Memorandum submitted by Thurrock Council
(PCT 20)
CHANGES TO
PRIMARY CARE
TRUSTS
1. I am writing in my capacity as Managing
Director of Thurrock Unitary Council to bring to the Committee's
attention a number of generic concerns which fellow Unitary Chief
Executive's share. These observations are based upon a survey
I personally conducted amongst the 47 Unitary Authorities over
the summer period.
2. Whilst Unitary Chief Executives have
welcomed some of the rationale behind the changes, particularly
regarding the closer congruence between health and social care
and indeed children's services) there is we believe a potential
unintended consequence that will cause major difficulties and
put in great jeopardy joint working between Unitary Councils and
PCTs. There are a number of issues.
3. CO-TERMINOSITY
(a) Examining the recent submission by the
SHA's Chief Executives it is quite clear that the vast majority
of the 47 Unitary Councils stand to lose their current boundary
alignment which they currently enjoy. The issue seems to be particularly
severe in those Councils which were created in the mid to late
1990s out of the two tier County Council/District areas. From
what I can gather from colleagues, the consistent theme emerging
is for SHAs to be proposing larger PCTs which erode current Unitary
co-terminosity with the result that the newly formed PCTs will
cover both the existing Unitary Council and significantly include
a geographical part of a County Council. This would be a retrograde
step as it ignores the functions and responsibilities of the upper
tier Unitary Councils and will marginalize their influence.
(b) Although Unitaries are smaller in size
than County Councils as all-purpose Councils I would contend that
they indeed have more functions.
(c) Whilst it is acknowledged that the present
configuration of Councils is less than ideal it is the contention
of Unitary Chief Executives that where present co-terminosity
exists between PCTs and the 47 Unitary Authorities that these
should as a minimum be retained. This would be consistent with
the principle set out in Sir Nigel Crisp's letter 28th July letter
under Stage 1, para 4a "As a general principle we will be
looking to reconfigured PCTs to have a clear relationship with
local authority social services boundaries"). In support
of above I would make the following observations:
4. COLLABORATIVE
WORKING AND
INTEGRATED COMMISSIONING
(a) Dismantling a coterminous PCT and Unitary
Council is likely to have fundamental consequences with regard
to collaborative working and integrated commissioning. Led through
the ODPM, both the introduction country-wide of Local Strategic
Partnerships and more recently the accelerated focus on Local
Area Agreements (to be implemented across England from 2007) are
indicative of the wide-spread move towards geographical area based
public sector working and community planning. In many areas under
a Council's Local Strategic Partnership, the local PCT plays a
vital role, not only in leading on the Healthier Communities agenda,
but also as active senior partners ("responsible authority")
in local Crime & Safety initiatives, the sustainable communities
agenda and over the past year or so, in the work towards developing
Children's Trusts. There is also a strong commitment to joint
local leadership in implementing Local Area Agreements.
(b) The Department of Health have recently
embarked upon a consultation, entitled "Your Health, Your
Care, Your Say" as a precursor to an integrated Community
Health and Social Care White Paper which I believe is due in December.
We are genuinely very optimistic in relation to the impact that
such a policy initiative will have and believe that it will further
enhance the opportunities for Councils to more imaginatively exercise
their well-being powers. Losing alignment could seriously weaken
the practical impact of the proposed policy.
(c) Since 1998 following the formation of
Primary Care Groups there has been over recent years gradual moves
towards greater co-terminosity between Primary Care bodies and
Social Services Authorities. There is a real danger that if PCTs
spanning a Unitary Council and part of a County Council are established
then we could see collaboration amongst groups of GPs which will
cross social care boundaries. This will complicate joint commissioning
arrangements with upper tier Councils.
(d) We fully accept the financial realities
within the NHS, and indeed across the public sector more generally
and the requirement to find substantial savings.Retaining current
co-terminosity does not mean preserving the status quo
but does retain the integration that has taken place at a local
level to modernize the health and social care system. In many
areas joint posts between the Unitaries and PCTs have ensured
an effective and co-ordinated approach to commissioning and service
provision.
5. RECONFIGURATION
SUPPORTING CO-TERMINOSITY
FOR UNITARY
COUNCILS
(a) Whilst there would indeed be differential
sizes (in terms of population covered) in terms of the new PCTs,
as now there could be an agreed split of functions between NHS
bodies with groups of PCTs agreeing lead arrangements but still
maintaining co-terminosity with Social Service Authorities. This
co-terminosity will further enhance the possibility of new governance
arrangements being put in place and new roles and responsibilities
being defined. More imaginative arrangements than those being
put forward by SHAs should be actively encouraged resulting in
new commissioning bodies between the NHS and Local Government.
This would build upon the current joint sharing of posts between
the two sectors and the practical benefits this level of integration
has brought to many contentious and difficult issues.
(b) With regard to the reconfiguration of
SHAs can I stress that it will be important that each SHA take
a consistent approach in proposals relating to Unitary Councils.
It is illogical to have a different treatment of Unitaries who
subsequently end up post-merger under the same SHA. For example,
in the East of England we have four Unitary Councils—Peterborough,
Luton, Southend and Thurrock. If the existing SHAs merge into
one, it would be sensible to pursue a common approach.
6. Focusing particularly on Thurrock all
Elected Members have unanimously passed a resolution seeking to
retain the local PCT on the present Thurrock boundaries. We are
at the heart of the Government's major regeneration area—the
Thames Gateway—and now have our own Government appointed
Development Corporation which will oversee the introduction of
c26,000 new jobs and 18,500 new dwellings over the next decade
or so. Given the major regeneration changes planned alongside
the significant health inequalities across the borough we believe
it is essential that effective joint working is not dismantled
by the NHS adopting a short term and hurried approach to structural
change.
David White, Managing Director
Thurrock Council
3 November 2005
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