Primary care trusts, strategic health authorities and regional
directors of health and social care will be at the heart of plans
to devolve delivery and development of services to local
communities, according to a Department of Health consultation paper
published last week.
“[PCTs] will be the lead NHS organisation for partnership
working with local authorities and other partners,” the paper
states. It proposes that they receive 75 per cent of total NHS
revenue allocation “to secure the provision of services by
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, Nigel
Crisp, DoH permanent secretary and NHS chief executive, outlined
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. At the same time 30
strategic health authorities (SHAs) will replace the 95 existing
health authorities. They will have responsibility for strategic
leadership and performance management.
The plans to devolve power locally have already seen the DoH
announce its restructuring around 12 directorates and a single top
management team for health and social care (News, page 4, 19
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
The new directors will be based in the government offices for
the regions, covering London, the south, the midlands and the
Their key functions will include supporting senior DoH staff in
assessing performance; managing the appointment and development 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.
ADSS social inclusion and health committee chairperson John Beer
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 from www.doh.gov.uk
Timetable for decentralisation
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.