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.”