Cameron and the NHS stable door: what campaigners can do now
Cameron has graciously told us that the April 2013 deadline for GP Consortia to be established no longer applies:
We will make sure local commissioning only goes ahead when groups of GPs are good and ready, and we will give them the help they need to get there.
This doesn’t, however, do anything to resolve the little matter that Primary Care Trusts are set to be abolished in April 2013 to make way for the GP Consortia, and are already a long way down the path to their own dissolution.
Chaos now awaits.
Let’s take my own area as an example. On 28th April my PCT, NHS Central Lancashire, held an extraordinary board meeting to sign off the formation of a PCT cluster with four other PCTs in Lancashire. It did so under “directional and not optional” guidance from the Department of Health, that such clusters should be in operation across the country by the end of June 2011.
The rationale for this clustering is simple. The NHS Central Lancashire board paper states:
The 2011/12 NHS Operating Framework set out the conclusion that it will not be possible to retain effective management capacity in all primary care trusts until their abolition in 2013, presenting unacceptable risks to quality and financial management. Between now and 2013, primary care trusts will therefore be retained as statutory organisations but there will be a consolidation of management capacity, with single executive teams each managing a cluster of primary care trusts.
The details may be slightly different in other areas, but this is happening everywhere in the country.
The horse has bolted, and Cameron’s stable door tactics need to be seen for what they are. PCTs no longer have the capacity to commission locally, with most of the key redundancies having taken place in the past year. The remaining staff are completely focused on handing over to the GP Consortia as best they can, and the idea that they can simply carry on commissioning as previously is laughable.
So what should NHS campaigners do now? Each area will have it’s own peculiarities, but broadly there are five interrelated things to get our teeth into in the short term:
1) Contact the Chair/Convenor of the Health Overview & Scrutiny Committee (at the Council) and request that an emergency meeting be convened to examine what Cameron’s statement means for the PCTs and the new Cluster. These scrutiny meetings should scrutinise whether the formation of cluster boards are now valid, given that the key rationale for their formation (the end of PCTs in April 2013) is in doubt.
2) Write to PCTs themselves/attend their board meetings and ask what steps are being taken to extend their lives beyond 2013 in a way which allows them to continue commissioning. Extraodinary board meetings to reconsider decisions taken on the basis of what are now changed facts should be demanded.
3) Attend cluster board meetings (there is also the issue of whether these are actually open to the public) and seek to scrutinise their validity (as above).
4) Get locally appropriate stuff in the press, focusing on a) the cluster boards as unaccountable/invalidly set up; b) the whole bloody mess that Cameron has created by delaying his intervention till it is operationally too late for PCTs to recommence their proper function.
5) Ask MPs to get on to the Shadow Health Sec, who should be demanding revised guidance from the centre.
None of this will resolve the operational chaos which is coming, but it might just bring about a better long term situation, with some local commissioning capacity reinstated while the broader battle is fought out.