MPs cast doubt on Darzi reforms

News

14 January 2009

December 1, 2016

The future pay of NHS managers should be linked to their data-analysis abilities, according to MPs concerned about the health service’s capacity to implement Lord Darzi’s health service reforms.

In a report on the Next Stage Review of the NHS, the House of Commons Health Committee says primary care trusts “lack analytical and planning skills” and that the quality of their management is variable.

It expresses doubt about whether the world class commissioning programme or strategic health authorities will be able to improve the situation. Keith Barron MP, chair of the committee, said: “We remain very concerned that PCTs are not yet up to the task of putting these reforms into practice.”

The report calls for improved leadership in the NHS and says better use should be made of the NHS Graduate Management Scheme and programmes to encourage clinicians into management.

It also says the Department of Health should urgently address the issue of weak management skills in the handling and interpretation or performance and routine administrative data, such as Hospital Episode Statistics.

It says: “Senior NHS management, clinical and non-clinical, should acquire analytical skills which will enable them to understand the products of expensive and increased investment in clinical and cost effectiveness data.”

Such skills should be a central component of annual appraisals and linked to performance related pay for clinicians through the Clinical Excellence Awards as well as influencing the pay and promotion prospects of all managers.

However, the committee’s criticism of PCT managers was “misplaced” according to the NHS Confederation, which represents NHS organisations. Chief executive Steve Barnett said: “With hard won financial stability, new expertise and the world class commissioning programme, we are confident that PCTs can deliver Lord Darzi’s vision for the future of the NHS.”

The British Medical Association said the report highlighted many of the concerns that it had about the Next Stage Review and called for more support for Practice Based Commissioning. However, the Health Committee said greater clarification was needed on the role of PBC and that it is not convinced that the Next Stage Review will “reinvigorate” the scheme.

The report is not only critical of NHS managers. In evidence sessions, MPs explored whether a further review of the NHS had been necessary. Their report says the Next Stage Review’s final report repeats the DH’s “bad habit” of providing a long list of priorities without ranking them.

It also notes that it provides little information about costs and calls on the DH to publish implementation costs for individual strategic health authorities and PCTs as soon as possible.

The Health Committee report welcomes the Next Stage Review’s emphasis on improving the quality of care but notes that variations in the quality of care have persisted for a long time and despite the doubling of NHS expenditure in real terms since 1997.

The Darzi report put considerable emphasis on driving up quality by providing more information for staff on new information portals and for patients on websites such as NHS Choices. It also proposed linking quality information to trust incomes.

The Health Committee report says plans to implement an initial set of Patient Reported Outcome Measures by April looks “extremely challenging.” It says both PROMS and individual trust Quality Accounts should be “piloted and evaluated rigorously” before they are adopted by the wider NHS.

The report adds: “There is a lack of information about how extensive the PROMs incentive scheme will be; how much it will cost to implement; when it will be fully implemented; and whether it will provide value for money.”

The Committee was also unconvinced by the DH’s argument that all PCTs should have a GP-led health centre and recommended that their creation should be decided locally on a case-by-case basis – a move warmly welcomed by the BMA.