Councils must ‘demonstrate readiness’ for greater health role
Author: Kaye Wiggins, LGC |
A report commissioned by Labour on how to bring about integrated care has endorsed a greater role for health and wellbeing boards, but cautioned against any further structural reorganisation of the NHS.
The report, by GP and former Department of Health director Sir John Oldham, said clinical commissioning groups should be retained and their budgets largely left intact.
LGC and sister title Health Service Journal reported last year that Labour was exploring the possibility of transferring the NHS commissioning budget to local authority control with clinical commissioning groups acting in an advisory role.
These ideas appear to have been refined – with many commentators saying such a move would require significant reorganisation, something the party said it was keen to avoid.
Sir John’s report, published on Tuesday, said health and wellbeing boards “or analogous local arrangements” should provide “the collective system leadership for services for people with multiple long-term conditions, disability and frailty”.
It added that these boards should be “responsible for a collective commissioning plan” which used the total health and social care budget for “this cohort of the population”.
The report called for “a statutory duty [to be] placed on commissioners (local authority and CCGs) to enact the collective commissioning plan”.
These joint commissioning arrangements would “require development” and commissioners would have to “demonstrate readiness” before taking on the role, Sir John’s report said.
A single pooled health and social care budget should only be brought in where both sides wished that to happen, it said.
Over the lifetime of the next Parliament, £10bn should be identified “from within allocated resources to strengthen community health and social care services”, it said. This should be routed via NHS England, which should be renamed Care England.
However, some in local government have voiced concerns about the apparent shift away from a transfer of funds to councils’ budgets. Graham Burgess, chief executive of Wirral MBC, told LGC he would be “disappointed” if councils did not hold some NHS funds.
“Health and wellbeing boards are absolutely crucial and should be in charge of commissioning,” he said.
“But fundamentally the budgets need to be held by councils. The only way to drive change, especially when you’re changing the acute sector, is to have democratic accountability and a democratic mandate. That accountability and legitimacy requires the money to be in councils’ budgets.”
The Oldham report also recommended that Section 75 regulations – which were introduced under the Health Act to govern competition – should be abolished, and “replaced with new regulations which support the development of whole person care”.
Meanwhile, the role of the Office of Fair Trading “in reviewing competition decisions should be removed”.
It said there should be “an independent national conversation”, looking at the future of health and care funding and entitlement, and the configuration of health services. This should be completed within a year of the election, the report recommended.
Explaining his resistance to structural reform, Sir John said in the report: “The scale of recent reforms so damaged the NHS and care system that we believe it would not survive intact from a further dose of structural change.” He added that in practice, “relationships and culture trump structures”.
The report is expected to contribute to Labour proposals for health and care approaching the election.