HEADLINE NEWS
PAYMENT BY RESULTS
The Health Services Journal will publish on 19 May an article
reporting on the findings of a recent CIPFA sponsored study
visit to Germany to compare and contrast their equivalent
Payment by Results policy. With radical changes to Tariff
Structure and major shifts in Market Forces Factors late last
year and now a twelve month delay in its application to all
but Elective Services, “Payment by Results” in
England has not had a smooth take off. Colin Dunn and Suzanne
Tracey look for lessons from Germany who are also implementing
a DRG based system for funding hospitals. In particular the
aim of the visit was to look at financial risks of implementing
such systems and how these are being managed.
CIPFA NEWS
CONFERENCES/SEMINARS
Health Conference 2005
This annual event will be held in Bournemouth on the 6 and
7 October. More details will be provided as soon as they become
available.
To register and receive more details of events please contact
Alexandra Aarons, CIPFA, 3 Robert Street, London, WC2N 6RL
(tel 020 7543 5751; e-mail alexandra.aarons
@cipfa.org). Further details can also be found on the
CIPFA website: www.cipfa.org.uk/shop
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CIPFA HEALTH ADVISORY NETWORK
An Introduction to Finance and the NHS
NHS Finance staff or those who have recently taken on budgeting
responsibilities often find it difficult to appreciate and
understand the continually changing structure of the NHS as
well as keeping up to date with the current health finance
reforms agenda.
The CIPFA Health Advisory Network has developed a one day
workshop to help participants gain a wider understanding of
where their role fits within the current NHS structure, to
explore the various functions of a typical finance department
and review the development of key aspects of finance and commissioning.
20 April - York
11 May - Central London
8 June - Leicester
22 June - Central London
If you would like further details about the CIPFA Health
Advisory Network or the above event, please visit our website
at www.ipf.co.uk/healthcare
or email health@ipf.co.uk
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FINANCIAL MANAGEMENT
Strong and effective financial management is key to well-managed
and sustainable public services.
The CIPFA Financial Management Model (FM Model) is a web-based
self-assessment tool that examines financial management in
the public services. It tests how an organisation measures
up against 42 good practice statements and places that organisation
into a spectrum of three 'styles'- Enabling Transformation,
Supporting Performance and Securing Stewardship - to build
a picture of how finances are working and identify areas for
improvement. A key feature is the ability to survey opinion
throughout the organisation.
The FM Model sits on a secure website that lets users score
and evidence the good practice statements, revisit, collate
and report on their scores and target questions at key people
to test views and opinions. It offers organisations the opportunity
to:
- Manage strategic risk through self-assessment;
- Identify strengths and areas for improvement;
- Prioritise improvement;
- Be better prepared for inspections and audit;
- Review and track its progress over time;
- Benchmark performance against other comparable organisations
For more information visit www.cipfa.org.uk/shop
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PUBLIC MONEY AND MANAGEMENT ASSOCIATION
(PMPA)
The Public Management and Policy Association (PMPA) is a
national membership organisation, managed by CIPFA, dedicated
to helping managers, policy makers and academics keep in touch
with and understand the wider cross-cutting developments in
public policy making that affect the governance, general and
financial management of the public services. In addition to
excellent networking and personal development opportunities
across the public services, the benefits package includes:
- Priority booking for PMPA lectures
- Subscription to Public Money and Management
- Up to three PMPA reports each year
- The PMPA quarterly review
PMPA lectures in 2005 include:
- Are We Being Served Appropriately? Citizens, Clients
and Customers as Service Beneficiaries: Andrew Gray. 18
October 2005.
The latest PMPA publication ‘Public Accountability
in Practice - The Need for Public Scrutiny’ authored
by Jane Martin of The Centre for Public Scrutiny - is now
available.
Individual Membership is £80 (£75 for CIPFA and
other associate member organisations) and £35 for retired
members and full time students. Corporate rates start at £350
for up to five persons registered by their employing organisations
to receive the benefits package.
Full details are available on the Association's website www.pmpa.co.uk/
or email info.pmpa@cipfa.org
asking for an information pack and sample publications.
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PUBLICATIONS
Financing of Chronic Disease Management
The Panel has commissioned guidance on the Financing of Chronic
Disease Management, which it plans to publish in May.The guidance
will examine clinical and policy issues and financial mechanisms
for promoting good practice with a number of case studies.
The guidance will examine clinical and policy issues and
financial mechanisms for promoting good practice with a number
of case studies.
