What did the newly minted coalition government describe in May 2010 as “a champion for patients”? The answer, of course, was primary care trusts.

Back in the coalition’s honeymoon period PCTs were slated for a central role in the proposed NHS reforms, responsible for commissioning “best undertaken at a wider level” and taking “responsibility for improving public health for people in their area”.

Then came the deliberations that led to the white paper proposals and the Liberal Democrat demand that local authorities should take the lead on public health. PCTs’ sacrifice must have seemed the easiest of wins for a coalition looking for ways to be accommodating to both partners.

Fast forward to the end of last year and a slimmed down Department of Health is working desperately to find a home for all the functions undertaken by disintegrating PCTs against a deadline which seems more unrealistic with each month. As one HSJ reader commented online, the exercise is being conducted in a climate where “no one knows who to ask, and those undertaking the function do not know who to tell”. Even the script given to managers briefing staff admits that – 15 months before the new system is meant to be up and running – there is “no clarity” about which functions are transferring to which organisations.

Commissioning reform is doing great damage to careers and morale. But there is an even greater concern.

PCTs may be heading for abolition, but the DH function mapping exercise shows the tasks they undertake are not disappearing too – but simply being transferred to new homes – some barely more than shells, some unknown. These tasks are being transferred because they are important, because they support and drive care quality. Confused and rushed reform makes it very hard for staff to perform those roles well.

The Mid Staffordshire Foundation Trust inquiry has already shown us how reorganisation, of a much smaller kind, can blind the system to poor quality care. It does not take great imagination to conclude what may slip under the radar during these, much more extensive, reforms.

The legislative reforms may have been “paused”, but on the ground reorganisation has ploughed on regardless, driven in part by the need to deliver management cost savings. The government should slow the pace, provide the missing clarity about future functions and – only then – move on.

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