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While it is early days, there does appear to be an emerging pattern to the Government's announcements in relation to local government. It can be described as a classic case of a ‘tight-loose' management style. With schools, we have announcements of new, parent-led schools, but all under a centralised framework for decision-making in relation to which bids will be approved. The announcement around the future of the NHS has similar hallmarks. Paul Wheeler is director of the political skills forum There are certainly good points for local councils. An increased role with regard to public health is excellent, together with promises of a greater scrutiny role – yet to be clarified. But the real action is with the revitalised role for GP commissioning, with the prospect of 80% of NHS spending being determined by consortium of GPs. Again, we have to be careful with the rhetoric around these changes. There are about 8,000 GP practices in England so, with an average of 16 GP practices in each consortium, these commissioning units are hardly going to be local. Moreover, these units will be directed by a NHS Commissioning Board, independent of the Government but not necessarily of medical vested interests. The tragedy is that the latest NHS re-organisation is a missed opportunity to integrate health and social services at a time when it is desperately needed. By happy co-incidence, the number of primary care trusts (PCTs) – 150 – was almost exactly the same as the number of unitary councils in England (154). We had already seen excellent councils seeking to merge with its coterminous PCT, producing a combined health and social care budget of £800m, and real potential for cost saving and imaginative commissioning, and shared service provision. Most GPs know that the wellbeing of their patients is related to a whole range of issues, including housing, education and employment. And while there are some brilliant GP practices, I suspect these are very much the exception. The creation of 500 mini-commissioning units reporting to a national board makes joined-up local solutions to health issues less, not more likely.

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WHITEHALL

Soap Box

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