Further devolution within the health service could help to improve service delivery according to a new paper published today (Wed) by the New Local Government Network. It argues that local authorities should be given a more significant role in and share more of their expertise with local Primary Care Trusts (PCTs).

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 delivery. 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”.

The paper also comes as West Sussex County Council recently passed a motion to make health services in their area more democratic. There has also been speculation that the Government may give local authorities a more prominent role in local health services in its forthcoming Empowerment White Paper.

NLGN argues that PCTs could benefit from incorporating the expertise of senior local authority managers, particularly with regard to financial management. It points out that whilst local authorities have consistently recorded year on year efficiency savings, PCTs recently posted an overall deficit of £633million. The House of Commons Public Accounts Committee has criticised PCTs for a “lack of financial management expertise in the NHS”. The paper argues that “PCTs sometimes lack commissioning expertise and have few officers with specialist procurement skills” whilst “information, expertise and knowledge within local authorities could help inform commissioning and procurement and improve the outcomes of local health services”.

NLGN also argues that because local authorities already commission services related to health outcomes in the area, such as Children’s services, Adult Social Care and Housing, make a coherent argument for a greater role in the strategic delivery and direction of PCTs. The paper concludes by encouraging the Government to pilot schemes to link together high-performing authorities with their local PCTs.

Chris Leslie, Director, NLGN said:

“Stronger local accountability in health services is not only right in principle, but we believe that the advances in local management accrued by local authorities over the past decade should now be available for English primary care commissioning as well”.

“We suggest piloting joint commissioning and pooled budgets where there is a strong management support case to be made in coterminous 4 star councils / 1 star PCTs”.

“If such pilots were successful, it would be a reasonable assumption that a closer working relationship between local authority and PCT boundaries would improve the prospects for improved performance, value for money and increased resilience from closer integration of services”.