Another step towards a democratically-commissioned health service?

Local Government Chronicle is reporting that plans are nearly finalised for a “health integration board” covering fifteen London Borough Councils and their respective NHS Primary Care Trusts.  To be honest the article is rather fuzzy as to what precisely is happening, but the idea is clearly to look at ways of integrating the work of commissioning local health services with the similar work that the Boroughs do in respect of social care.  Already the Chief Executive of Hammersmith and Fulham Council doubles as Chief Executive of the Primary Care Trust and there are a number of models of joint commissioning around in London and elsewhere.

The key point in this is that it will be a move to providing some local democratic ownership of NHS decision-making.  It runs rather contrary to the approach that is being promoted by the Department of Communities and Local Government whereby local authorities are taking on a wider scrutiny role for local public services in their area (which would obviously includes health).  However, as far as the public are concerned, a model that enables their democratically-elected local councillors to take the strategic decisions about the shape of local healthcare is probably more transparent and attractive than a model where those same councillors are merely empowered to ask questions of the unelected bodies that are responsible for the NHS.

The long-term direction of travel remains unresolved and a London Health Integration Board will certainly be worth watching to see what it delivers.

2 thoughts on “Another step towards a democratically-commissioned health service?”

  1. Surely the idea of democratic control, especially in conjunction with local authorities, might produce endemic and contagious cardiac arrest throughout the upper echelons of the Department of Health and then spreading into the Communities and Local Government Department. Whatever next? Decentralising the Madelson empire? Perish the thought.

  2. My sense of the impact of the changes is to disperse and concentrate services. Disperse so that patients have further to travel to reach their GP and concentrate services in larger and more impersonal centres where patient centered care becomes irrelevant and less personalised.

    Changes proposed in my area are the creation of a medical centre by merging 3 gp practices. I will have twice the distance to travel to see my gp. I will rarely see my gp and often be fobbed off with a locum and/or trainee.

    It will also be further than my hospital so I will probably clog up A and E more often. I will also require transport to get there.

    Because I suffer from a number of different health conditions (I’m under 6 hospital consultants) there is every chance that due to proposals to concentrate specialisations in different hospitals I will find I need to travel even further.

    All of this will cause me increased distress, increased inconvenience and increased costs and disruptance. Given changes already in the pipeline where will be my choice? My choices are already being limited to the point of meaninglessness. My last years of life loom like a nightmare and will cause increased costs and inconvenience to myself and family. So far I can manage without a wheelchair, these changes will hasten my need for a chair and further deterioration in my health and well being.

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