Does one size fit all?

There are few things quite so unsettling as seeing a demolition crane pull up outside the house next door. Certainly, many observers in social services had a sinking feeling when the government unexpectedly announced that up to half of all primary care trusts – their closest working neighbours – were to be dismantled.

The plans involve redrawing the boundaries of more than 300 PCTs across the country, culling around 150 of them in the process. A new generation of larger, combined trusts will be created whose boundaries more closely match those of local authorities.

It was tactless of the government to call in the demolition crew before  informing the neighbours. But to give local authorities their due, many can see the sense behind the plan. In fact a new survey of local authorities by Community Care and the Association of Directors of Social Services has revealed widespread support for the idea of PCT reorganisation; 93 per cent of authorities want PCTs and local authorities to have identical boundaries. 

This is simple common sense. At present the jumble of boundaries can mean some councils – particularly large county councils and metropolitans – have to negotiate partnership arrangements with 10 or more different PCTs. The reorganisation should mean many councils end up with a single PCT.

But anxieties remain. In some areas a multitude of small PCTs look like an ideal target for “rationalisation” but actually – according to those working there – perform well and should be left alone. London boroughs in particular are reportedly furious that productive working relationships are to be sacrificed in pursuit of health service funding targets.

There are certainly long-term potential benefits for many authorities in this overhaul, but the lack of involvement is short-sighted and the timing stinks. Social services are coping with enormous structural change, including the advent of children’s trusts and local area agreements, not to mention the tail end of the adult care green paper and a new health and social care white paper.

Demolition is all very well, but watch where you swing the ball.

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