NHS reforms will harm joint-working, say directors

Health secretary Andrew Lansley's NHS reforms risk damaging joint working between health and social care, failing vulnerable children and an accountability deficit, social services directors have warned.

Health secretary Andrew Lansley’s NHS reforms risk damaging joint working between health and social care, failing vulnerable children and an accountability deficit, social services directors have warned.

In their clearest intervention on the Health and Social Care Bill, the Association of Directors of Adult Social Services and the Association of Directors of Children’s Services called for “urgent clarification” from ministers on key aspects of their plans to transfer health commissioning responsibilities to GP consortia.

It came as Lansley announced a “pause” in the passage of the bill to consider objections from Liberal Democrats and the medical profession, with a view to making possible amendments.

In a joint response to last November’s public health White Paper, Adass and the ADCS said they were “concerned” that the proposed governance structure “offers no clear proposals on lines of accountability and scrutiny in the system”.

Health and well-being boards will be set up within councils to oversee local health and social care commissioning and increase democratic accountability in the NHS, but Adass and the ADCS warned these lacked clout.

The associations said boards needed statutory powers to sign-off NHS commissioning plans and to hold GPs to account for their delivery.

Directors also warned that joint NHS/council work could be damaged because no requirement has been placed upon GP consortia to mirror local authority boundaries, nor was there a duty upon commissioners to take account of the health and well-being strategies that boards will produce.

The two organisations were critical of the “potentially inadequate representation” of the needs of vulnerable children in the proposed arrangements, with only one children’s services representative – the director of children’s services – due to sit on health and well-being boards.

The joint statement warned that responsibilities for safeguarding children currently held by primary care trusts and strategic health authorities may be “diluted” when the two bodies are abolished in 2012-13.

In a separate report, the Commons health select committee called for widespread changes to the bill to improve accountability.

The MPs called for a social care representative and a local councillor to sit on the boards of GP consortia in order to improve their accountability. It also said that consortia should have a chief executive, an independent chair and nursing, public health and hospital representatives, and be renamed NHS Commissioning Authorities.

“Our proposals are designed to ensure that NHS commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities,” said committee chair Stephen Dorrell. “We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly coordinated healthcare”.


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