Education And Debate

The case for closer cooperation between local authorities and the NHS

BMJ 1995; 310 doi: (Published 17 June 1995) Cite this as: BMJ 1995;310:1587
  1. David J Hunter, directora
  1. a Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL

    The need for the NHS to work closely with local government is not a new one. Since the first major reorganisation of the NHS in 1974, the development of effective interorganisational relationships has been a priority.1 The principal interface between the NHS and local government has centred on social care and the development of community based alternatives to institutional care. While this remains a crucial interface, particularly in respect of the sharpening of the divide between health care and social care since the NHS and community care reforms, it is not the only one. There is a growing recognition of the importance of much of what local government does for the wider pursuit of health.2 3 Effective purchasing (or more recently commissioning) for health gain cannot succeed without securing close collaborative links with local authorities. The key issue is whether in the longer run it makes sense to have separate agencies sharing a common health agenda or whether it might not be more appropriate to bring health and local authorities together to form single integrated agencies.

    The case for local authorities assuming this role becomes stronger when the second component of the argument for closer cooperation between the NHS and local government is examined. The NHS suffers from a “democratic deficit” that no amount of tinkering with the present arrangements for selecting and appointing members of trust boards and health authorities can overcome.4 Various commentators and organisations have persuasively argued the case for local government assuming responsibility for health commissioning.5 6 7

    Even the NHS's architect, Aneurin Bevan, wrote in 1952 that “election is a better principle than selection.”8 He was convinced that “no Minister can feel satisfied that he is making the right selection over so wide a field.” Bevan claimed that the only …

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