A primary care trust chief executive has given a 'warts and all' account of the fitness for purpose programme now about to launch into its third wave, demanding to know whether it is value for money.
Westminster PCT chief executive Lynda Hamlyn is the first senior NHS manager to talk publicly about fitness for purpose, which has been under way since early summer.
She said the most useful parts were the scrutiny of financial and strategic planning - two of the five elements in the assessment tool which tests PCTs' competency.
'Up to now the NHS has not had a robust way of comparing PCTs' financial planning and strategy,' she said. 'McKinsey have brought a methodology that will allow that.'
However, she felt the value of the tools on governance, external relations and emergency planning were 'rather superficial'.
She added: 'We completed the operational framework but it was never graded because McKinsey said they could not come up with a way to do it.'
'It's not their area of expertise and I felt it had been put in to prove it was a rounded assessment,' said Ms Hamlyn. 'The Department of Health and McKinsey should have focused on our strategic capability and financial planning.'
The diagnostic tool - the second element of the programme and designed to test PCTs' commissioning - was disappointing, she added.
It was a 'very onerous burden' with not much in the way of benefit. A buddy process, in which Westminster PCT was paired with Croydon PCT, was limited. 'The people at Croydon were excellent but I was disappointed by what McKinsey and the DoH put into it,' she said.
Overall, Westminster PCT came out well, with green lights across the board on its assessment. The results of the diagnostic tool indicated it met at least minimum standards in all areas of commissioning, with some areas scoring good to best practice.
A development plan was agreed by the Westminster PCT board last week and will be incorporated into the business plan. The PCT is working with McKinsey on a template that can be used across the NHS.
Ms Hamlyn said that while there had been some undoubted benefits, she wanted to know whether these were balanced by the cost.
Fitness for purpose set the PCT back by one month on its delivery targets, and it jeopardised financial reporting because it was done at the same time as closing the annual accounts, she said.
The PCT received no financial support for the six-week exercise but had to allocate senior mangers and support staff.
Ms Hamlyn said: 'I do not have a problem with a high level of scrutiny. My question and that of my board is whether we got enough out of it and what sort of level of service improvement we should expect for the investment.
'If it was a good process it would be worth the money spent on it.' She added: 'The jury is still out.'
The Department of Health has consistently refused to reveal the cost of its contract with McKinsey, rejecting HSJ's Freedom of Information request on grounds of commercial confidentiality.
Caroline Taylor, chief executive of Croydon PCT and interim chief executive of Sutton and Merton PCT, has now been through fitness for purpose. 'Overall we feel it was positive and helpful,' she said.
It was hard work, she agreed, although easier in Sutton and Merton, which is in financial turnaround. 'The processes felt familiar,' she said.
Her biggest criticism was the lack of focus on health promotion and inclusion. 'This aspect was not covered at all,' she said.
First wave complete
The first wave of 25 primary care trusts completed the fitness for purpose review in August and is now working on development plans.
The second wave of 55 non-reconfiguring PCTs is nearing the end of board-to-board meetings and will start on development plans soon.
The Department of Health told HSJ it would release the results of these two waves next month along with details of measures expected of PCTs with 'red lights'.
Wave 3a of 33 reconfigured PCTs starts in October 2006 and 39 more will go ahead in January 2007 in wave 3b.