On Monday, the government revealed plans to amend the Local Government and Public Involvement in Health Bill, so that PCTs and local authorities are required to produce joint 'strategic assessments' of the health and social care needs of their populations.
Local government secretary Ruth Kelly announced the intention to lay the amendment during the debate on the second reading of the bill in the Commons. Her department said joint priorities - such as those to tackle obesity, or to focus on home care - should form part of an overarching community strategy for the area and could be supported by funding from local area agreements or other mainstream sources.
Speaking last week, Department of Health commissioning policy lead Anthony Kealy said the DoH's commissioning framework for health and well-being, due to be published next month, would detail precisely how PCTs and local authorities should work together.
Mr Kealy outlined draft proposals for a 'potential future single regime for the NHS and local authorities', to include joint outcome measures. 'There will be a much clearer focus on outcomes and the joined-up partnership between local authorities, social services, NHS organisations and practice-based commissioners,' he said.
Mr Kealy set out the DoH's 'seven steps' for more effective commissioning, which will be included in the framework.
He told delegates at a conference on commissioning that commissioners needed to better understand the needs of their local population: 'We need to make it clear who commissioners are accountable to - their local population,' he said.
Mr Kealy said the DoH knew that the current NHS commissioning system was 'not delivering'.
He said that the new commissioning framework was intended as a 'reorientation towards promoting health and well-being and actively promoting better health'.
HSJ understands the DoH framework will also set out proposals to develop commissioning skills at local level. These will include a programme to establish a 'commissioner career pathway' as the government attempts to 'professionalise' public-sector commissioning. Other commissioning skills to be outlined in the framework include:
- 'working with regulators to assess and drive up the capability of commissioners';
- 'sponsoring and shaping appropriate commissioner development programmes';
- 'facilitating access to specialised skills and expertise, including national procurements where appropriate'.
Mr Kealy also set out how the DoH intended to 'build leadership capacity'.
Proposals will include supporting PCTs to develop their commissioning capability following their fitness for purpose assessments; explicit support for directors of public health; and strengthening practice-based commissioning.
'We want to allow commissioners to have some teeth and stability going forward... We need to look at what we want to do now and how we create a shift from commissioning one-size-fits-all to services tailored to individual needs,' Mr Kealy said.
NHS Confederation deputy director of policy Jo Webber said that joined-up objectives between health and social care was 'vital' to deliver care effectively for patients with long-term conditions and mental health issues and to reduce health inequalities.
'We do have to work together, and we have got to get this message reinforced over time. I can see why the government might want to introduce joint targets to do this,' she said.
Ms Webber said that local area agreements already drawn up between local authorities and the NHS meant that local targets were already being developed, but she cautioned the government against setting national targets for local authorities and PCTs.
Local Government Association senior policy adviser for adult social care Trish O'Flynn agreed. She called on the government to set out a 'local organic approach' to measuring outcomes. 'We want to reduce the number of national targets for local government but there has to be some form of national framework for joint working,' she said.