NHS managers’ skill levels criticised by MPs

The National Health Service lacks the leadership and commissioning skills to implement the labour government’s plans for high quality care in the NHS, a cross party committee of MPs warned.

Despite a programme called “world-class commissioning” aimed at boosting the ability of primary care trusts to buy care for their patients, “there are few signs yet” that wide variations in how well PCTs commission care have been addressed. “We doubt that most are currently capable of doing this task successfully,” the Commons health committee said.

Too many managers lacked the analytic and planning skills needed. And the MPs added that it was “striking and depressing” that commissioning was still not given sufficient status within the service, despite its being nearly 20 years since a ­purchaser/provider split was first introduced.

Furthermore, the link between primary care trusts buying care, and doctors doing the same through practice-based commissioning, “remains opaque”, the committee said, with little progress on the latter.

Part of the drive to im­prove quality involves giving a much higher profile to reporting of the outcomes of the care patients receive. But the committee says there is a lack of information about how extensive the financial incentives associated with that will be, how much it will cost to implement, when it will be fully implemented and whether it will give value for money.

The sceptical assessment of the government’s plans came as a leading academic suggested very few extra new cancer drugs were likely to be approved for use by the NHS, despite a change in policy on “end of life” treatments by Nice, the National Institute for Clinical Excellence.

Nice is to give more weight to such treatments in future assessments, and Professor Michael Rawlins, its chairman, has suggested two to three extra drugs may be approved a year as a result.

However, James Raftery, professor of health technology assessment at Southampton university, says the new arrangements “may do little to improve availability of expensive cancer treatments”.

The price of the 14 cancer drugs Nice has recommended against since 1999, either provisionally or finally, is way above the threshold of £30,000 ($44,325) per quality adjusted life year (Qaly) normally needed to gain Nice approval, Prof Raftery says, writing in the British Medical Journal.

For example, for four kidney cancer drugs that Nice is due to reappraise shortly, the cost per Qaly ranged from £72,000 to £171,000 per Qaly.

Even with a big rise in the threshold, his assessment is that “few of the rejected drugs would qualify under the new criteria”. One or two may, Prof Raftery says, where there is lack of any alternative treatment. But much will depend on how Nice interprets that stipulation.


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