Chris Ham, professor of health policy at the University of Birmingham, said the ‘NHS recession' had come too soon for initiatives like World Class Commissioning (WCC) and Lord Darzi's quality agenda to take root.    

Rewarding hospitals to treat patients and building choice and capacity are no longer suitable, he said. ‘My fear is that the NHS recession has arrived too soon for World Class Commissioning,' he told the NHS Employers conference in Birmingham last week.

‘PCTs are delivering improvements to services but it was always intended to take a couple of years. The funding challenges will kick in next year and the year after, at a point where WCC has yet to be delivered across the NHS as a whole.'

Lord Ara Darzi's quality agenda, while useful for ensuring standards do not slip, was also being implemented at the wrong time, he said.

‘Quality accounts and all the other tools in the quality kitbag - they are being implemented and tested out, but they are fragile and embryonic, at a time when they needed to more firmly embedded.'

Since the economic collapse, health ministers have maintained improving quality can deliver enough efficiency savings to rein in NHS finances. But Professor Ham said that policies created to bring down waiting times must change to suit the current economic situation.

‘Choice, capacity, and rewards for hospitals to treat patients are no longer appropriate as we move to recession and address other priorities like prevention. We need to review the policy levers, as they are not fit for purpose.'

Read this week's edition of GP dated 13 November for the full version of this story