NHS commissioning '20 years of costly failure'

30 March 2010

The Health Committee today delivers a damning verdict on two decades of NHS commissioning following the establishment of the purchaser/provider split in 1991

In a report published today, Primary Care Trusts (PCTs) are criticised for failing to commission effectively. The Committee says PCTs are too passive, and lack the clinical knowledge and other skills to challenge hospitals over the provision of services.

Constant reorganisations and high turnover of staff have made a bad situation worse.

The Committee questions whether the Government’s "World Class Commissioning" initiative will lead to the necessary transformation of PCTs. Research commissioned by the Committee found misplaced confidence amongst PCTs about their achievements.

Insufficient progress has been made on implementing the Carter Review of specialised commissioning for rare diseases and conditions. Many PCTs remain disengaged from specialised commissioning and the coming period of financial restraint could threaten funding in this area.

PCTs require a more capable workforce, higher quality management, the ability to attract and develop talent, and more power to deal with providers.

The Committee cautions against a reliance on management consultants to address commissioning weaknesses and urges the Department of Health to determine if this costly exercise represents value for money.

The Committee is dismayed that the Department has failed to provide clear and consistent data on the overall bureaucratic costs of commissioning, which suggests it does not want the full story to be revealed. Unpublished research estimates administrative and management costs may be as high as 14 per cent of total NHS costs.

The failure by the Department’s four most senior civil servants to give accurate figures on staffing levels and operation costs is appalling and this deficiency must be addressed immediately.

The Committee warns that the commissioning system may need to be scrapped altogether if reliable figures reveal an uneconomic policy which is failing to reap the desired benefits.

Kevin Barron, Committee Chair, said:

"It is a sorry story if, after 20 years of attempting to operate commissioning, we remain in the dark about what good it has actually done. The Government must make a bold decision: if improvements fail to materialise, it could be time to blow the final whistle."

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