PCT reforms were mishandled

12 Jan 06
Health Secretary Patricia Hewitt has admitted that her department 'mishandled' its instruction to strategic health authorities last year, telling them rapidly to reorganise the provision and management of primary care.

13 January 2006

Health Secretary Patricia Hewitt has admitted that her department 'mishandled' its instruction to strategic health authorities last year, telling them rapidly to reorganise the provision and management of primary care.

Her admission came at the NHS Confederation on January 10, in response to questions about the proposed extent of independent sector involvement.

This followed a Commons health select committee report that condemned the Department of Health's approach as 'clumsy and cavalier', and risked setting the NHS back three years through an 'ill-judged cycle of perpetual change'.

'Change has been imposed on local NHS organisations 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,' the report argued.

The central tenets of the department's instruction were that primary care trust commissioning should be streamlined and strengthened through the merger of neighbouring PCTs by 2006 and that direct provision of health services should be reduced to a 'minimum' by 2008.

SHAs were given 11 weeks to consult with relevant parties before presenting the department with their responses in October.

Following opposition from within the NHS as well as Labour backbenchers, Hewitt stepped back from the 2008 deadline, saying such changes would be subject only to local decisions, not central command.

But the health committee this week said it was 'appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of their provider functions'.

It said that many senior civil servants appeared 'genuinely bewildered' as to what government policy now was.

As well as criticising the procedure of the reforms, the MPs condemned the principles, arguing that the loss of PCT provision 'could lead to the fragmentation of community services... Moreover, it is unclear whether sufficient alternative providers exist to provide a market in community services.'

A response of sorts arrived at the NHS Confederation event, when Hewitt appeared to endorse recent proposals by Tony Blair's health adviser Paul Corrigan that patients be given the power to demand that failing PCTs commission services from new private sector and voluntary providers.

Hewitt promised that the health and social care white paper – due at the end of this month – would 'give people more effective choice of GP and other local services [and] more say when services are unsatisfactory'. She added: 'We will expand services in neighbourhoods that have historically been under-served.'

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