Health Committee

10 January 2006
Session 2005-06 Government plans to reduce the numbers of Primary Care Trusts have been criticised by the Health Select Committee as 'ill-judged' and 'not conducive to the successful improvement of health care services'.

10 January 2006
Session 2005-06 Government plans to reduce the numbers of Primary Care Trusts have been criticised by the Health Select Committee as 'ill-judged' and 'not conducive to the successful improvement of health care services'.

In their report,  MPs concluded that:

"The risks of the proposals contained in Commissioning a Patient-Led NHS are high and there is little evidence that the costs will be outweighed by the benefits. The Department must more carefully consider the impact of its proposals on its staff, which are its most valuable asset … Major changes to the NHS have large costs and should not be embarked upon lightly."

The impact of continual reform on the NHS

The Committee found that it takes on average eighteen months for organisations to 'recover' after restructuring, ie. to bring their performance back to its previous level. The restructuring of PCTs is likely to have significant effects on their ability to undertake their core functions, including commissioning services, providing community health services, and protecting public health.

The destabilising effects are already becoming apparent, with reports of clinical staff moving from PCTs to the acute sector because of uncertainty over their future roles. There are well-founded concerns that patient care will suffer because of the proposed reforms.

After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge - a total of three years from the initial reforms. Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them.

The Committee concludes that: "The cycle of perpetual change is ill-judged and not conducive to the successful provision and improvement of health services. Major restructuring should only be undertaken if there is an overwhelming argument in its favour; in this case there is not".


The Government claims that the main reason for the reforms is to strengthen PCTs' commissioning function. The Committee strongly supports this aim, but improvements to commissioning should have been addressed long before now.

The fact that it was not may give rise to an uneven balance of power in the NHS that will now prove difficult to redress.

The Committee also concludes that there is no 'perfect size' for a commissioning organisation. In fact, there is a trade off between larger PCTs, which may have greater bargaining power and co-terminosity with local authorities, and smaller PCTs, which can achieve better local involvement.

Moreover, where there are advantages in becoming larger, PCTs are already capturing them through successful collaborative working with one another. Ministers should allow PCTs "to develop organically, and adopt a managed approach to sharing best practice in commissioning. This would avoid the hugely disruptive and costly impact of another root and branch reform of the NHS."

The Consultation process

The Government's initial consultation period was also criticised as 'insufficient and flawed' as the NHS was only allowed 11 weeks to put together complex proposals for restructuring local health services. The short timescale was compounded by its inappropriate timing at the beginning of the summer holidays. "As a result, patients, local people, NHS staff, other NHS organisations, MPs, local councillors and other key stakeholders have been unable to contribute meaningfully to the process."

The flawed nature of the pre-submission engagement makes the proper conduct of the formal three month NHS consultation starting on 14 December vital. The Department of Health should ensure that the consultation is fairly conducted by all SHAs, especially where the External Panel has required SHAs to consult on additional or different options than those originally considered in the pre-submission engagement. Not to do so would leave the Department vulnerable to allegations that the result of the consultation process was pre-determined and a sham.

Contracting out

The Committee also directed stinging criticism at Government plans to contract out provider services. MPs believe this should be subject to full and open debate, and that announcements should have been made as part of the forthcoming White Paper. Releasing its views on this before the completion of the Your Health, Your Care, Your Say consultation makes a mockery of the Government's consultative processes.

Despite the Government's numerous announcements it is still unclear what its policy is on the divestment of PCTs' provider services. This clumsy and cavalier approach to NHS staff has had a very damaging effect on staff morale. There also strong concerns about the consequences of the divestment of PCT provider services. Should this go ahead, it could lead to the fragmentation of community services, and make joined-up care even harder to provide.

Commenting on the report, Committee Chairman Kevin Barron, said:

"It is clear that there are lessons to be learnt from the difficulties that have arisen following the publication of Commissioning a Patient-Led NHS and I am pleased that the Government seems already to be taking account of these. In particular, the Government must ensure that in future, consultation on restructuring is fully inclusive right from the beginning of the process."

Notes to editors

1. The Health Committee will publish its Second Report of Session 2005-06 on Changes to Primary Care Trusts (HC 646) on Wednesday 11 January 2006 at 00.01.

2. Advance copies of the report, which will be embargoed until 00.01 on Wednesday 11 January, will be available for collection on Tuesday 10 January  between 11.30 and 12 noon from the reception desk at Westminster House,  7 Millbank, London SW1P 3JA.

3. Advance copies of the report will also be made available to the Press from the Press Gallery, House of Commons at 11.30 on Tuesday 10 January.

4. All media inquiries are to be made to Luke Robinson on 020 7219 5693

5. Witnesses' copies of the Report will be posted to them.

6. The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No. 152 to examine the expenditure, administration and policy of the Department of Health and associated public bodies. The Committee has the power to send for persons, papers and records.

7. Following publication, copies of the Report will be on sale from the usual Stationery Office outlets (tel. 0870 600 5522) and the Parliamentary Bookshop (tel. 020 7219 3890) and may be viewed on the Committee's website.

8. The text of Committee reports, minutes of evidence and press notices can be accessed through the Internet at Parliament's website

9. NHS Primary Care Trusts (PCTs) were created in 2002, and are currently responsible for controlling some 80% of the NHS's £76 billion annual budget, which they use to commission health services for their local populations. In addition, they have responsibility for public health, and many PCTs also provide community-based health services, such as district nursing and community hospitals.

10. In July last year, the Government announced plans to reduce the number of PCTs in order to achieve cost savings of £250 million and to improve commissioning, and to contract out community health services currently provided by PCTs to non-NHS providers by the end of 2008.