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« Will East: Open the NHS up to new providers, competing on price | Main | Richard Jenner: 100% reserve banking »


clive elliot

This is one of the most intelligent analyses put up on this site so far. Whether the proposal is absolutely right may be open to question, but the basic thinking, namely that we must prevent the needless duplication and thus target limited resopurces better, is spot-on.

Ian Mullins

This would certainly work and be popular at both PCT level and undoubtedly with local authorities.
If we are going deliver quality person-centred services, we have to make sure that there is genuine partnership working between the 2 different organisations. Moreso there needs to be more of an ethos of accountability within health, and less of a driver to simply 'cost shunt' to the poor cousins at LAs. The only way of making this happen is a systemic change in the monolithic commissioning bodies of the NHS.
Strategic partnerships with the generally better managed and streamlined, not to mention politically accountable Adult Services depts of councils is the way forward......ultimately I passionately believe that Joe Public doesn't care who delivers services, or who they work for; all they care about is that they get those much needed services delivered.


I think local accountability is an excellent idea. The possibilty then comes of saving your local hospital. I would also prefer that the financing was raised locally, and I might even go further and annualy elect the chairman of the local trust. My only concern would be an increase in postcode lottery, but at least people would have a say.


I think this is an excellent idea - I've seen Govenrment get off the hook by blaming PCTs and PCTs by blaming the Government recently - we need local accountability and to remove the expensive distinction b/w health and adult care.

Slightly off topic: Voreas06 - you cannot welcome local accountability and still be concerned about a post code lottery! They are two sides of the same coin. I wish that Conservatives would stop using the latter phrase - local accountability might mean differences based on postcode - but they are based on democratic choices not a random lottery!

Penultimate Guy

Dr Joyce's proposal is welcome although not novel. It's already Lib Dem party policy, for one thing (on the local authority model). And Prentiz is quite right about the postcode-lottery/postcode-democracy distinction.

Denis Cooper

I think county councils might cover the right size of area and population, rather than local councils which for some purposes could be too small.

Simon Chapman

I whole-heartedly approve & had been considering a similar proposal myself. I am baffled that the party has not embraced health localism. The outline NHS Bill that we announced a few weeks ago had nothing on this at all - a real missed opportunity.

A main focus of local outrage here in SW Lincs, as in other parts of the country, when faced with a threat to our local A&E Service at Granthm Hospital, is the lack of any locally-elected politician who is accountable.

Health is political - but it should be done locally.

An unequivocal Yes.

matt wright

I think improved working between adult social care and NHS is important and like this aim but I worry about the bureaucracy in having all the seperate bodies and we cannot dodge the "postcode lottery" issues. When Mrs Smith can't get what she wants in Exampleshire when its available in Blogshire she will blame the Govt (us if we were the Govt who instituted this). As someone said above, people just want good services but don't really want to know how its done. In summary like many I am drawn to localism in theory but I think it needs an awful lot of working out and health is an area where any problems would become very emotive,


Mark Wadsworth


Paul Charlson

I dont think local Government should run the NHS. The service is already beginning to fragment and local Government would increase this. I would not have confidence in local politicians making decisions as I am doubtful they have sufficient understanding of how healthcare works.

An independent national body is required to ensure standards and direction and clinicians in the driving seat locally This is not the same as the current sham with PECs

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