County ‘facing bureaucratic minefield’ over NHS shake-up

The Government is finalising details of the radical shift in healthcare across the country which will kick in this spring as NHS directors battle to slash spending by £20bn.

But grave doubts have been expressed over the new structure that will be put in place in England’s largest county amid mounting fears there will be an increasing postcode lottery in care for the 800,0000 residents in North Yorkshire. The Government’s new regime will see GPs take charge of spending worth about £65bn nationwide.

Senior councillors have warned North Yorkshire’s complex system of local government coupled with the provision of healthcare across vast rural areas will create cumbersome bureaucracy.

Six GP-led Clinical Commissioning Groups (CCGs) will replace the existing primary care trust (PCT), NHS North Yorkshire and York, which is expected to have a £12m deficit at the end of the financial year. The PCT will pass on the bulk of the debt – which it was feared could have been as high as £19m – to the CCGs from April 1, leaving North Yorkshire as the only area of the country to be saddled with a deficit with the launch of the new structure.

The Department of Health is adamant the new regime will curb red tape blighting the NHS, claiming more focus will be placed on the actual care of patients. But the responsibilities of PCTs will be shared between the CCGs along with the NHS Commissioning Board and local councils, which will oversee campaigns to tackle obesity and smoking.

In North Yorkshire, the bureaucracy will be even more pronounced as it is the only part of the region where a two-tier system of local government exists with both a county council and seven district councils – as well as a unitary authority covering York.

The chairman of North Yorkshire County Council’s scrutiny of health committee, Coun Jim Clark, said he was concerned there would be wide variations in care across the county’s 3,120 square miles.

He said: “It is going to be very difficult to manage at a time when there is significant under-funding in North Yorkshire, and it could lead to an increasing postcode lottery for care. We have the specific challenges of providing a service in a largely rural area. There is no other area that has the complexity we are facing in North Yorkshire with so many organisations involved in the new structure.

“The challenge is to ensure the service is delivered and clinical excellence is maintained at a time when budgets are very tight and a whole new regime is being put in place. There is a very real danger that it will turn into a bureaucratic minefield.”

North Yorkshire’s healthcare system came under intense scrutiny this week amid accusations hundreds of thousands of pounds had been wasted employing consultants to help draw up a heavily criticised report.

The PCT’s managers were condemned after they failed to set out long-awaited proposals to transform care in North Yorkshire, despite paying £320,000 to experts at management consultants KPMG who helped collate analysis for the report.

Dismayed non-executive directors at the PCT said the report was “hugely disappointing” as it set out eight themes for future changes instead of an expected shortlist of options to transform services which have been mired in a decade-long financial crisis.

The Department of Health maintained the new national regime is aimed at providing the “very best care” by giving doctors and nurses more power to make decisions.

A spokeswoman said: “Doctors, nurses and other health professionals know what their patients need better than anyone. They are best placed to make sure health services meet the needs of their local communities.”

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