS regional offices will be abolished and replaced from April 2003 by four regional directors of health and social care who will oversee the development of local services. However, the 30 SHAs will inherit the performance management functions previously carried out by the regional offices.

The new directors will be based in the government offices for the regions, covering London, the south, the midlands and the north. Their key functions will include supporting senior DoH staff in assessing performance; managing the appointment, development and succession planning of senior management staff; supporting ministers through casework and local intelligence; and troubleshooting.

"Regional directors of health and social care will not be simple replacements for regional offices," the paper stresses.

The Association of Directors of Social Services cautiously welcomed the consultation, saying future power arrangements, not partnerships and joint working themselves, were the key issue.

John Beer, ADSS social inclusion and health committee chairperson, said: "Clearly the way in which the SHAs will operate remains to be seen. One wants them to develop a better relationship between health and social care, but one that focuses on the preventive agenda and the promotion of good public health."

Shifting the Balance of Power within the NHS available from http://www.doh.gov.uk/shiftingthebalance/shiftingthebalance.pdf

Timetable:

Consultation on proposals to 7 September

July 2001 - publish National Human Resources Framework

August to October 2001 - appoint first wave of PCT chief executives

September to November 2001 - consult on strategic health authority boundaries; appoint chairpersons (designate) and chief executives (designate) for SHAs

December 2001 - agree boundaries for SHAs

January 2002 - appoint second wave of PCT chief executives

April 2002 - establish SHAs and disestablish existing health authorities; new PCTs become operational

April 2003 - establish new offices of regional directors of health and social care