When joint working breaks down

Brent Council leader Paul Lorber tells Amy Taylor why the relationship between the London local authority and the primary care trust has completely broken down

As the effects of the NHS’s funding problems deepen, relations between primary care trusts and councils in many areas are strained. But in Brent, north London, the two are at loggerheads.

This month the dispute took a new turn when council leader Paul Lorber (pictured) wrote to health secretary Patricia Hewitt demanding an investigation into the financial management of Brent Teaching PCT.

The move comes after months of disagreements between the PCT and the council over the trust’s proposals to prevent a projected deficit of £25m in 2006-7 and £28m in 2007-8. The council says the plans will transfer costs of £15m over this period.

Lorber says a large proportion of these costs are for the care of long-stay hospital patients previously paid by the NHS who have been transferred into the community. The council estimates this will lead to a £2.1m bill being shunted to it in 2007-8.

Another substantial part of the costs comes from some 400 continuing care cases. Lorber says the PCT has already started to invoice the council for £2-3m for such cases for the final three months of this financial year. He estimates the council will be billed £8-12m for them over the whole of 2007-8.

Service users are seldom concerned which part of the council provides for them. But Lorber points out that if social care had to pick up the continuing care costs the service would become means-tested.

He says: “These people and their carers have a difficult life anyway and the last thing they want to know is that there is a punch-up between the council and the PCT that is not of their making.”

Lorber sees the PCT’s demands as “totally unrealistic”. “We have gone up to the maximum amount of increase to our council tax but we just haven’t got the money,” he says.

He says that, although the council has “indicated clearly” that it is not accepting the costs, it has been forced to consider tightening its eligibility criteria from providing services to people with critical and substantial needs to just critical cases.

Lorber says: “If we did decide to do that it would contribute £3.6m but that doesn’t meet the £15m and it would have a devastating impact.”

While Lorber is critical of the PCT, he says the real problem is changes to national NHS funding. “The reality is the government asks the PCT to establish the preventive care agenda, the PCT responds and the government pulls the plug,” he says.

Although the health and social care white paper proposes more joint working, the situation in Brent could not be more different. The council is considering joining with other local authorities similarly affected to bring legal action against the PCT.

“All the joint working that is so essential to delivering good services has gone straight out of the window,” Lorber says.

Primary care trust denies shunting

Brent Teaching PCT has hit back over some of council leader Paul Lorber’s claims.

In a statement, it said: “The PCT is aware that the review of continuing care patients has caused some timing issues for the council however the PCT is keen to continue dialogue with the council to ensure a sensible way forward is reached.

“Brent PCT does not believe it has ‘shunted’ costs or responsibility. On the contrary, there is an agreed process and set of criteria that we have applied in undertaking a full and extensive review of residents who we believe may have been receiving the wrong service.

“NHS London has already commissioned an independent inquiry into the financial and governance practices used by the PCT in the past – Councillor Lorber is also aware of this. Until that inquiry is complete, the PCT has no further comment to make.”