Government consults on healthcare shake-up, proposes statutory partnership boards
The government has fleshed out its plan to hand local authorities a greater role in healthcare, launching two consultations on key proposals contained in its recent White Paper on the future of the NHS.
The consultation papers – Local Democratic Legitimacy in Health and Commissioning for Patients – set out how patients, councillors, local authorities, public health experts and others will work alongside GP consortia, which will now make most commissioning decisions.
Proposals include establishing a statutory partnership board or “health and wellbeing board” within local authorities.
The Secretaries of State for Health and Communities and Local Government, Andrew Lansley and Eric Pickles, said the partnerships, led by local authorities, would mean services “will become more responsive and be developed in ways that fit around the people who use them”.
The ministers added that patients and the public would have a stronger voice through local HealthWatch, a new patient group dubbed a “citizen’s advice bureau” for health and social care.
Under the scheme, within a ring-fenced public health budget local health improvement funds will be held by local authorities, with decisions about how this is spent taking into account all local issues that impact on well-being.
Pickles said: “For the first time in 40 years there will be local democratic accountability and legitimacy in the NHS. Elected councils will have a key role including commissioning HealthWatch services to guarantee patients a voice. As we push power away from Whitehall we will make the health service more answerable to patients, not politicians.”
In Local Democratic Legitimacy in Health, the government sets out how local authorities will have greater responsibility in four areas:
- leading joint strategic needs assessments (an assessment of the health and wellbeing needs of the population in a local area) to ensure coherent and co-ordinated commissioning strategies
- supporting local voice, and the exercise of patient choice
- promoting joined up commissioning of local NHS services, social care and health improvement, and
- leading on local health improvement and prevention activity.
The consultation paper says: “With the local authority taking a convening role, it will provide the opportunity for local areas to further integrate health with adult social care, children’s services (including education) and wider services, including disability services, housing, and tackling crime and disorder.”
Take up of current flexibilities to enable joint commissioning and pooled budgets has been relatively limited, the paper says. “It has tended to focus on specific service areas, such as mental health and learning disabilities,” it continues. “The full potential of joint commissioning, for example to secure services that are joined up around the needs of older people or children and families, remains untapped.”
The government believes there is scope for stronger institutional arrangements, within local authorities and led by elected members, to support partnership working across health and social care, and public health.
One option, the consultation paper says, is to leave it to NHS commissioners and local authorities to devise their own local arrangements. However, the government’s preferred approach is “to specify the establishment of a statutory role, within each upper tier local authority, to support joint working on health and wellbeing”.
The consultation paper argues that the advantages of such a statutory arrangement would be that it provides duties on relevant NHS commissioners to take part, a high-level framework of functions and therefore clarity of expectation about partnership working.
A statutory partnership board could also enhance the respective roles and responsibilities of participants and act as a vehicle and focal point through which joint working could happen, it says.
The functions of such a board would include a scrutiny role in relation to major service design, and the consultation paper proposes transferring across the statutory functions of overview and scrutiny committees.
The government insists that any requirements for a statutory partnership board would be minimal “with local authorities enjoying freedom and flexibility as to how it would work in practice”. Arrangements would need to be put in place in two-tier areas so that democratic representatives of areas below the upper tier can contribute.
Membership of the board would bring together “local elected representatives including the Leader or the Directly Elected Mayor, social care, NHS commissioners, local government and patient champions around one table”. Directors of Public Health, within the local authority, would also have a critical role. GP consortia will be represented, while councils could also choose to invite representatives from the voluntary sector and “other relevant public service officials”.
In cases where there is a dispute between commissioners and local authorities, health and wellbeing boards will have a power to refer the commissioning decision to the NHS Commissioning Board. If concerns still exist, then they will have a statutory power to refer cases to the Health Secretary.
Local Democratic Legitimacy in Health can be downloaded here.
Commissioning for Patients meanwhile seeks views on a on a number of areas including:
- How GP consortia and the NHS Commissioning Board can best involve patients in improving the quality of health services
- How GP consortia can work closely with secondary care, community partners and other health and care professionals to design joined-up services that are responsive to patients and the public
- How the NHS Commissioning Board and GP consortia can best work together to make effective and efficient commissioning decisions
- How the NHS Commissioning Board can best support consortia and ensure they achieve improvements in outcomes within NHS resources
It can be downloaded here.
