PAC says publish cost and outcome data

The Common’s Public Accounts Committee has called for more information on NHS costs and outcomes to be released to the public to inform the debate on the future of cash-strapped hospital services.

The PAC issued a report this morning that is highly critical of the Department of Health’s approach to the mounting financial problems of some NHS acute trusts and the new commissioning regime that will be introduced next year.

It says DH witnesses were unable to explain how they expected key elements of the new financial regime to work, or how they would deal with trusts that became insolvent.

The report also says that while “some service reconfiguration within the NHS to reduce costs is inevitable” there is little cost or outcome data to inform local debates about the future of specific services.

One of its recommendations is that: “The DH should work with the NHS information Centre to ensure that information on costs and outcomes is easy for members of the public to access and understand.”

PAC chair Margaret Hodge said: “Ensuring a viable financial future for healthcare providers is vital if the public are to have confidence in the delivery of their local services.

“Yet we still do not have critical details of how the new system introduced by the NHS reforms will work so that services remain available to patients in their locality.”

The PAC report finds that although the NHS in England reported a surplus of £2.1 billion in 2011-12, this masked some significant local problems.

Three primary care trusts, ten trusts and 21 foundation trusts reported a combined deficit of £356m, with £115m of this accounted for by two trusts in London.

One of these, South London Healthcare NHS Trust, has had a special administrator appointed.

Yesterday, a draft report from administrator Matthew Kershaw suggested that it should be broken up, and its hospitals taken over by other trusts.

Pressure on NHS finances is likely to intensify as trusts try and meet the ‘Nicholson challenge’ to cope with flat funding at a time of rising demand by finding £20 billion in efficiency savings by 2014-15.

However, the PAC has little confidence in the new arrangements being put in place for when things go wrong.

The DH is planning to create central ‘risk pools’ to support trusts in financial difficulty, yet it notes that these will inevitably mean ‘top slicing’ funds from other services and create “yet more pressure in the system.”

Its report says the DH was also “unable to spell out to the committee a clear plan to achieve financial stability and a clear strategy for dealing with financial failure in individual trusts” – particularly those saddled with unaffordable private finance initiative contracts.

It also warns that “the incentives for clinical commissioning groups to work collaboratively within regional health economies remain unclear.”

Yet it notes that the pressure to ‘reconfigure’ services – or to reorganise them to maintain clinical quality at a smaller number of centres while moving cheaper services into the community – is growing.

Local reconfigurations tend to be hotly contested, and the PAC is effectively saying that more information is needed for both commissioners and campaigners on whether they deliver the promises that are invariably made for them in quality and cost terms.