Put councils at heart of healthcare commissioning, says LGA

Local authorities must be at the heart of healthcare commissioning, especially in “Cinderella services” for the vulnerable, the Local Government Association has argued after submitting its response to the government’s health White Paper.

The LGA claimed councils were ideally placed to take the pressure off GPs by ensuring vulnerable children, dementia sufferers, people with learning difficulties and the homeless get the services they need.

The association said town halls, not just doctors, should play a key role in commissioning services, particularly in those areas where they have most expertise. These areas include: mental health; health and wellbeing of homeless people; long-term conditions; drug and alcohol dependency; dementia services; services for children and young people; services for people with learning disabilities; HIV/AIDS services; carers’ services, older people’s services and free nursing care.

The LGA said its key messages included:

• Its strong support for the increased public health role for local government
• The need to create strong and focused health and wellbeing boards to provide effective local leadership and coordination of services for everyone. “These must be given a statutory footing and be seen as equal to GP consortia and the National Commissioning Board”
• The scrutiny of the National Commissioning Board, health and wellbeing boards and GP consortia was very important, as was the need for them to be locally accountable
• The need for urgent clarification on funding of patient and public involvement in 2011. Funding for Local Involvement Networks runs out in March, but the replacement Health Watch does not go live until April 2012, it pointed out.

Cllr David Rogers, chairman of the LGA’s community wellbeing board, said the government’s shake-up was an opportunity which – if handled properly with a clear allocation of roles and good communication between councils, GPs and NHS bodies – could be “a real shot in the arm for health”.

But he warned: “Councils need to be at the heart of commissioning, especially in the areas they have experience and expertise in like so-called ‘Cinderella services’ for the vulnerable. GPs are inexperienced here and there’s a real risk they may not see the incentive of commissioning services where success isn’t easy to measure, or might outsource commissioning for these groups, breaking a vital link between an individual’s health and social care services.

“Decisions on where to spend money and commission services need to be taken locally. Councils know their residents’ needs best and using available funding as they see fit will keep people healthier and reduce the burden on the health service.”

Rogers added that health and wellbeing is “much more than just doctors and nurses”. He said: “The foundations of local government in the 19th Century were in the need to beat typhoid, cholera, poverty and poor housing. The challenges may have changed but councils are still best placed to improve their residents’ health in many ways, whether it be promoting nutritious food and exercise, or helping people quit smoking or excessive drinking."