Published: 08/09/2005, Volume II5, No. 5972 Page 5
The government should slow down and re-examine 'rushed', 'incoherent', 'political' and 'vague' plans to reshape primary care, chief executives have warned.
Almost two thirds of respondents to HSJ's survey of PCT chief executives said the Department of Health should put back its deadline for submissions on PCT reconfiguration until the white paper on healthcare outside hospitals is published at the turn of the year. Strategic health authorities currently have until 15 October to submit merger proposals.
The survey suggests the majority accept the case for reform, but are angry at the government's delivery and the tight timetable imposed.
Asked to choose adjectives describing the DoH's approach, 87 per cent said it was 'rushed'. Almost three quarters described the policy as 'incoherent'.
Just under two thirds (65 per cent) described the policy as 'political'. Just under half said it was 'prescriptive' while a similar number thought it was 'vague'.
Not one described the government's approach to reconfiguration laid out in Commissioning a Patientled NHS as 'patient-led'. One per cent described it as 'coherent', two per cent said 'flexible', five per cent described it as 'permissive', and the same number said it was 'timely'.
One chief executive said that although they thought the 'underlying themes' set out in the document were 'reasonable and positive, ' the 'gung-ho' approach of the DoH and some SHAs meant the NHS is approaching an 'abyss'.
'The utter disregard for any need to construct a logical critical path to realise the benefits of the different elements mean one is making decisions on issue 'd', before one has understood the outcome of issues 'a', 'b' and 'c', they said.
'This, coupled with the gung-ho behaviour from some SHAs, means the DoH has set the NHS on a road to an abyss. Hopefully Houston will hear that we have a problem before everyone falls over the edge'.
Another agreed, arguing the process could undermine the white paper expected to reform primary, community and social care services.
'To give such a timetable in the absence of the white paper gives the impression that decisions have already been made, ' they said. Others pleaded for the government to allow 'more flexibility' and a 'more realistic timetable'.
Chief executives were asked to describe the government's approach to PCT reorganisation in their own words. Phrases and words they chose included 'crass, ' 'insensitive, ' 'naive, ' 'ill-informed, ' 'internally inconsistent - lost in translation, ' 'lunatic', 'destructive, ' 'knee-jerk, ' 'depressing, ' 'frantic' and 'irresponsible.' Another chief executive told HSJ the PCT reconfiguration was the 'right thing done the wrong way'.
'I believe DoH policy is incoherent and its leaders are refusing to accept the need to manage the introduction of payment by results, practice-based commissioning and choice in a sophisticated way. The result could be a disaster, ' they warned.
Another said the policy was illthought out. 'Policy-makers do not understand the nature of what they are changing.' Just 19 per cent of those polled were happy with both the principles and timetable for the reforms. Forty per cent said they agreed with the principles but not the timetable, while 41 per cent described themselves as opposed to the principles behind the changes.
HSJ's survey was sent out to PCT chief executives across England. A total of 86 responded.
Sir Nigel: 'It is important we eliminate uncertainty'
In response to HSJ's survey, NHS chief executive Sir Nigel Crisp said the 'ambitious and important' policy had been 'widely anticipated and debated over the last few months.' 'It is important that we move swiftly and decisively to make these changes and eliminate uncertainty, ' he told HSJ, adding he wanted to see 'imaginative local solutions about how best to improve commissioning and improve services.' He added he would be holding 'a series of meetings with PCT chief executives over the next few weeks', and is 'looking forward to discussing all of these issues in more detail.'
Survey: on other pages
Clinical engagement at risk; staff morale dealt a blow; NHS Alliance holds talks with Sir Nigel Crisp; chief executives on the loss of PCT service provision, page 6.
Management cost cuts 'will damage patient care'; chief executives on how the process has been handled; delays on senior managers' pay review sparks anger, page 7.
The survey findings in full, pages 8-9.
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