Poor quality data analysis skills have played a key part in the failure of many primary care trusts to work effectively as commissioners, MPs have concluded.
A report into commissioning by the Commons’ Health Committee says that while there are some examples of good work from PCTs, many believe they are working effectively “although the evidence would suggest otherwise.”
It also says that if PCTs are to remain they should be strengthened with a more capable workforce, including staff better able to analyse and use data to commission services.
The MPs claim that management and administration costs could account for as much as 14% of the entire NHS budget and heavily criticise the government for being unable to specify the costs of commissioning.
They call for a proper analysis of the costs and say the entire purchaser/provider split may have to be abolished if it is shown to be uneconomic and commissioning fails to improve.
However, the NHS Confederation said the MPs’ findings do not accurately reflect improvements made to commissioning in recent years.
Steve Barnett, chief executive, said: “We believe that the figure of 14% is both out of date and has no relevance to the commissioner/provider split as the report implies. This is both unhelpful and misleading.”
The Health Committee’s report says that many PCTs are passive. It says they need to insist on quality and challenge the inefficiencies of providers, particularly unevidenced variations in clinical practice.
“Weaknesses are due in large part to PCTs’ lack of skills, notably poor analysis of data, lack of clinical knowledge and the poor quality of much PCT management," the report says. "The situation has been made worse by the constant re-organisations and high turnover of staff."
On data quality skills, the report says MPs heard two concerns from those who gave evidence to the committee. Firstly, that PCTs were not making the best use of the data they have and secondly that they are failing to obtain important data that they lack.
“We were informed that there was reluctance among commissioners to use the data that is available to challenge providers and reluctance among providers to be transparent about variations.
"They are often unwilling to challenge clinical ‘norms’ which may often be inefficient. This ‘information asymmetry’ had enabled large providers to resist change.”
The MPs are not convinced that World Class Commissioning is going to address the lack of capacity and skills at PCT level and weak clinical knowledge.
The committee is also concerned that the government is putting its faith in initiatives such as PROMs and Quality Accounts without piloting and rigorously evaluating their effectiveness before implementation.
The MPs say the Department of Health should commission a quantative study of levers that might be introduced to persaude trusts to improve quality and that rigid and enforceable quality and efficiency measures should be written into all contracts.
Despite the committee’s concerns about PCTs, the report says it is not convinced that the government’s plans to reduce management costs by 30% between 2010 and 2013 will help them to become effective commissioners. It says strategic health authorities should bear the brunt of the cuts instead.