The chair of the influential Public Accounts Committee has said the cross-party group of MPs struggled to find anything positive in the government’s NHS reform plan
Labour MP Margaret Hodge told HSJ committee members were “unanimous” in key concerns about funding, accountability and value for money.
“It was difficult to find a positive story to tell and we do try,” she said. “We don’t try to be critical for the sake of it.
“But there are all sorts of ways in which the reforms could actually make it more difficult to get best value just at a time when we’re trying to make savings.”
In a report published today, the committee concluded “many critical issues” had yet to be resolved, having heard evidence from the Department of Health and a range of healthcare experts.
These include the fact the overall cost of the changes could rise, especially if GP commissioning consortia refuse to employ ex-primary care trust staff.
“We were very concerned to discover that the figure is just a best guesstimate,” said Ms Hodge.
Another big worry was what would happen if healthcare providers collapsed. “There will be failures and when that does happen we need a way to ensure the interests of patients and the public are protected,” Ms Hodge said. “But it seems clear they have not thought that through.
“They seem to take it for granted that in a situation where you have a single private provider in a large area, which collapses financially and goes into liquidation it would be the taxpayer that comes to the rescue.”
Committee members were particularly concerned about services in at least 20 areas where hospitals will struggle to achieve Foundation Trust status.
The Provider Development Authority will be responsible for bringing these trusts up to scratch “but this will be particularly challenging where hospitals are burdened with PFI or other debts”, said the report.
“The department should set out its contingency arrangements to ensure the supply of services in areas where trusts cannot meet the criteria to become Foundation Trusts,” it added. “This should clarify the roles of Monitor and the Care Quality Commission in such cases.”
The DH will need to “make arrangements for handling PFI debt in a way that allows all Foundation Trusts to operate on equal terms in the marketplace”, the report continued.
MPs also said it was not clear who would ultimately responsible for ensuring local funding was well-spent and called for clarification on the roles of the health secretary, NHS chief executive, regulators and FT accounting officers.