40% of PCTs failing on financial management

More than 40 per cent of PCTs have inadequate financial management and about 8 per cent provide inadequate services, according to the Healthcare Commission.

About half were rated adequate for ‘use of resources’ under a broader and tougher replacement for the star ratings system for England unveiled last week. But fewer than 8 per cent were rated better than adequate on finances, and none achieved the highest grading of excellent.  

Some 24 of the old 303 PCTs were rated inadequate for service provision. SHAs will order these PCTs, and other poor-performing NHS trusts, to produce action plans within 30 days setting out how they will improve. Any failing to do so face further intervention from either the DoH or SHAs.  

A total of 11 PCTs were rated inadequate on both quality of services and financial management, achieving the lowest possible score of ‘weak’ in both.  

GPC deputy chairman Dr Laurence Buckman said he was not surprised that PCTs had scored poorly on use of resources: ‘PCTs are not good at managing budgets because they haven’t got enough money.’  

He warned that GP performance should not be linked to PCT service quality scores: ‘GPs have minimal impact on the scores.’  

PCTs scored far better overall on quality of services than use of resources. A total of 99 PCTs were good or excellent in this category, compared to 24 in the financial rating.  

Healthcare Commission chairman Sir Ian Kennedy said the NHS ‘must raise its game’.  

He called the new performance rating system the ‘most comprehensive assessment of NHS performance ever carried out’.  

Under the system, called the annual health check, trusts were asked to publish reports on their performance, self-declaring failure in any key target areas. About 43 per cent of trusts admitted failure in at least one.  

The accuracy of their reports was tested through random inspections and targeted visits.  

Trusts were rated on a four-point scale of excellent, good, fair and weak. Quality of services ratings were based on achievement against core standards covering issues such as public health, patient treatments, DoH targets and the results of regular ‘improvement reviews’.  

Gary Needle, head of the annual health check at the Healthcare Commission, said PCT performance was ‘particularly concerning’.  

‘PCTs have the poorest performance, and deficits are not the only cause of concern — 87 PCTs would have received a rating of weak on financial management even without them,’ he said.  

In some areas, high quality of services appears to be linked with poor financial management. In the East of England SHA, 76 per cent of PCTs were weak on financial management, but almost half scored good or excellent on quality of services.  

However, Mr Needle told GP there was ‘no evidence that PCTs have to overspend to achieve high quality’. He pointed out that no PCTs with a rating of weak for quality of services scored better than fair for financial management.  

The ratings apply to the 303 PCTs in operation in the 2005/6 financial year, many of them have now merged.  

Healthcare Commission chief executive Anna Walker said there was undoubtedly a link between poor performance and reorganisation.  

‘A high number of trusts that scored weakly on both quality of services and use of resources have been reorganised,’ she said. 

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