Public Money and Management (PMM)
Public Money & Management is owned and managed by CIPFA,
and is the official journal of the Public Management and Policy
Association which is published on behalf of CIPFA by Blackwell
Publishing.
Public Money & Management has a multidisciplinary and
international audience. It publishes articles which contribute
new knowledge as a basis for policy or management improvements,
or which reflect on evidence from public service management
and finance in order to suggest topics for research. Readers
include: officials in all types of public service organizations;
academics; consultants and advisers working with the public
services; politicians; journalists; and students on both academic
and professional courses.
In response to a steady rise in sales and submissions, Public
Money & Management increased its frequency in 2004 from
quarterly to five issues per year. The number of pages in
the volume was also increased: from 256 pp. a year to 320
pp. Future issues in 2005 will be published in June, August,
and October. Articles for consideration by the editors should
be sent to micky@mickylavender.com
Public Money & Management has a strong reputation: citations
have increased steadily in the UK and abroad and its articles
were prominent in submissions by academics to the Research
Assessment Exercise of 2001. Blackwell Publishing's recent
survey of readers has also strongly endorsed Public Money
& Management's position as a bridge of academic and practitioner
interests.
For further information on PMM and details on how to subscribe,
please see www.cipfa.org.uk/pt/pmm.cfm.
Spectrum
The March issue of Spectrum includes two contributions from
the United States – one reviewing the US accounting
standards setting scene and the other drawing on US local
government’s experience of encouraging citizen participation
in the finance and budgeting process.
The issue can be downloaded at www.cipfa.org.uk/pt/download/spectrum_issue08.pdf
(PDF size: 147KB)
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STUDENT WEBSITE
The student section of the CIPFA website has been voted overall
winner in PASS Magazine's annual review of professional accountancy
body websites. This achievement reflects CIPFA's ongoing commitment
to developing online services and ensuring that the most up-to-date
resources are available to students online. Read more: www.cipfa.org.uk/eandt/current/show_notice.cfm?news_id=22889
TIS HEALTH ONLINE
If you are interested in contributing, or would like free
trial access to the site, please contact Sarah Ellison on
020 7340 1203 or at sarah.ellison@ipf.co.uk.
OTHER NEWS
ENGLAND
ACCIDENT & EMERGENCY
Hospital Trusts who have consistently seen 97% of patients
in and out of A&E within four hours or less will receive
£100,000 extra capital funding each to develop services
across their hospital, the Health Minister announced in February.
This is the fourth stage of a capital scheme where every
hospital trust in England delivering faster care for patients
in A&E is able to access up to £500,000 until March
2005.
For further details on A&E attendances; total time spent
in A&E from arrival to admission, discharge or transfer
and waiting for emergency admission through A&E: quarter
ending 31 December 2004, please visit www.performance.doh.gov.uk/hospitalactivity/index.htm
ADULT SOCIAL CARE
A Green Paper to consult on a new vision for the future of
social care for adults in England was published in March.
It sets out ways to transform the lives of people who use
social care by giving them more control and more choices on
how their needs are met. This can be done by re-designing
services, developing new ways to support people and improving
the skills and status of the social care workforce. Responses
can be completed via an online questionnaire.
For more details visit www.dh.gov.uk.
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AUDIT COMMISSION
The Audit Commission is reducing its public service inspection
costs by 50 per cent as part of its strategy to maximise the
value for money of its work. It aims to drive improvement
in public services, while minimising the burden of regulation.
In April, the Commission issued a statement highlighting
the different responsibilities of grant-paying bodies, authorities,
the Audit Commission and appointed auditors in relation to
claims and returns. Also A Code of Audit Practice determining
the nature, level and scope of local audit work has been developed
in consultation with the Healthcare Commission. The Code will
enable the Commission to provide the assurances on proper
stewardship and value for money in the use of resources, which
underpin the delivery of high quality services to the public.
The new Code will first apply to 2005/06 audits.
For more details visit www.audit-commission.gov.uk.
BREAST SCREENING
Statistics published in February show a big increase in the
number of cancers detected by breast screening. In 2003/04
over 14% more cancers were detected compared to the previous
year with over 11,000 women having breast cancer detected
and treated following screening for the disease. Since 2001
the total number of cancers detected through breast screening
has risen by nearly a third.
Screening can help cancer be detected and treated earlier
which means women can have a much better chance of survival.
Of the 11,000 cancers detected last year, nearly half were
smaller cancers, which could only be picked up through screening.
The increase in the number of cancers being detected by screening
is largely due to the introduction of two-view mammography
- which involves taking two views of each breast at every
screen instead of just at the first. As of December 2004,
over 95% of local screening units were using this technique.
