comment: Tory plans for PCTs may give succour to those who undervalue their worth

Published: 01/07/2004, Volume II3, No. 5912 Page 15

Michael White (page 21) highlights the ever-present danger of the NHS becoming a political football. However, one of the most significant things to emerge from last week's head to head between Labour and the Conservatives over their respective health policies was the realisation of how similar they are.

The notable differences - for example, the Tories' shaky plans to subsidise private health provision - are relatively few. Privately, and sometimes publicly, politicians from both sides were admitting as much last week. Greater patient choice, increased capacity, diversity of provision and more autonomy for those providers are the headlines in both sets of policies. This is good news as it will help to reduce both uncertainty in service planning during an election year and the possibility of an NHS kick-about.

But drill deeper and a little more devil emerges with the detail. Conservative plans for strategic health authorities and primary care trusts are being sold as an attempt to make the NHS more efficient and responsive by scrapping unnecessary layers of management. These changes would mean major upheaval, and they are likely to slow the pace of change in the short term.

The significant reduction the Tories are proposing in PCTs' powers is also likely to lead to a high-profile re-emergence of the debate over their effectiveness. There have always been - and still are - those inside and outside the NHS and the Department of Health eager to predict that PCTs were 'here today, gone tomorrow' organisations .

HSJ hopes the forthcoming debate reflects the scale of the challenge facing them and the success that the best PCTs have had in meeting that challenge, particularly in view of their youth. Discussion should also reflect the fact that most of the solutions being discussed seem little more than variations on past themes which had their own, significant, problems.