The setting up of care trusts could effectively be shelved as primary care trusts concentrate on the delivery of improved health services, it has emerged.
A centrepiece of the government policy, care trusts were seen as the vehicle to deliver 'seamless services' within the primary care sector, bridging the long-standing gap between the NHS and social services.
The official line from the Department of Health is that the planned pilot schemes - due to start next spring - are going ahead, providing trusts volunteer.
But HSJ understands that initial interest has plummeted from around 30 trusts to about eight.
Hints from leading NHS figures are suggesting a slowdown in reform as PCT and primary care groups exploit flexibilities built into the Health and Social Care Act. These offer the provision expected to be delivered through the move to level-five trust status.
NHS Alliance chair Dr Michael Dixon said: 'Although we might not see the creation of care trusts, they will exist - it is just the name that will be missing. I think the scope is already there with the Health and Social Care Act to allow PCTs to set up the partnerships with local councils to realise the aims of care trusts.'
He said the benefits of a more relaxed approach would allow partnerships to develop 'organically', rather than under selfimposed timetables. It could also ease the potential friction between local government and health service staff during the merger of service provision.
'We have seen senior people lose their jobs when PCGs moved towards PCT status. That is one issue that may be avoided, ' Dr Dixon said.
He also stressed that putting the break on structural reform would allow time for trusts to deliver the much-needed improvements to actual services Health secretary Alan Milburn has already hinted that the formal creation of care trusts should be less important than the creation of a 'single care system'.
He told delegates at the NHS Confederation conference this month: 'I want to get to having one care system. When the consumers come into the system, they think It is Byzantine.'
He added: 'We should have one care system on the ground, but how do you get there? We can't impose partnership on people - we have to provide the means for them, whether That is the care trust model or pooled budgets, but It is fiendishly difficult to do.
'But the public will not forgive if It is technical barriers that prevent them getting the care they need.
We need to use the powers we have to forge one organisation, rather than two with different ways of working and different cultures. . . I am agnostic about the form that will take. It would be perfectly possible to make it work on a pooled budgets basis.'
The implications for PCTs are becoming apparent. Hillingdon PCT is seen by many as at the forefront of modernisation of primary care.
But its chief executive David Panter told HSJ: 'I can't seen any genuine benefits of moving towards care status. . . the flexibilities [of the Health and Social Care Act] do provide us with the ability to do everything that a care trust can do without the complications.'