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Clocks turn back as authorities gain NHS influence...
Clocks turn back as authorities gain NHS influence

By Nick Golding

Local government looks set to regain much of the influence over NHS institutions it lost 30 years ago.

Although ministers are yet to finalise their blueprint for the democratisation of the NHS, councillors are likely to be promoted as patients' champions with a right to trigger inquiries into health provision and to scrutinise decisions by primary care trusts.

Councillors will be able to propose new community hospitals, trigger investigations into GP provision and refer controversial decisions to close hospitals to ministers.

It is widely hoped that local area agreements, named by ministers as the primary means of forging health and

social care partnerships, will ensure NHS quangos are subjected to the democratic influence of local government.

Local Government Association chairman Sir Sandy Bruce-Lockhart (Con) said: 'Council-led public service boards will be commissioning community healthcare and social care by 2008. That's very welcome.

'We are extending democratic rule further across public services and that has to be very good news, especially when you go back two years and remember people were asking if adult social care would be moved into the NHS, divorcing it from councils.'

The white paper states ministers can 'see many advantages' to strengthening the powers of councils' overview and scrutiny committees but no final decision will be made until April. The review of accountability will also examine links between councillors and the patient and public involvement forums which consider the services offered by individual NHS institutions.

However, it is clear that councillors will gain a new role as 'advocates' for their ward, with a role in facilitating a 'community call for action'.

Rodney Brooke, the chairman of the General Social Care Council, said: 'This brings in an element of democratic control onto the NHS that hasn't been there since 1974.'

But it remains to be seen how the new system compares with the pre-1974 model where councillors made strategic decisions on health authorities. This was ditched in favour of a more managerial model.

Comment - Liam Byrne

If there is a leitmotiv to this white paper, it is the theme of empowerment.

In Britain today, we have never been better educated, better trained or better connected. And as a result we know the kind of services that we want and we know how to ask for them.

Our fundamental aim is to give people more control over their health and social care. One way of doing this is giving people the money to purchase their own services. Another way is to involve people in how services are planned, designed and delivered. We will do this by carrying out a fundamental review to strengthen the arrangements for a local voice in health and social care and involving people in commissioning.

However for empowerment to become a reality we need to shift the balance of resources, so more is spent on prevention not cure, and help makeit easier for local government and the NHS to partner together in common cause.

We listened to what people told us about the availability of resources for prevention from council budgets. We're clear about our ambition for change but clear the NHS is part of the answer. So we set out ambitious plans to change the balance in the NHS.

But resources will not be well used if local government and health don't work together well. They must draw up common plans and budgets, develop combined facilities, and work together towards the same goals to boost community wellbeing and reduce inequalities.

We will also seek to synchronise planning and budget cycles, bringing the NHS in line with local authorities.

In particular, we will ask for strong teamwork to prevent ill-health and to commission and provide care that maximises independence for the elderly, the disabled and for those with on-going needs. Driving this change will be stronger leadership, including a strengthened role for the director of adult social services (with revised statutory guidance during 2006), and a redefinition of the role of the director of public health so that public health resources promote health and wellbeing for the whole community. We expect the current trend for joint appointments to accelerate.

By sharpening our focus on empowerment and inclusion and by bringing down the barriers between two powerful partners, I believe we will help people stay healthier and independent for longer, connecting more people faster with the opportunity society we have all worked so hard to create.

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