There’s a fantastic
post by Nicholas Timmins at the FT’s Westminster blog. Using the example of Enfield Council, which has just blocked moves to close failing wards in a local hospital, Timmins argues that
councils commissioning healthcare is a recipe for disaster:
‘The reason council commissioning of care is a not a good idea is that it mixes representation without taxation. Councillors have democratic legitimacy. But they don’t raise the money for the NHS. So over the long term, giving them responsibility for commissioning is simply a recipe for councils to say there is not enough money in the system and to blame central government for the NHS’s deficiencies, rather than take hard decisions – hard in the sense that they are always locally unpopular – over how services need to be reshaped as medicine changes.
That was what almost invariably happened when councillors sat on health authorities back in the seventies and eighties. Today, Enfield has just made the point again.’
The worry is that Lansley, as part of the ‘pause’ in the NHS reforms, may give councils a significant voice in commissioning without reforming how the NHS is funded; the DCLG is also understood to favour democratising health as part of the localism agenda. Above all though, this is indicative of the flawed relationship between Whitehall and town halls: local government is tasked with running services, but remains financially dependent on central government grants, and therefore wields power without taking full responsibility.
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