Is the breakup of the Local Health Authority in Leeds into five segments really making it more local, or just more confusing? The answer lies in local access and influence. 

Primary Care Trusts

Health services are getting a new local look through the launch of Primary Care Trusts in April 2002. Primary Care Trusts, or PCTs, will be taking over most of the functions of the Local Health Authority.

The Leeds Local Health Authority area is being carved up into five PCT areas (see map opposite), each with the autonomy to develop its own agenda and ideas about service delivery. The potential for disparities between areas and chaos in services is obvious. There’s also the question of how ‘communities of interest’ (eg disabled people) and city-wide services, such as many counselling and advice services, will cope with up dealing with up to five different PCTs while already struggling with limited resources.

United we stand, for now...

To try and make the transition smooth and avoid the worst case scenario, Leeds Health Authority is spending its last few months of existence ensuring all five PCTs work closely together. They describe this as  ‘collegiate working’ - a curious choice of language for a process that is supposed to bring the health service closer to the people! What this translates to is a binding of the five PCTs together with a web of inter-dependency and co-operation. A good example of this is the collaboration to create common service frameworks across the city, with  each PCT leading the develop-ment of a range of issues on behalf of the other four. The North West Leeds PCT is, for example, leading on mental health issues and services.

A local PCT for local  people

One of the aims of the PCT structure is to encourage local participation in developing local health strategies and solutions. How this will actually work and how it will be resourced remains unclear, but there is already a mental health service user reference group which is getting its own paid worker shortly.

This group feeds into the ‘mental health services modernisation team’ who are currently working on a common framework for mental health services across the five PCTs. In most other areas of development, although PCTs have yet to fully finalise their arrangements for user input and community involvement.

Go west: local PCT forums

The structure of a PCT resembles many other Government ordained agencies, and is headed by a Board of hand-picked people.  Beneath the Board are layers of committees and working groups. Many of these committees include representatives from different service providers and sectors. What representation there is for the voluntary sector within PCTs is usually in the form of a local service provider which is big enough or loud enough to have been noticed and invited on. This has created a dilemma for both PCTs, the voluntary sector agency representative and the wider voluntary sector: the PCT has no formal input form the wider voluntary sector; the agency representative has a very limited mandate and the wider sector is left without any accountable representation. West Leeds PCT have taken the bold step of opening up the process quite widely by setting up local and thematic forums, attended by any number of practitioners and other interested people. The role and remit of these forums is still unclear, but their success has already aroused the interest of the other PCTs who are now considering this as a way forward for greater participation.

The Leeds Voluntary Sector Mental Health Forum are developing ways for information to be fed into and disseminated from these forums and committees, as well as trying to establish standards and criteria for more formal, mandated voluntary sector representation. If they succeed, many of the smaller groups and organisations in the city will have a voice once more.

Keeping your eye on the ball

If you are interested in these developments, a good way to stay informed is to attend the Leeds Voluntary Sector Mental Health Forum meetings at the Host Centre in Chapeltown.

Full details are available from the Leeds Voluntary Sector Mental Health Forum on 0113 270 4000.