WIREDGOV

Council leaders are requesting a meeting with Health Secretary Andrew Lansley to reassure them his health shake-up won’t replace genuine democratic accountability with mere “window dressing”.

Town halls want local representation to remain at the heart of the Government’s health reforms. They also want to make sure the crucial opportunity to link health and public health isn’t squandered and services for homeless people, mental health, learning disabilities, AIDS/HIV, dementia and child health don’t take a backseat.

Baroness Margaret Eaton, Chairman of the Local Government Association, which represents about 350 councils in England, has written to Mr Lansley asking for face-to-face talks during the two month ‘listening exercise’ in the Health and Social Care Bill. She said:

“We hope that this period of reflection will be used to consider how the reforms can best address the need for a truly integrated approach to health and social care delivery.

“I would like to invite you to hear directly from the local government sector in a session here at Local Government House. We can bring together a complete cross-section of local authorities to talk directly to you and your colleagues about how the Health and Social Care Bill can best move forward.”

The letter calls for:

• GP Consortia to be more democratically accountable by placing on them “a duty to cooperate with” Health and Wellbeing Boards.
• Clarity over roles and relationships between Health and Wellbeing Boards, GP consortia, Public Health England and the NHS Commissioning Board.
• An explanation of the new public health budget and how funding will be allocated.
• Legislation to ensure GP Consortia don’t just focus on people on their practice lists, but also work with councils on the ‘Cinderella services’ linked to homeless people, mental health, learning disabilities, AIDS/HIV, dementia and child health.

It also criticises the Health Select Committee’s proposal this month to scrap Health and Wellbeing Boards, replacing them with Local Commissioning Authorities made up primarily of GPs with just one locally-elected councillor. Not only would this reduced democratic accountability in any new system, it could see a further bias away from the ‘Cinderella services’ vital to the often voiceless members of society .

Baroness Eaton added:

“Local government, nationally and locally, has already begun to develop close working relationships with GPs and public health colleagues to understand better each other’s sector and the advantages of working together. 

“We are concerned, however, about the Health Select Committee’s recent report which calls for the setting up of Local Commissioning Authorities at the expense of Health and Wellbeing Boards (HWBs). I think that you will agree that this proposal clearly misses the point of the need for HWBs and will lead to a greater divide between public health and primary care when the intention of your reforms is to bridge this divide. 

“Placing just one councillor on Local Commissioning Authorities as the solution to democratic accountability may be seen by some as merely ‘window dressing’, whereas HWBs have the opportunity to look beyond immediate commissioning needs at the wider determinants of health and work with their GP colleagues to tackle the root causes of poor health and health inequalities.

“The Bill currently does not place on GP consortia “a duty to co-operate with” Health and Wellbeing Boards, only a requirement “to have regard to” them. The strengthening of this relationship would help to alleviate concerns in the public arena about the scrutiny and public accountability that will be applied to GP consortia. We also propose that HWBs have a duty to sign off GP commissioning plans to ensure that a fully open, transparent and democratic process surrounds commissioning decisions.”