NHS trusts lack proper skills over commissioning services for patients, MPs in the Health Select Committee have said.
PCTs, which control 80% of the NHS budget and buy in services for local people, including from GPs, hospitals and private companies, had "misplaced confidence" over their own abilities, the report by the committee added.
Many PCTs are "too passive", believing they are working effectively although evidence suggests otherwise, said the report. Weaknesses are due in large part to PCTs' lack of skills – notably poor analysis of data, lack of clinical knowledge and the poor quality of much PCT management.
"The situation has been made worse by the constant reorganisations and high turnover of staff. Commissioners do not have adequate levers to enable them to motivate providers of hospital and other services."
The MPs were "dismayed" that the Department of Health had not given them clear and consistent data.
"We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts," said the study.