Dorrell criticises ‘surprise’ shake-up

The Commons’ health committee has criticised the government’s approach to implementing the latest round of NHS reorganisation and reform.

In a report published this morning, the committee headed by former health secretary Stephen Dorrell says there is an urgent need to address “significant shortcomings in the current arrangements for commissioning in the NHS.”

It also backs the government’s decision to involve clinicians in the process, by handing commissioning to GP commissioning consortia.

However, it says the government’s decision to abolish primary care trusts in the process took most observers “by surprise” when it was announced as the white paper ‘Equity and excellence: Liberating the NHS’ was unveiled.

Striking a wry note, it says that “a surprise approach is not necessarily wrong” but it requires clarity and planning and “the committee does not think that the white paper reflected these qualities.”

It says the move instead increased the level of risk involved in implementing the new policy, distracting management time and attention from what the report calls ‘the Nicholson challenge’.

This is the pressing need, first outlined by NHS chief executive Sir David Nicholson, to find £15-£20 billion efficiency savings over the next four years to meet the potential gap between funding and demand caused by an ageing population, increased chronic disease, and medical inflation.

“The NHS needs to make unprecedented efficiency gains if it is to meet rising demand for healthcare against the background of budgets that are broadly stable in real terms (the Nicholson challenge),” the report summarises.

“More effective commissioning is the key to the delivery of this requirement [but] the surprise approach created uncertainty among commissioners and therefore increased the risks and costs associated with the delivery of the Nicholson Challenge.”

The committee also describes the lack of Parliamentary oversight of the new proposals as “unsatisfactory” and calls for clarity on how GP commissioning consortia will be accountable to ministers and Parliament as well as local communities.

It accepts the “pragmatic” decision to let PCTs form into clusters ahead of the changes, but expresses concern at the 15 month delay that will occur before consortia are in place.

It warns that decisions on what services to provide and where are already being made that “reflect management instability and weakness” rather than long-term clinical priorities. It also says “clear and credible plans” must be drawn up to tackle structural deficits.

The committee is planning to do further work on how commissioning can be made more effective, but clearly thinks the government has made an unfortunate start.

Launching the report, Dorrell said: “The value of effective and accountable healthcare commissioning has been discussed for 20 years.

“The challenging financial context in which the NHS now operates reinforces the requirement to take full advantage of these opportunities. Today’s report reflects the commitment of the committee to engage in debate about how this is best done.”