NHS reform plans 'seriously flawed'

Tuesday, January 13, 2009

Proposed reforms to the national health service leave a lot to be desired, according to a report from the Health Select Committee, not least because they tend to rely on primary care trusts (PCTs) to put them into practice and they seem more focussed on access than quality. Also, the thinking behind polyclinics is flawed and should be tested through pilots.

Referring to Lord Darzi's next stage review (NSR) of the NHS, the committee disagreed with the suggestion that while policy in the last decade has concentrated on access, now it should be about improving quality.

"We do not accept that it was necessary or sensible to improve access before improving quality," the report said, adding: "We have concerns about the implementation of the report, which will be the responsibility of PCTs, because we doubt that most PCTs are currently capable of doing the task successfully. As we have noted in a series of inquiries, PCT commissioning is too often poor. In particular, PCTs lack analytical and planning skills and the quality of their management is very variable."

Even though the Department of Health has admitted serious weaknesses in PCT commissioning, the committee was not convinced that the improvements needed will happen, meaning "implementation of the NSR may be slower and more uneven than the government hopes".

The committee also cast doubt on the ability of strategic health authorities to manage the performance of PCTs.

On polyclinics, the committee said the plan to create 150 GP-led health centres needs careful management and evaluation to determine whether it leads to better evidence-based medical interventions for patients and whether it reduces disparities in health care access and service use between different social classes.

The report said: "We are not convinced by the department's argument that all PCTs should have a GP-led health centre … PCTs should not make their decisions on a whim, but national criteria should be set out to ensure that benefits and costs of their decisions are known. We were disappointed that neither the government nor witnesses representing doctors could tell us what criteria should be used to decide whether a PCT needed a GP-led health centre. While polyclinics and GP-led health centres can bring benefits, we are disappointed that the department is introducing them without prior pilots and adequate evaluation."

The British Medical Association was delighted with the report. Chairman of council Dr Hamish Meldrum said: "The government didn't listen to the BMA's concerns as it pushed headlong into introducing a new untested way of delivering healthcare. We hope they will now listen to the Health Select Committee and address some of the flaws in the NSR."

He added: "The report supports the BMA's view that the government directive [on polyclinics] was short-sighted. It also reiterates our concerns that GP-led health centres have been introduced without proper pilots or evaluation."