The Committee’s report, which examines Lord Darzi’s NHS Next Stage Review (NSR) proposals, also says that weaknesses in NHS leadership must be urgently addressed and that not enough detail has been given on costs of the reforms.
Poor PCT commissioning and the failure of successive reforms to enhance it mean that implementation of the reforms may be slower and more uneven than expected. The Committee calls on the Government to publish and rigorously monitor milestones for each stage of implementation and says greater clarification is required on the role of practice based commissioning, which at present remains opaque.
More emphasis needs to be placed on the importance of recruiting and developing better managers and the issue of weak management skills in this area should be tackled. The Committee recommends more effective use of the NHS Graduate Management Scheme and says that talent should be fully exploited through sustained career support.
Not enough detail about cost is given in the NSR and the Committee is concerned that neither Strategic Health Authorities (SHAs) nor the Department have been clear on where and how much money will be saved. Figures on implementation costs for individual SHAs and PCTs should be published as soon as possible.
While the focus in the NSR on improving quality of care is welcome, variations in quality have been known about for a long time and have continued despite increased funding. The Committee does not accept that it was necessary or sensible to improve access before improving quality.
The Committee is not convinced by the Department’s argument that all PCTs should have a GP-led health centre and recommends that their creation should be decided locally on a case-by-case basis.
The Chairman of the Committee, Kevin Barron MP, said:
"We were pleased by the extent of consultation with clinicians and patients which went into the NSR, and the emphasis in the report on quality and leadership must be welcomed.
"However, we remain very concerned that PCTs are not yet up to the task of putting these reforms into practice. We heard a lot of evidence about weaknesses in PCT commissioning, which our Committee has highlighted in previous reports, and the ability of PCTs and SHAs to manage effectively these changes is a genuine worry.
"Lord Darzi’s reforms must not just be the latest in a series of failures to make real change; the blueprint for effective reform is there, but the Department must listen and respond to the concerns and challenges highlighted in our report."
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