PCTs lack the skills to commission services effectively and should make greater use of clinicians to improve the situation, MPs have concluded.
A report by the Health Select Committee (HSC) savages the standard of commissioning in the NHS.
It criticises PCT-led commissioning for being expensive, contradictory and lacking quality, and questions whether the purchaser/provider split should continue.
The HSC blames low skill levels among commissioners, particularly for a lack of analysis of data and clinical knowledge. The problems have been compounded by constant re-organisations and high turnover of staff.
The report says: “Commissioners do not have adequate levers to enable them to motivate providers of hospital and other services. We recommend the Department of Health commission a quantitative study of what levers should be introduced to enable PCTs to motivate providers of services better and a review of contracts to ensure that rigid, enforceable quality and efficiency
measures are written into all contracts with providers of healthcare.”
The cross-party committee of MPs were “dismayed” and “appalled” that the DoH could not provide clear and consistent data on transaction costs nor accurate figures for associated staffing levels. It said: “The suspicion must remain that the DoH does not want the full story to
be revealed.”
It believes the “full story” would reveal an increase in transaction costs, notably management and administration costs. It points to research commissioned - but not published - by the DoH which estimates that transaction costs could represent 14% of total NHS costs.
The report also says that there are contradictory aims within system since the introduction of a more market-based approach to service delivery and Payment by Results. It questions whether the government’s World Class Commissioning programme will address the problems or just become a tick box exercise.
It says: “The NHS remains characterised by tensions between purchasers and providers. The weakness of commissioners faced by powerful providers means that the reforms have threatened to undermine some of the government’s key aims, such as switching care from hospitals to
the community.”
The HSC also expressed concern over the governments intention to cut management costs by 30% in PCTs and SHAs by 2013. It believes SHA should bear the brunt of cuts while strengthening PCTs.
It says: “While some PCTs do a good job with low overheads, we are not convinced that taking money away from weaker PCTs will automatically encourage them to improve their performance. At a time when we are expecting so much of PCTs, it seems risky to be cutting their management costs by 30% when they need better skills and more talent.”
Commenting on the report, Professor Ian Gilmore, president of the Royal College of Physicians, said: “MPs today have delivered a stinging rebuttal to the way health services are presently commissioned. Not only is there often insufficient clinical input, but high staff turnover and a lack of relevant data means that many commissioners are not in place long enough to add value to the complicated process of setting up services that meet a community’s health needs.
“If the government is committed to the present formula we need at least to make sure that the wider package of reforms of the last ten years doesn’t, as it does now, militate against the laudable aim of delivering high quality care for patients and value for taxpayers.”
The BMA’s Dr Richard Vautrey, deputy chairman of the GPs committee, said:
“Commissioning is a key function of planning NHS services, but its purpose has been subverted through ideologically driven reforms. The purchaser-provider split, and the application of a market model to the planning of services have created unnecessary bureaucracy.
“Doctors are fed up with repeated re-organisations, which has not allowed commissioners to build up experience and expertise. There have been too many central initiatives that have been the focus for local managers, rather than the commissioning itself.”
Read the full report.
