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Directors warn of NHS reform downside

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Directors of adult social services have warned that the government’s health reforms risk prompting “greater fragmentation” between health and social care if integrated commissioning  is not mainstreamed and service boundaries become blurred.

The Association of Directors of Adult Services (ADASS) has told the Department of Health that the transformation from the existing system to the GP-commissioning model outlined in Equity and excellence: Liberating the NHS, posed “major risks associated with a loss of organisational capacity”.

In its white paper consultation response, ADASS said it strongly supported many of the government’s proposals – including the public-health role given to councils and the potential for maximising health and social care integration.

But its 14 page response also offers a frank evaluation of the risk that scrapping primary care trusts and handing commissioning powers to GP clusters could break up existing joint working if current coterminosity is lost.

Directors also echoed fears from the NHS Confederation that there could be a loss of organisational capacity resulting from the demise of PCTs coupled with the need for the health service to find some £20bn in efficiencies at the same time.

ADASS president Richard Jones, left, said it was vital to ensure that the redesign of health services had as diverse an input as possible.

“There is a major need to involve existing and new bodies, local authorities, citizens, local communities and providers in co-designing the changes at national, regional and local levels to achieve a different system that delivers different outcomes across health and social care rather than reinventing the system we have worked on to date,” he said.

Elsewhere in the submission, ADASS called for:

  • Maximum flexibility for spending ring-fenced public health funding if it supports agreed local priorities;
  • Further clarity on the role of childen’s services in Health and Wellbeing Boards;
  • Consideration of linking HealthWatch functions to Citizens Advice Bureaux
  • Proper consideration for the back office and commissioning support that councils could offer GP consorita
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