In its new report on commissioning, the select committee agrees that reform is essential if the NHS is to meet the challenge of making 4 per cent efficiency savings over each of the next four years, totaling some £20billion.  But the MPs say the “disruptive” proposals to hand control of much of the health budget from PCTs to family doctors “came as a surprise to most observers”, which “created uncertainty” and “therefore increased the risks and costs” of making savings.  They claim the significant change of policy direction has not “been sufficiently explained”, partly because of the pace of reform and the “limited consultation”.  The report says that the Government’s approach to reform has not been the “most efficient way” of meeting its objectives, and has had an “inevitable effect on management morale”.  It warns that some PCTs are already being forced to make “awful decisions” on cuts to services and rationing treatment, which are not justified clinically.  The MPs cite evidence from one patients’ group that people are already suffering as hip replacement operations are postponed and referrals for pain treatments are not being carried out. As a result of the turmoil, some PCTs are reportedly now only offering to carry out one cataract operation on patients who require treatment to both eyes.  Stephen Dorrell, the Health Secretary under John Major who is now chairman of the Select Committee, told a press briefing on Monday: “We think there is developing evidence of some decisions by commissioners which don’t reflect the clinical priorities that I’m sure the Government would have wanted to see.  “There was one example of where patients who need two cataract operations in their eyes are being told they can only have one currently. That seems to me a relatively difficult decision to defend from a clinical point of view.”  It is also feared that the new commissioning bodies will make poor decisions as experienced staff leave the doomed PCTs and SHAs.  Dr Sarah Wollaston, a former GP who is now the Conservative MP for Totnes, said: “All of us have concerns about the process that this came forth by. Certainly to my mind it does look like someone had tossed a grenade into the PCTs.  “If the expertise isn’t there within the remains of the PCTs, inevitably they’re going to be having to turn more to the private sector.”  Valerie Vaz, the Labour MP for Walsall South, added: “I see it as a kind of smash and grab. We’re already hearing of areas where the private sector is already in there.”  She also fears the changes could see GPs subject to EU competition law for the first time, putting them at risk of legal action if they appear to give preference to local hospitals for treatment.  “My private view is that I do have concerns that it could be open to competition law.”  Leading health groups welcomed the MPs’ report.  Chris Ham, chief executive of The King’s Fund, said: "The Committee is right to highlight the risk these reforms pose to delivering on the key priority facing the NHS in the period ahead - finding up to £20 billion in productivity improvements to maintain services and improve the quality of care.”  Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said: “We too are very concerned about the scale and pace of these reforms, coming as they do when the NHS also has to find up to £20 billion in efficiency savings.  “The speed of the reforms means primary care trusts are imploding as staff leave in droves and those managers who are left are focused on delivering the reforms rather than efficiency savings and the maintenance of patient care.”  A separate report published this week is expected to cast doubt on the Government's claim that substantial savings would be made to the public purse as a result of the reorganisation.  The National Audit Office is expected to say that the creation of hundreds of mini-quangos to monitor spending by new GP consortia would cancel out efficiencies from scrapping bureaucracy in the form of PCTs.  Mr Cameron has claimed that nearly £2bn would be saved as a result of the changes within two years.  The Health Secretary, Andrew Lansley, insisted that the Government had listened to concerns about its plans and said they represented a “carefully staged transition”.  “We will cut down management costs and move away from a system run by Whitehall and regional bodies that are so far removed from patients, to one that is clinically driven and focused on quality. However, while the NHS budget is protected, it must still simplify its structure and cut bureaucracy, to release further savings to invest in care for patients.”
Patients are missing out on vital operations as the Government&rsquo;s rushed    reforms &ldquo;toss a grenade&rdquo; at the National Health Service, an influential    group of MPs has warned.