Notes from the field of public involvement

Friday, 23 September 2005

"Fit for Purpose" in 2008: Is this the future shape of London’s Health and Care Services?

This is a speculative view of what health and care might look like across London by 2008. This is meant to stimulate thought and discussion, especially amongst lay representatives and organisations, in the wake of "Commissioning a Patient-Led NHS" which appeared at the end of July. (www.dh.gov.uk/assetRoot/04/11/67/17/04116717.pdf)

MAC believes that it is better to grapple now with potential changes that some might term "unthinkable" and at best unpalatable rather than find ourselves surprised by radical reconfiguration when it is too late to influence anything. We are not necessarily advocating the following scenario. It is simply an attempt to draw together what we see as the significant factors influencing change and then describe the possible picture which results. Our overriding concern is to maximise the influence of patients and the public in any new arrangements. We believe these opportunities exist and must be exploited even if PCTs as we have known them disappear.

With the coming "fitness for purpose" debate about PCTs and the consultation later this year on healthcare outside of hospitals in mind, we've looked at the possible future from the wider London perspective, not just from the perspective of whether PCTs might survive. In doing so, we have tried to identify what arrangements could, in our view, give service users and the public the biggest leverage for changing health and care to benefit Londoners and also involving them and their elected representatives in planning and scrutinising the process.

Feedback is always welcome, so let us have your comments, brickbats or carefully considered views on what you think of our picture of where the NHS and social care in London could be heading.


1. One Health and Care Authority for Greater London
One Strategic Health and Care Authority (or some other name - titles don't really matter) for the whole of London relating to the Government Office for London and, more importantly, to the Greater London Assembly.

2. Five PCTs for Greater London

3. London Boroughs as the new "localities"
Each constituent boroughs of a London PCT will be a locality within the new structure

4. Boroughs have neighbourhoods
Localities are encouraged to designate neighbourhoods if there is local demand/need, eg to relate patients/public more closely to practice-based commissioning activities, to encourage clinician engagement/clinical governance.

5. Services are commissioned from and provided by a range of organisations
The most contentious part of the reconfiguration affecting both health and social care is that provision of primary care, community health and social care services is commissioned from a mixed economy of Trusts and Foundation Trusts (which all NHS Trusts will be eventually if they remain in business), private sector providers (both for profit and NFP), voluntary agencies, and new "community interest companies". How Practice-Based Commissioning organisations relate to other providers needs clarifying as they have an ambiguous role.

Andrew Craig | Send feedback