Andrew Lansley's proposed shakeup of PCTs is causing confusion at heart of NHS, say service's top managers
Andrew Lansley's decision to shrink the number of NHS trusts has seen health service directors told they will have to leave their jobs by the end of the year, distracting the NHS leadership when it is undergoing the biggest shakeup in 60 years, internal documents reveal.
In a letter to the NHS Confederation – which represents the health service's top managers – senior executives write that a decision to cut both the size and number of primary care trusts, which commission £90bn of healthcare on behalf of patients, has led to the threat of a mass clearout at board level earlier than expected.
"We write to you with almost immediate urgency to express our huge concerns about the efficacy of the current proposals … during the current transitional period created by the health and social care bill," writes Sir Bill Taylor, the chairman of Blackburn with Darwen Teaching Care Trust, on behalf of the chairs of NHS boards in Cumbria and Lancashire, which collectively spend £3.5bn of NHS cash.
Under the health secretary's proposals, many of the chairs and non-executive board members – the local great and the good of the NHS – will be swept away.
While Lansley has made it clear the trusts will be gone by 2013, it was assumed these non-executives would be on hand to ease the transition to a new NHS where GPs call the shots and spend the health service budget. The process has already seen 151 PCTs moving to 52 PCT "clusters".
Describing the proposals to do away with boards as "on the hoof arrangements" the letter – copies of which were sent to No 10 and Lansley – warns there is "a huge potential to lose corporate memory".
The shakeup, claim executives, has left a trail of confusion at the heart of NHS – diverting precious management time away from trying to run the health service. "The whole letters, resignations, reappointments … is divisive and diversionary from the active and effective transference of responsibilities," writes Sir Bill in the letter, seen by the Guardian. Copies have been sent to Downing Street and Lansley.
Andy Burnham, Labour's health spokesman, said the government had "plunged the NHS into a leadership crisis on the brink of the toughest year in its history" and warned this was occurring without parliamentary approval.
The health bill is at a crucial point in the Lords, with the government poised to make concessions to Labour and the Lib Dems as it reaches the end of the decisive committee stage.
"The coalition's bill has still not been approved by parliament but the NHS has been radically altered anyway," said Burnham. "Andrew Lansley looks increasingly like a man on a kamikaze mission to destabilise the NHS.
"Not only has he chosen the worst possible moment to reorganise the NHS, he now removes the very people who were crucial to holding things together. By combining the financial challenge with the biggest-ever reorganisation, the government has created the conditions for a perfect storm that threatens to engulf the NHS in 2012."
The Appointments Commission, which regulates non-executives in the NHS, wrote to directors in Greater Manchester this month saying that it was "sorry to have to write to you in this manner. I know that is particularly hard to resign after you have given years of service to the NHS" but that there were only two routes open: resignation or termination of contract.
Non-executives are the only lay people with intimate knowledge of the NHS trusts, providing checks and balances in the system. The frustration with the sudden disappearance of a tier of oversight in the north of England has been mirrored by similar complaints in the south.
Last week the respected health think tank the King's Fund warned that the government was a making a mistake by handing NHS budgets in London to GPs without any body having oversight of the £20bn of public spending.
There has also been dissent by Conservatives over the turmoil caused by Lansley's shakeup.
Lord Mawhinney, a former Tory health secretary in the 1990s, told peers in October that health bosses had "decided to amalgamate the Peterborough and Cambridge PCTs. Nobody wants this. In Peterborough it did not consult the primary care trust. It did not consult the Peterborough hospital. It did not consult the Peterborough council. It just did it because it would save some money".
A department of health spokesperson said: "Primary Care Trust (PCT) clusters bring together a group of PCTs under a single executive team to ensure clear accountability for the health services provided for their communities.
"The strong feedback we have received from the NHS is that forming a common board across all PCTs in the cluster is the most effective [body]. As common boards form, the number of different non-executives needed will reduce. We have given clusters flexibility to take more time to complete this process, where necessary, and form a strong and representative common boards. The Guardian