Council expertise with social care providers may help win role in health commissioning

    On the face of it, the Local Government Association’s expected
    demand for councils to be given a “wider role” in health
    commissioning is deeply unrealistic.

    The NHS is already in the middle of a structural reform,
    announced in July, to slash the number of primary care trusts to
    about 150, to save £250m and align their boundaries more
    closely with those of local councils.

    The proposals state that health commissioning should be PCTs’
    core function and that their role as providers should end, with
    services opened up to competition from the private and voluntary
    sectors.

    The government is also pushing ahead with practice-based
    commissioning, under which PCTs devolve budgets to GPs to buy
    services in their areas. But there are a few reasons why the LGA’s
    goal may not be so outlandish.

    One is the growing belief in local and central government that
    reduced central intervention and closer working between local
    agencies will improve both value for money and outcomes in public
    services.

    Local area agreements are a significant step in this direction.
    Piloted in 20 areas, these give councils and their partners more
    flexibility over their use of funding in pursuit of targets agreed
    with the government.

    For the LGA, councils, given their democratic mandate, must take
    on a “steering” role to make partnerships effective, and it is in
    this capacity that it suggests a wide role in health.

    Another reason councils could be given more influence is the
    increased focus on public health since last year’s white paper
    Choosing Health.

    While leadership has been vested in PCTs, local government’s
    responsibilities over environmental health, housing, leisure,
    regeneration and social care mean they have a central role to
    play.

    Alyson Morley, policy officer at the Democratic Health Network,
    a think-tank promoting partnership working between local government
    and the NHS, says: “We would say there’s a lot of sense in local
    authorities commissioning services around healthy lifestyles, such
    as smoking cessation and sexual health. They are often better
    placed to do that.”

    PCTs have potentially a lot to learn from councils in developing
    and managing markets for services, according to Penny Banks,
    research fellow in health and social care at the King’s Fund.

    She says: “Local government has more experience in market
    development and market management. It’s very new to the health
    sector.”

    Then there is the forthcoming white paper on out-of-hospital
    health and social care.

    Despite worries within social care that the sector could be
    overshadowed by the NHS, there
    could be movement in the other direction.

    For instance, there is much speculation that direct payments
    could be extended to NHS services, particularly for people with
    long-term conditions.

    Banks says this raises a question of how the menu of health and
    social care services from which direct payment users can choose
    should be commissioned – on an integrated basis or with local
    government in the lead.

    However, Morley argues there are limits to increasing councils’
    role in health, given their lack of expertise in clinical
    services.

    She says: “I don’t know what local authorities would have to
    gain, or how they could demonstrate [that commissioning clinical
    services would lead to] better services for their communities.”

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