The report on commissioning from the Commons health select committee is both insightful and flawed.
Its analysis is excoriating, caricaturing commissioning as 20 years of costly failure. Many of the accusations would not be contested by players on either side of the purchaser/provider split; primary care trusts are too passive, lack the clinical knowledge and management firepower to take on the hospitals, and struggle to show the return on their costs.
The direct and indirect costs from abolition would haemorrhage cash precisely when the NHS needs to slash waste
But the committee is mistaken in claiming the commissioning system may need to be scrapped. While their frustration at the slow pace and high cost of progress is understandable, tearing up commissioning would be wrong in principle and expensive and harmful in practice.
There could be no worse time to leave the hospitals supremely powerful, when clinical standards are still too poor too often, money is tight and there is an increasingly desperate need to move care into the community, for the sake of the budget and the patients.
The direct and indirect costs from abolition would haemorrhage cash at precisely the time the NHS needs to be slashing waste, while the disruption to service provision would be severe and long lasting.
Done well commissioning can, and increasingly does, improve healthcare. While there is a long way to go, PCTs are heading in the right direction. “Clustering” - an appealing euphemism for merging PCTs’ operations - is becoming common. This is avoiding the pain and distraction of yet another national reorganisation, while recognising that the current total of 152 PCTs is too many. Talent and expertise is gradually being pulled together across cities and counties to provide the critical mass to make a difference.
It is becoming fashionable to rubbish world class commissioning, and the select committee has jumped on that bandwagon. Of course it hasn’t delivered adequate commissioning in two years, and its competency framework is better at exposing weaknesses than developing excellence. But after two decades of aimless wandering it has given commissioning a destination and a direction - as well as expose the impossibility of creating a first class commissioning organisation 152 times over.