Health Services Management Centre School of Public Policy How can PCTs shape, reflect and increase public value? Iestyn Williams, Joan Durose, Edward Peck, Helen Dickinson and Elizabeth Wade December 2007 The vision … is to create self-improving institutions of public service, independent of centralised state control, drawing on the best of public, private and third sector provision. These institutions must be free to develop in the way they need to, responsive to the needs and preferences of citizens, and with a flexible workforce that is able to innovate and change. Out of this vision will come a new concept of modern public services: one built around the user of the service (HM Government, 2007). Current health system reforms position commissioning bodies not simply as the ‘co ordinators’ of a local NHS system but, potentially, as the only ‘pure’ NHS body existing at a local level … The principles of publicly funded health services are not, however, being questioned. It is the PCT that will be accountable for making sure that these principles are upheld for the local population … In effect, the PCT becomes the ‘NHS Local’ (Wade et al, 2006). Public managers are duty bound to have and present ideas of public value … But if the ideas are to succeed they will have to incorporate much from the surrounding environment. They will have to fit with the political aspirations of overseers. They will have to engage the employees who will be asked to help achieve the new goals. And they will have to meet the test of plausibly representing a set of purposes that citizens and taxpayers would choose to support if they had deliberated carefully on the question (Moore, 1995).