Saturday, January 14, 2006


The Government's latest NHS reforms have been savaged by a Commons select committee, which describes them as ill-judged and unlikely to improve healthcare. The risks of the changes are high and there is little evidence that the costs will be outweighed by the benefits, says the Helath Select Committee in an attack on changes to primary care trusts (PCTs) that were introduced in July. "The cycle of perpetual change is ill-judged and not conducive to the successful provision and improvement of health services," the committee's report concludes. "Major restructuring should only be undertaken if there is an overwhelming argument in its favour; in this case there is not."

The report addresses changes to PCTs that were announced in a circular to the NHS by its chief executive, Sir Nigel Crisp. The trusts, established in 2002, were given the task of commissioning NHS services: identifying what patients needed, planning how this should be provided, allocating resources and buying operations in hospitals. There are 302 PCTs, which the new policy plans to cut to 100 or fewer. Sir Nigel's letter also said that the trusts should stop providing services themselves, such as community nurses, and that commissioning should be done by GP practices - a throwback to GP fundholding under the Conservatives.

At the time, analysts were shocked by the scale of the changes and the abrupt abandonment of the trusts as the driving force of the NHS. One reason for the changes was a promise made during the election campaign to save 250 million pounds by cutting bureaucracy. The changes were "clumsy and cavalier", the select committee said, and six months later it was still not clear what the policy actually was. Staff morale had fallen, and there was a risk of the fragmentation of community services, it said. The committee found that it took an average of 18 months for organisations to "recover" after restructuring. That is the time it takes to bring performance back to its previous level. "Thus, just as the benefits of PCTs are about to be realised, the Government has decided to restructure them." Instead, ministers should have allowed the trusts "to develop organically, and adopt a managed approach to sharing best practice in commissioning". They added: "This would avoid the hugely disruptive and costly impact of another root-and-branch reform of the NHS."

Sir Nigel's letter had allowed for just 11 weeks to put together complex proposals, starting as many people went on holiday. This was "insufficient and flawed", the committee said. "As a result patients, local people, NHS staff, other NHS organisations, MPs, councillors and other key stakeholders have been unable to contribute meaningfully to the process." The irony was that, at the very moment Sir Nigel's letter appeared, Patricia Hewitt, the Health Secretary, was beginning what she claimed to be the largest consultation by the NHS to work out the future of care outside hospitals. Yet the results were largely anticipated, or negated, by the changes introduced by Sir Nigel, making a mockery of the whole expensive exercise.

Ms Hewitt has since told the Commons that district nurses, health visitors and other staff who work in the community would continue to be employed by the trusts, unless a decision were made locally by them. But this has failed to mollify the committee. It says: "The department must more carefully consider the impact of its proposals on its staff, which are its most valuable asset. Major changes to the NHS have large costs and should not be embarked upon lightly." It is not even clear that the changes will save 250 million pounds. "It is worth noting that only three years ago, when they were created, the Government thought PCTs good value for money," the report says.

Kevin Barron, chairman of the committee, said: "It is clear that there are lessons to be learnt. In particular, the Government must ensure that, in future, consultation on restructuring is fully inclusive right from the beginning of the process."

Ms Hewitt denied that the reform was "change for change's sake". She said: "We aim to create stronger and more effective PCTs which can secure the best possible health and healthcare, for all patients. We are responding to local wishes in many parts of the country to merge PCTs. These changes were well signalled, for example through the commitment in May 2005 to save o250 million from streamlining. "All the changes that are being made in the NHS are designed to achieve even better NHS services for patients. That is the goal and the test of everything that we do."



I have just received from NHS Doctor the following comment on the above article:

"The merry-go-round of politically “inspired” changes in the NHS is absolutely bewildering for those of us working within it. The restructuring of the PCTs, and in particular the re-introducing of what used to be called “fund-holding” (Thatcher) but is now going to be called “commissioning” (Blair) is causing confusion all round, from administrators to doctors. We have recently been told we have a “choice matrix” of hospitals we can now refer to, but have received no information as yet as to the referral mechanisms. We are being buried in expensive gobble-de-gook".


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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