Investing £11.5 million to extending the breast screening
programme to women aged 65-70 coupled with an extra £11.4
million for equipment has also helped to significantly improve
the number of cancers picked up.
The statistical bulletin 'Breast Screening Programme, England
2003-04' are available on www.dh.gov.uk
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CANCER SERVICES
Reform has published a new report showing that increased
expenditure on unreformed NHS cancer services has failed to
provide value for money.
The report, Cancer care in the NHS, is written by
two leading oncologists, Professor Karol Sikora and Dr Maurice
Slevin, and Professor Nick Bosanquet, Professor of Health
Policy at Imperial College London. It shows that the Government
has devoted very large expenditures to improve cancer care
since the publication of the National Cancer Plan: nearly
£2 billion over five years. Very little value for money
has been achieved for this huge investment. The Cancer Plan
is not delivering as hoped and there are no reasons for expecting
any dramatic improvements in the future.
The Department of Health has drawn attention to increases
in staffing and equipment. In fact the staff expansion has
been modest and has probably had little impact on direct patient
care. 75 per cent of the new radiotherapy machines are simply
replacements of existing machines. Many new machines are lying
in boxes because of staff shortages.
Cancer services are operating in a confused, top-down bureaucracy.
Cancer patients often live in poor health unnecessarily for
long periods of time due to a lack of co-ordination of their
care.
The report concludes: "Sustained improvement in system
performance is essential. Real improvement will not be achieved
by simply giving more money to a burgeoning bureaucracy. It
requires a serious commitment to reform."
To download the report visit www.reform.co.uk/website/home.aspx
CARE EFFICIENCY SERVICES PROGRAMME
To keep up to date with the Programme, a newsletter is now
available at www.dh.gov.uk
CARE HOMES INSPECTION AND REGISTRATION
Commission for Social Care Inspection fees are to rise across
the board by 20 per cent from this year’s levels. Healthcare
Commission registration fees will rise by 50 per cent, with
increases in inspection fees ranging from 20 to 55 per cent.
The changes will see care homes’ registration fees
rise from £1,584 to £1,901, and their annual inspection
fees from £216 to £259.For more details visit
www.csci.org.uk
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CARERS GRANTS
In February Health Minister Stephen Ladyman encouraged local
councils to give carers a break from their duties by announcing
an extra £60m for Carers’ Grants.
A fund of £185m will be allocated to councils in 2005/6
for the Carers Grant. This will enable them to provide support
to England’s estimated 5m carers, bringing the total
awarded since the Carers’ Grant was introduced in 1999
to £635m. The Minister also announced that the Carers
Grant will continue at this new higher level until at least
2008.
The government is currently consulting on guidance relating
to the Carers (Equal Opportunities) Act, which received Royal
Assent on 22 July 2004.The Act will ensure that carers are
able to take up opportunities which those without caring responsibilities
take for granted. As a result of the new Act, existing legislation,
namely the Carers and Disabled Children Act 2000 and Carers
Recognition and Services Act, will also be amended.
The grant guidance, grant determination and allocations are
available from the Department of Health website www.dh.gov.uk
CATARACT SERVICES
Long waits for NHS cataract operations have ended following
a £73 million drive to speed up access for the procedure
announced by Health Secretary John Reid.
The Department of Health said that by the end of January
2005 there was no one waiting more than three months for their
first cataract operation. Most cataract patients can now expect
to be treated within six weeks.
The achievement of a maximum three-month wait for cataract
operations is four years ahead of the NHS Plan target. Alongside
extra operations in the NHS, independent sector treatment
centres have been providing more than 13,000 additional cataract
operations. The independent sector treatment centre programme
includes two ophthalmology mobile units operating throughout
England, and a fixed site in Daventry.
For more details visit www.dh.gov.uk
CONTRACEPTIVE SERVICES
An adjustment has been made for selected PCTs. This additional
one-off investment is a result of the £1 million announced
in the Government's response to the Health Select Committee
report on sexual health.
For more details visit www.dh.gov.uk
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COUNTER FRAUD
Section Four of Revised Secretary of State Directions to
NHS organisations on counter fraud measures issued in November
2004, specified the role of non-executive directors or non-officer
members of NHS bodies in the promotion of counter fraud measures.
This section has now been withdrawn and CFSMS is considering
the most appropriate way to progress this work. All the other
sections of the original Direction remain extant.
The revised Direction can be found at: www.dh.gov.uk/PublicationsAndStatistics/Publications.
