Published: 13 January 2006
PCT Reform lacks clarity
Stinging criticism of the government’s proposals for NHS reform of primary care by the Commons Health Select Committee has been welcomed by Amicus, which has 100,000 members working in the health sector.
The Health Select Committee report comes a day after Amicus members staged a successful lobby of MPs at Westminster to reiterate their opposition to the break-up of the NHS.
The Amicus Head of Health, Gail Cartmail said:
“We, like the committee, are appalled at the continuing lack of clarity about whether primary care trusts will eventually divest themselves of their provider functions.”
She called for NHS Chief Executive, Sir Nigel Crisp to end the confusion about the proposals – which Amicus, and the committee, argue will lead to:
· fragmented services,
· creeping privatisation,
· job losses and
· poorer patient care
Gail Cartmail continued:
“We welcome the select committee’s report which vindicates the campaign that Amicus has been waging to reverse these ill-conceived plans.
There must now be a clear statement from the Department of Health explaining that proposals that would fragment service delivery in the community were wrong minded.
The Select Committee branded plans to reorganise primary care trusts, which control 80% of the NHS budget, as ‘ill judged in the extreme'.
The MPs said: ‘The cycle of perpetual change is not conducive to the successful provision and improvement of health services.’
Gail Cartmail concluded:
“Our members at the chalk face are grappling with job cuts and freezes on filling posts, plus reduced trainee places – and this does not fit in with the health policies the government says it wants to deliver and that we support.’
Amicus welcomes the government’s investment in the NHS and pledges to improve services in the community, but we cannot agree that creeping privatisation or fragmentation of service delivery are in the interests of client/patient care.”
Gail Cartmail said that Amicus will campaign for a White Paper – due at the end of January - that supports high quality services in the community, addresses health inequalities, and recognises the skills and dedication of NHS health professionals.
While some people may have a duty & requirement to read the whole 255 pages of the Health Committees damming report, we suggest readers should at least read the 3 page summary at the beginning of the document.
Having done so, one begins to understand just why the government seems unable to achieve much in the way of ‘reforming’ the NHS ands it’s not because the staff are unwilling to adopt change.
Extracts from the summary in the report:
Commissioning a Patient-Led NHS was published on 28 July 2005. It set out proposals to dramatically reduce numbers of PCTs in order to achieve cost savings of £250 million and to improve commissioning.
The paper also announced plans to contract out community health services currently provided by PCTs to non-NHS providers by the end of 2008. At the same time, the number of Strategic Health Authorities (SHAs) would also be substantially reduced.
These proposals were received with widespread alarm, and were described by commentators as ‘incoherent’.
Those working in the NHS expressed outrage at the prospect of a further large scale structural reorganisation only three years after PCTs were created in the last round of restructuring, as well as raising serious doubts as to whether the reforms would achieve their stated aims……………………….
The consultation process
The NHS was allowed only 11 weeks to put together complex proposals for restructuring local health services. The short timescale was compounded by its inopportune timing at the beginning of the summer holidays. As a result, patients, local people, NHS staff, other NHS organisations, MPs, local councillors, and other key organisations have been unable to contribute meaningfully to the process.
Despite the Government’s repeated reassurances, it is clear from our evidence that the consultation has been a ‘top down’ process: change has been imposed on local NHS organizations by central government for financial reasons and as a result solutions that would best meet local needs are being overruled because they do not yield the required savings………………………
Contracting out PCTs’ functions
Equally strong criticism was directed by our evidence at the announcement made in Commissioning a Patient-Led NHS that PCTs should divest themselves of their provider services.
This is a major change in policy direction that must be the subject of full and open debate.
One channel for such debate might have been the Government’s consultation Your Health, Your Care, Your Say, which was launched in June to shape the Government’s forthcoming White Paper on out-of-hospital care.
However, the inclusion of far-reaching changes to PCT primary care provision, well in advance of the consultation’s conclusion, makes a mockery of the consultative process……………………………
There are also important concerns about the consequences of the divestment of PCT provider services. Should this go ahead, it could lead to the fragmentation of community services, and make joined-up care even harder to provide……………………………
Moreover, it is unclear whether sufficient alternative providers exist to provide a market in community services.
As well as plans to contract out PCTs’ provider functions, during the course of this inquiry it emerged that proposals were also being made by one Strategic Health Authority to put Oxfordshire PCTs’ commissioning functions out to tender.
This raises crucial questions about accountability and transparency. Once again, a significant policy change has been proposed without consultation………………………..
Impact on day to day functions, including clinical services
It is clear that the impact of proposed reconfigurations on PCTs’ day to day functions, including clinical services, will be substantial—it takes on average eighteen months for organisations to ‘recover’ after restructuring and to bring their performance back to its previous level.
The restructuring of PCTs is likely to have significant effects on their ability to undertake their core functions, including commissioning services, providing community health services, and protecting public health. The destabilising effects are already becoming apparent: clinical staff are moving from PCTs to the acute sector because of uncertainty over their future roles.
There are also well-founded concerns that patient care will suffer because of the proposed reforms.
After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge—a total of three years from the initial reforms.
Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them. The cycle of perpetual change is ill-judged and not conducive to the successful provision and improvement of health services………………….
Impact on commissioning
The evidence suggests that the benefits of larger PCTs are far from certain, and will be offset by the disadvantage of the loss of a local focus for the NHS. Moreover, where there are advantages in becoming larger, PCTs are already capturing them through successful collaborative working with one another………………
It is striking that, despite the considerable attention these proposals have attracted in Parliament and elsewhere, debate has focused almost exclusively on the shape of future organisations, the morale of staff, and the consultation process, largely ignoring the critical issue of how commissioning can actually be improved in the NHS…………………………..
Financial impact
In fact, it is doubtful whether the reconfiguration will yield the £250m savings the Government is hoping for if the costs of restructuring including those incurred by redundancies and by establishing new structures to secure local engagement are taken into account…………………………
Overall impact of restructuring
Debate on the Government’s proposed changes to PCTs has focused almost exclusively on the shape of future organisations and the divestment of PCTs’ provider services, largely ignoring the critical issue of how commissioning can actually be improved in the NHS.
Irrespective of their future size and number, in order to improve commissioning PCTs urgently need better skills and better information systems.
To this end, we have recommended that rather than reconfiguring PCTs, which is unlikely of itself to bring about improvements, and which will be hugely disruptive, the Government should allow PCTs to develop organically, and adopt a managed approach to sharing best practice in commissioning, targeting specific support at improving commissioning in the poorest performing organisations.
Further information
CPHVA campaign
Health Select Committee: Changes to Primary Care Trusts (Caution- 255pages)
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