Published: 03/11/2005 Volume 115 No. 5980 Page 7

Strategic health authorities must not interfere or pressure primary care trusts over decisions to divest services to the independent and voluntary sector, the NHS Alliance has warned.

In its submission to the Commons health select committee's inquiry on PCT reconfiguration, the alliance welcomed the health secretary's statement last week that decisions would be made by individual PCTs, after local consultation.

The evidence said: 'Decisions on divestment should be made locally, with full consultation, and discussed in public session. Policy should be agreed by the PCT and its stakeholders without interference or pressure from SHAs.' The alliance repeatedly stressed the importance of stakeholder involvement - in particular in the case of staff working for services which might be divested, noting that 'many nurses have expressed dismay' at changes to transfer direct provision out of the NHS.

'Ultimately, human services depend on constructive relationships, integrity and trust. Evidence tells us that mergers are more likely to be successful where there is a focus on the human and cultural aspects of integration, actively gaining the support of staff as well as other stakeholders. The NHS Alliance recommends this approach.' The evidence also notes the risks that larger PCTs would concentrate on specialist functions at the expense of public health, and that changes to relationships with councils could cause emergency planning functions to be overlooked.

'There is a risk that large PCTs commissioning expensive hospital services and covering more than one local authority will give preeminence to the narrower specialist function required to support commissioning and clinical governance, at the expense of local public health advocacy.' It also expresses concern that larger PCTs will be unable to maintain strong relationships with councils, causing emergency planning functions to be overlooked.

The organisation warns that the restructuring will 'inevitably' dissolve good local partnerships, trust and knowledge, with a negative impact on the delivery of joined-up health and social care, the management of long-term conditions and public health.