Lansley denies primary care trusts are in “meltdown” as 2000 managers agree to go

Primary care trusts are not in “meltdown,” the health secretary Andrew Lansley has said, despite figures that show more than 2000 managers have agreed to a voluntary resignation scheme.

Mr Lansley told MPs on the parliamentary health select committee on 23 November that primary care trusts were not, as had been suggested to him, “in meltdown” over the government’s plans to abolish them along with strategic health authorities as GP-led consortiums take control of much of the NHS budget by 2013.

As part of the committee’s inquiry into public expenditure, Nadine Dorries, Conservative MP for mid-Bedfordshire, asked about the impact of the government’s Equity and Excellence white paper published in July (BMJ 2010;341:c3796, doi:10.1136/bmj.c3796) on primary care trusts and the fact that some managers were already leaving.

“We do have PCTs [primary care trusts] in meltdown and one of the reasons is that many people working within these trusts at the moment are taking a redundancy or sabbatical package,” she said. “You are actually giving these valuable people the opportunity to go off and do something else.”

Mr Lansley said, “PCTs are not in meltdown. They are delivering a continuing responsibility.”

The Department of Health witnesses said more than 2000 people had taken up the national Mutually Agreed Resignation Scheme (MARS), which is aimed primarily at managers in primary care trusts and health authorities.

The scheme, which was open for six weeks from mid-September to the end of October, allows individual employees, in agreement with their employer, to choose to leave their employment voluntarily, in return for a severance payment—a fixed payment rate of one half of a month’s salary for each full year of service, up to a cap of 12 months’ salary.

NHS chief executive David Nicholson, also giving evidence, said this had cost the department £40m (€47m; $63m), but would mean a saving next year of £70m and the same saving every year after that. “It saves money because we won’t replace those people. They will be part of the management cost savings we want to make,” he explained.

Accusations that these steps would leave primary care trusts in a weakened state with less capacity were rejected by Mr Nicholson, who said the department would publish an operating framework in December that would help manage the transition period.

“If you were to say to me can we sustain 152 independent PCTs between now and 1 April 2013, we can’t do that and increasingly in parts of the country we see we can’t do that now,” he said.

“We need to make arrangements so that we can pool the capacity that we’ve got. Hence in London they are looking at clustering organisations together and having one management team to run a series of PCTs. I have absolutely no doubt that that is going to be the model across the country as a whole. That will sustain the management capacity.”

The number of senior managers in the NHS has seen a 7-8% reduction in the past eight months.

MPs asked why were the government’s plans for the NHS on the scale of a “revolution,” to which Mr Lansley replied: “What I am proposing is an evolution. I have never called it a revolution.

“Practice based commissioning (PBC) consortia already exist and 92% of the country has a PBC consortia, but they don’t have the powers they ought to have. The Labour government said this should happen and didn’t do it. Why? Because PCTs existed and had the legal and budgetary control.”