MPs criticise ‘high-risk’ NHS reforms

By Lilian Anekwe

The Government has failed to come up with any ‘credible plans' for wiping PCT debts or achieving the necessary £20bn efficiency savings required in its blueprint for NHS reform, a damning report from MPs has found.

A report by the Health Committee published this week warned that the target for the NHS to make £20bn in efficiency savings by 2015 was a ‘high-risk strategy', which ‘increased the level of risk considerably without setting out a credible plan for mitigating that risk.'

In December, the NHS Operating Framework revealed that GP consortia will not be responsible for resolving PCT legacy debt that arose prior to 2011/12, in a key victory for Pulse's A Clean Slate campaign.

But after hearing evidence from Dr Paul Zollinger-Read, a GP in Cambridgeshire and the DH pathfinder lead, the committee ruled that ‘it is questionable whether PCTs and SHAs will be able to eliminate their deficits over the next two years.'

The report said: ‘The key problems arise where there is an underlying structural deficit. Whilst handing over a clean balance sheet to consortia is no doubt welcome, it does not resolve the issue.'

‘The Government must support consortia and existing commissioning organisations to form clear and credible plans for debt eradication and for tackling structural deficits within their local health economy.'

Health Committee chair Stephen Dorrell MP said the reforms proposed in the white paper were not ‘fit for purpose' and would fail to meet the scale of the required efficiency savings.

He said: ‘4% efficiency gains for four years running is an unprecedented change, more than anything any comparable health system has achieved. The question is, are the plans fit for purpose? The answer would inevitably be no, but we need to make sure they are as fit as can be.'

He warned increasing numbers of PCTs ‘are already struggling to maintain financial balance, and consequently implementing what amount to service cuts and rationing'.

The committee also warned that the pace of change meant GPs in pathfinder consortia had been left with ‘no option' but to turn to private firms, as Pulse revealed last week.

Committee member Dr Sarah Wollaston, a former GP and MP for Totnes, Devon, compared the reforms to 'tossing a grenade' into PCTs.

‘Just at the time when individual expertise was needed to get decisions there was a haemorrhage of PCT staff in an uncontrolled fashion.'

‘It does look as if a number of pathfinders are consulting private firms. But they do have to act in their patients' best interest so if that is where the expertise is I can hardly blame them. The pace of change may have left them with no option.'

GP leaders backed the Committee's conclusions. RCGP chair Dr Clare Gerada said.'Good commissioning is central to making these health reforms work for our patients, but how this will be achieved against a backdrop of unprecedented cost savings must be resolved as a priority.

'GPs are not opposed to reform, but our concerns at the pace and scale of these reforms remain unanswered, as do our concerns surrounding the real, long-term impact these changes will have on the delivery of joined up, stable health care.

GPC chair Dr Laurence Buckman said: 'We would not want to see the potential benefits of clinically-led commissioning lost, and that is a risk at the moment because key components of the Bill will make effective collaboration between doctors very difficult. We agree that for commissioning to really benefit patients it must involve all clinicians. Yet the government's insistence on ratcheting up competition will make it harder for them to work together. '