Plans unveiled to devolve control of health and social care

    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

    “(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

    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

    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

    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

    “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


    Consultation on proposals to 7 September

    July 2001 – publish National Human Resources Framework

    August to October 2001 – appoint first wave of PCT chief

    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








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