Primary care trusts are “too passive and lack the clinical knowledge” to commission services effectively, according to a damning report from MPs.
The Commons health committee report of its inquiry into commissioning, published on Tuesday, also questioned whether the world class commissioning programme would lead to the necessary improvements in PCTs.
This report does not offer a recommendation on how best to improve commissioning functions yet it suggests a fundamental restructuring of the NHS
The highly critical report described commissioning in the NHS as “20 years of costly failure”, and warned that the current system may need to be “scrapped” if it is found to be uneconomic.
However, committee members said one of the problems was finding accurate figures on the “bureaucratic costs of commissioning”. In particular, it said it was dismayed that senior civil servants at the Department of Health failed to provide them with “clear and consistent data”, which suggested the government “does not want the full story to be told”.
The report said constant structural reorganisations and high staff turnover had made “a bad situation worse”.
It also criticised a lack of sufficient progress on implementing recommendations made by the 2006 Carter Review on specialised commissioning, saying that many PCTs remained disengaged from it.
But PCT Network director David Stout said: “This report does not offer a recommendation on how best to improve commissioning functions yet it suggests a fundamental restructuring of the NHS which would be counterproductive and fail to address the committee’s specific concerns.”
He added: “While the full impact of the world class commissioning programme may not be evident for another two years, the first year results show the significant progress PCTs have made and we would urge caution against disregarding this.”
Department of Health acting director general for commissioning Gary Belfield has told HSJ he expects most PCTs to have significantly improved their performance on commissioning in the second year of WCC assurance results, due to be published in June.
A Department of Health spokeswoman said: “Commissioning is improving and there are many examples of PCTs across the country making a difference for their patients by investing in better quality, better value, and better-designed healthcare. Commissioners have a valuable role in helping shape more personalised and efficient care for their local populations by continuously reviewing services.
“The introduction of World Class Commissioning in December 2007 has been the first major step in transforming the commissioning skills of PCTs and is showing encouraging signs in its second year.”
A separate report on commissioning, published jointly by the King’s Fund and the Nuffied Trust, said commissioners had “few effective levers” to improve quality and reduce costs. The Where Next for Commissioning in the English NHS report recommends stronger clinical engagement in local commissioning and that PCTs may need to merge in order to secure “greater management, analytical and clinical expertise” and gain more “purchasing clout”.