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Local Authorities to play a bigger role in health? Health Policy Today - Thursday 26th June

Tom Smith on today’s health policy debate.

The most interesting report of the day comes from a local government thinktank. It believes that local authorities should play a much greater role in health.

New Local Government Network call for great local authority involvement in health

For a while there has been debate on the best way to make health services accountable. The Health Service Journal recently reported that West Sussex County Council are keen to take on the activities of its local PCT. A report today from the New Local Government Network has issued a report citing this example and arguing for ‘a more significant role’ for local authorities in health. ‘The paper disagrees with a recent King’s Fund report, Should Primary Care Trusts be made more locally accountable?, which was sceptical of the need to devolve health services further and give local authorities a greater role in their deliver.

NLGN argues instead that “there are not only strong democratic and service user reasons for improving PCT accountability, but crucially that local democratic control may also be a better route to swifter service improvement and enhanced management arrangements. Some have argued for a while that local authority involvement would make up some of the democratic deficit. Some go so far as to say the move would help to enliven local democracy and increase the turnout at local elections. Others argue, however, that there is little interest in voting proxy representatives for health and that the local authority does not need to play a large role in health.

There are a range of models around, which range from full merger – as West Sussex County Council wants – through to strengthened arrangements for joint commissioning. There is appetite for better relationships between PCTs and local authorities. It is a question of how far it should go. THE NLGN clearly believe that local authorities could teach the NHS a thing or two about financial management.

The report points out ‘that whilst local authorities have consistently recorded year on year efficiency savings, PCTs recently posted a overall deficit of £633m’. They note that ‘The House of Commons Public Accounts Committee has criticised PCTs for a “lack of financial management expertise in the NHS”.’ In addition to improved democracy and financial management is a third argument for greater local authority involvement, the report says. ‘Because local authorities already commission services related to health outcomes in the area, such as Children’s services, Adult Social Care and Housing’ there is ‘a coherent argument for a greater role in the strategic delivery and direction of PCTs.’

The report notes ‘speculation’ that ‘the Government may give local authorities a more prominent role in local health services in its forthcoming Empowerment White Paper (due next month). The full report can be read here.