Moving the chairs… again

Civitas, 19 January 2011

Over the past few weeks Civitas staff have written many articles questioning the Government’s plans for the NHS, not on invigorating competition – which is needed, particularly with the productivity challenges the NHS faces – but on commissioning: on abolishing all PCTs, the current commissioning bodies in the NHS, by 2013, replacing them with ‘consortia’ of GPs.

One of the key criticisms outlined was that the reforms follow a long line of centrally-driven initiatives that “move the chairs” in NHS commissionning, without fundamentally altering lines of accountability. GP consortia fundamentally will be statutory bodies placed in a hierarchical framework reporting first and foremost to Whitehall, and not to patients or the public; just as with PCTs.  The difference – and, the Government hopes the key difference that will lead to a step change in the quality of commissioning – is that consortia will be led by clinicians, not managers (or ‘bureaucrats’ as Cameron et al. prefer to badge them).

But the reality is the central grip over commissioning will be retained, through the NHS Commissioning Board.  Today, the Health Bill confirms this, stating, for example, that:

• The NHS Commissioning Board can sack a GP consortium’s accountable officer, or disband the consortium altogether if it underperforms.
• The board can vary the area a consortium covers, force it to take on additional practices, or remove practices from it.
• The board can strip consortia of any functions it wishes if they underperform.
• The board can top-slice consortia funding to create contingency funds.
• Consortia performance will be assessed annually and published by the NHS Commissioning Board.

This creates significant potential for any local action by consortia to be constrained.

Given that the DH has, also today, announced some 130 performance indicators for PCT clusters/GP consortia in the transition, there is, is there not, a very real possibility that the next three years is spent performing less of a ‘liberation’, more of a reinvention of the wheel?  Sir David Varney, former head of public service transformation for Gordon Brown, documents the big risks involved in the plans, in an essay for Civitas today.

Lansley would be better off pursuing a course of commissioning reform that would, instead, transfer accountability to the patient and taxpayer.