PCT PROVISION Nurses criticise lack of consultation on key policy

Published: 03/11/2005 Volume 115 No. 5980 Page 7

The Royal College of Nursing is pushing to get a decision from the High Court before Christmas on a judicial review of Commissioning a Patient-led NHS.

The RCN has put in an application to the High Court, based on the claim that the 28 July letter from NHS chief executive Sir Nigel Crisp, instructing primary care trusts to minimise direct provision of services, constituted a 'significant change in policy' and therefore should have been subject to national consultation.

RCN general secretary Dr Beverly Malone said she had 'no warning' of the July announcement. She said subsequent local consultation which has been promised was 'about implementation rather than the new direction of travel; there has been a mis-step by the government.' And she said health secretary Patricia Hewitt's 25 October Commons statement, which said decisions on provision were for local PCTs subject to consultation, was not clear enough to constitute a change in the government position.

'You could draw implications from the language, but how do we operate on that basis, particularly as it came after submissions had already been made [by SHAs] based on the original [letter, on 28 July]?

In August, the Department of Health said submissions should not include 'firm' proposals on provision, but Dr Malone suggested all plans on reconfiguration should be halted, pending a national consultation.

She contrasted the lack of consultation with past negotiations on Agenda for Change and revisions of the pension scheme 'where we felt very involved'.

She said the decision to seek judicial review was 'not something we take lightly; the RCN is not against reform and never has been'. The RCN has lodged an 'urgent' request for a review, and asked for a decision on whether to go to review by Christmas.

NHS Alliance chair Dr Mike Dixon said the health secretary's 'conciliatory and permissive' statement to the Commons last week rendered a judicial review unnecessary.

'The health secretary has really listened carefully and reacted quite strongly in slowing things down to talk about things a little more.' He said clinicians did not oppose the direction of travel on splitting provision and commissioning, but wanted more say in which alternative providers became involved.

'I wouldn't go as far as ruling out private providers. You need a little contestability and there can be a complacency about provision. But integration is more important than competition; That is what's coming out of the public consultation'.