Briefing P034 - Government NHS White Paper Proposals: Local Democratic Legitimacy in Health


As part of its work Hastings Voluntary Action have produced this briefing - as part of a series on the Governments NHS White Paper.

Devolving Decisions to a Local Level

As a general principle decisions will be taken at the level closest to patients. This is envisaged as being the role of the General Practitioner acting alone or in concert with others through GP consortia to commission services previously undertaken by Primary Care Trusts which will be abolished. However some specialist services, such as paediatrics, will need to be commissioned at a higher geographical unit, by the NHS Commissioning Board.

Strengthening the Role of Local Authorities

Local Authorities to be given stronger role by leading on local health improvement and prevention activity, leading joint strategic needs assessments (JSNA), promoting joined up commissioning of local NHS services, social care and health improvement and supporting local voice, and the exercise of patient choice. Some further work will be done to look at the use of “place based” budgets where services are required which cross housing, health and social care boundaries. The Government are envisaging a stronger role for elected councillors rather than individual patients on new bodies such as GP consortia although detailed proposals relating to this are not yet published. Local Authorities will also be given responsibility to commission an appropriate complaints advocacy service through its local Healthwatch service and overseeing its performance against its contract.

Strengthening public and patient involvement

The proposals will convert the existing LINk process to become the primary consumer champion becoming a body known as Local Healthwatch. However they will be given new powers and resources to take on some additional new functions. Thus the new body will be responsible for collecting patients views, as they do now, but will assess whether local commissioning decisions have reflected or taken into account the requirements of the NHS constitution. A new function is to advise and support patients in making completes – described in the White Paper as becoming more like a “Citizens Advice Bureau” for health. This role could involve direct contact with patients helping them make informed choices about, for example picking a GP practice to meet their needs.

Improved Integrated Working

Performance in promoting joint working crossing organisational boundaries between health, social care and housing. Powers exist for it to happen but these are used inconsistently (if at all). The Government prefers an approach which will specify the establishment of a statutory role, within each upper tier local authority, to support joint working on health and wellbeing. A statutory partnership board with specific powers and responsibilities is envisaged. This would be at a County level (although they have the power to set up sub groupings at a more local level). There would be a statutory obligation for the local authority and GP commissioners to participate as members of the board and act in partnership on these functions. The health and wellbeing board could also be a vehicle for taking forward joint commissioning and pooled budgets, where parties agree this makes most sense and it is in line with the financial controls set by the NHS Commissioning Board. These boards replace current health partnership arrangements as a way of reducing bureaucracy. the boards would bring together local elected representatives
including the Leader or the Directly Elected Mayor, social care, NHS commissioners, local government and patient champions around one table. The Directors of Public Health, within the local authority, would also play a critical role. The elected members of the local authority would decide who chaired the board. There is duty for the Board to include representation from the voluntary sector although the power for them to do this exists if they wish. To avoid duplication, the Government propose that the statutory functions of the Local Authorities Health Overview and Scrutiny Committee would transfer to the health and wellbeing board. Where the Board remain unsatisfied with a commissioning decision or performance they have – after local resolution steps have been attempted – to refer the matter to the NHS Commissioning Board.

Local authority leadership for health improvement

All current health improvement activity undertaken by PCTs the so called “life-style” activites. would transfer to local authorities who would appoint Directors of Public Health and would be the custodian of a ring fenced health improvement activity budget.

Further information

A full downloadable copy of the consultation paper can be found via the Department of Health website:-

Responding to the Consultation

Responses to the questions in this consultation document should be sent to or to the White Paper Team, Room 601,
Department of Health, 79 Whitehall, London SW1A 2NS by 11 October 2010.


Group Support: