19 June 2008
Two independent reports have called on the government to avoid a major upheaval of the health care system in addressing the democratic deficit in the NHS.
With health minister Lord Darzi's NHS Next Stage Review to be published shortly, an independent health commission set up by the Local Government Association urged that the system be reformed from within.
King's Fund chief executive Niall Dickson, who chaired the commission, writes in Who's accountable for health? that there 'is currently no appetite for further major upheaval in the governance, structures or boundaries of the health care system'.
The June 17 report – backed by a poll showing that 52% of respondents do not know what primary care trusts do – calls for PCTs to be renamed to make their NHS responsibilities clear, and for a greater effort to make people aware of how they can be held to account. The poll found that the fourth most popular answer to the question of what a PCT did was that it was responsible for emptying bins.
The report also recommends that local authorities' health overview and scrutiny committees be strengthened and that they be given the right to refer PCTs to strategic health authorities or regulators – and to demand a public response.
The commission stopped short of calling for councillors to be placed on PCT boards, but said local authorities should have a representative on the selection panel for PCT board members and should participate in 'performance management'. It also said patient participation groups should have an input into practice-based commissioning.
Dickson said the government was committed to devolving decision-making to a local level, making it vital that local NHS organisations become more accountable. 'The public does want to feel it is being listened to about how local resources are being used and how local services are run. As they stand, the arrangements now in place will not achieve that,' he warned.
The second report, Out of our control? The case for better health accountability, published by the Local Government Information Unit on June 16, recommends merging the commissioning arrangements for local authorities and PCTs, to ensure local targets gain parity with national ones.
The LGIU also proposed bringing in PCT non-executive directors for public 'question time' events hosted by overview and scrutiny committees and an 'urgently needed' review of local strategic partnerships.
Policy analyst Alyson Morley, who wrote the report, said the PCT commissioning process needed to be broken down to be more easily scrutinised, and it was currently hard to make PCT non-executive directors accountable to the community.
Jo Webber, deputy policy director at the NHS Confederation, said: 'We are very clear that we can't use accountability in a way that promotes health inequalities. What is local flexibility can also be seen as being postcode issues.' She also questioned the merits of merging all commissioning functions.
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