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White paper abolishes PCTs and gives councils public health powers

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By David Williams

12 July 2010

The government is proposing to scrap primary care trusts and give councils responsibility for public health and joint working between NHS and other services.

Health Secretary Andrew Lansley’s white paper, published this afternoon, also set out plans for local GP consortiums to take on the PCT role of commissioning hospital treatments. As expected, strategic health authorities will also be abolished.

Lansley reiterated the Department of Health’s target of £20bn savings by 2013/14. He said abolishing PCTs would save £1bn, helping to slash NHS management costs by 45%.

All the measures in the white paper, Equity and excellence: liberating the NHS, will affect health services in England only.

Councils will become responsible for a newly ring-fenced public health budget, currently around £4bn a year, and be required to appoint a local director of public health.

They are also to take responsibility for ‘joint strategic needs assessments’, setting local health priorities and supporting commissioning in their area.

A new non-departmental body, HealthWatch, is to be established within the Care Quality Commission, to champion patients’ concerns nationally. Local HealthWatch divisions will be funded by and accountable to councils, and will support patients unable to make choices unassisted.

A timeline for implementation shows that strategic health authorities will be abolished by 2012/13, with PCTs phased out from April 2013. All hospital trusts will become financially autonomous foundation trusts in 2013/14.

Foundation trusts will have new freedoms, and staff will be given the opportunity to run them as social enterprises. The paper says: ‘We aim to create the largest social enterprise sector in the world.’

Dental services will be commissioned centrally through a new NHS Commissioning Board, which will also have a duty to promote equality of choice and of access to health care, and allocate NHS resources.

Patient choice is to be extended, with more information made public on providers’ performance and outcomes. Lansley plans to give patients choice of treatment and provider in the ‘vast majority of NHS-funded services’ by 2013/14.

NHS Confederation chief executive Nigel Edwards said: 'These proposals, if implemented successfully, will recast the relationships between government, the NHS, patients and the public. This is a serious attempt at major and lasting reform in the NHS and will require considerable skill and leadership to make it work.'

David Rogers, chair of the Local Government Association's community wellbeing board, said councils should play a central role in any NHS reorganisation.

'Town halls want to promote healthy, active lifestyles and help people live longer, happier lives. With a long and proven history of addressing public health issues, they are ideally placed to deliver these goals and guarantee public involvement in local commissioning decisions,' he said.

The secretary of state also denied reports that he intends to abolish the Food Standards Agency and bring its function back into the Department of Health.

‘There is a review under way, but no final decisions have been taken or announced about this. I’m afraid the story is not right.’ However, Lansley admitted that before the election he had argued for the FSA’s diet and nutrition oversight functions to be brought into a more integrated public health service.