STRUCTURE: A care trust chair has accused the government of enacting “on the hoof” reforms, and warned that moves to sack non-executive directors risked draining expertise out of the local health economy.

Sir Bill Taylor, chair of Blackburn with Darwen Teaching Care Trust Plus, criticised a central directive for primary care trust clusters to have a single chair and board structure in a 15 December letter to the NHS Confederation.

The letter, which was written on behalf of all NHS chairs in the Lancashire, was copied to prime minister David Cameron and health secretary Andrew Lansley. It said government actions would destroy the “trust and credibility we have established as a cluster”.

Sir Bill told HSJ that non executive directors were being threatened with “blacklisting” if the Lancashire cluster did not adopt a single board structure as required by the DH. Non executive directors had been told that if they did not resign they would be barred from serving for two years, which Sir Bill said would stop them being involved in clinical commissioning groups.

However, he said Blackburn with Darwen wanted to keep a separate board because the care trust had entered into an agreement with Blackburn with Darwen Council, allowing the two organisations to jointly commission health and social care services.

If there was no separate board it would be harder for the council to prove that cash was being spent locally and it would have to withdraw from the arrangement, setting back years of work towards greater integration.

“We’ve baked a cake of modern service delivery,” he said. “It’s hard to unbake a cake.”

The letter said: “The whole letters, resignations, reappointments, threats of ‘blacklisting’ farrago is divisive and diversionary from the active and effective transference of responsibilities.”

“We have mixed views on various aspects of the Health and Social Care Bill and its implementational style,” it said. “But we are united in that, as we move from the current arrangements to a clinician led model, long held and cherished standards, efficiency and effectiveness are not put under dire threat.”

Shadow health secretary Andy Burnham said hundreds of chairs and directors of primary care trusts across England had been sent pre-written resignation letters.

He said it threatened to create a leadership vacuum and accused Andrew Lansley of “steering the NHS towards the rocks”.

“Andrew Lansley looks increasingly like a man on a kamikaze mission to destabilise the NHS,” he said.

A Department of Health spokesman said: “The strong feedback we have received from the NHS is that forming a common board across all PCTs in the cluster is the most effective way to carry out their responsibilities, and we have therefore asked PCT clusters to move towards this model of governance.

“As common boards form, the number of different non-executives needed will reduce. We have given clusters flexibility to take more time to complete this process, where necessary, and form a strong and representative common board. Strategic health authorities are supporting them to manage this transition.”

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