DENTAL SERVICES
A revised Statement of Dental Remuneration, effective from
1 April 2005, and covering letter, is available at www.dh.gov.uk/PublicationsAndStatistics.
DEPARTMENT OF HEALTH
The Department has published this year's winter report, which
thanks staff and demonstrates that despite pressures and increased
demand for services, the NHS delivered sustained improvements
in key areas such as A&E and primary care and patients
received better quality health services during the winter
months.
Available at www.dh.gov.uk
DIAGNOSTIC SERVICES
NHS Patients will get speedier access to high quality diagnostic
tests in future thanks to a £1 billion procurement announced
in February.
The scheme will dramatically boost NHS capacity to provide
diagnostic services and means patients will benefit from much
quicker access to services such as MRI, CT and ultrasound
scans.
The Department of Health will invite expressions of interest
from independent sector providers in the next few weeks. The
current estimate of the number of procedures that will be
procured under this scheme is around two million per annum.
This project now enters programme procurement phase where
an outline business case is finalised and a formal advertisement
placed in the Official Journal of the European Union.
Last summer the Department of Health completed a deal with
Alliance Medical to provide 120,000 scans in mobile MRI scanners.
This one deal boosted MRI scanning capacity by 15%.
For more details visit www.dh.gov.uk
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EXTRA CARE HOUSING FUND
In February, Community care Minister Stephen Ladyman announced
the winning bids for this year’s £40m Extra Care
Housing Fund.
The winning bids will provide an extra 979 homes for older
people and learning disabled adults across England.
Extra care housing supports independent living and increases
choice by providing older people with their own homes together
with care and support that meets their individual needs. Extra
care housing schemes can provide 24-hour support, meals, domestic
help, leisure and recreation facilities and a secure environment.
The 21 winning bids who will each receive a share of £40m
for extra housing units or improvements to existing communal
areas. The Housing Corporation has committed an additional
£4,623,185 match funding towards three of the bids.
Further information on the successful bids can be found on
the Department of Health website at www.dh.gov.uk
FEE FOR SERVICE SCHEME
An initiative to reward doctors and other staff for carrying
out extra work is to be rolled out further across the NHS,
the Health Minister John Hutton announced in February.
It will mean new ways of working, leading to thousands of
NHS patients having their operations more quickly and help
the NHS work towards the 18 week referral-to-treatment target,
Mr Hutton said.
The Fee for Service scheme involves consultants and other
staff receiving bonus payments for the operations or other
treatments that they perform on top of the volumes they would
normally be expected to carry out.
Mr Hutton also said the scheme would be piloted for the first
time in the diagnostic sector to help speed up diagnostic
tests.
Fee for Service has been piloted in 32 NHS Trusts from last
October. The pilots involved 400 doctors and other clinical
staff and set a target of 8,000 additional operations and
6,000 outpatient consultations. A report undertaken for the
Department found that the scheme is expected to deliver these
targets by the end of March 2005 and - in the case of inpatient
activity - to exceed the target by delivering over 8,400 additional
operations.
The report on the pilots was undertaken by SERCO and is available
at www.dh.gov.uk/publications.
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FOUNDATION TRUSTS
In March Monitor published the compliance framework for NHS
foundation trusts following full consultation with stakeholders.
The framework makes the board of directors of each foundation
trust principally responsible for ensuring that the foundation
trust complies with its terms of authorisation.
Monitor has adopted a risk-based approach to regulation
with transparency in how the risks that each foundation trust
faces are assessed. This will ensure that the regulatory burden
is proportionate, with the most successful foundation trusts
having less regulatory oversight. Steps have also been taken
to avoid duplication of regulation with other organisations
and to minimise the information requirements on foundation
trusts.
In addition Monitor also published the Compliance Framework,
which adopts a risk-based approach to regulation with transparency
in how the risks that each foundation trust faces are assessed.
This will ensure that the regulatory burden is proportionate,
with the most successful foundation trusts having less regulatory
oversight.
For more details visit www.regulator-nhsft.gov.uk/publications.
The CIPFA responses to the above consultation documents can
be found at www.cipfa.org.uk/panels/health/responses_health.cfm.
FOSTER CARE
Local authorities wishing to develop a multi-dimensional
treatment foster care programme are invited to bid for a pump-priming
grant, which will assist the introduction of a specific intervention
for young people with anti-social behaviour and severe behavioural
problems within a structured living environment. Training
and on-site consultation will be provided to the multi-disciplinary
team in the successful programmes. Bids should only be submitted
if the criteria identified in Annex A of LASSL (20050 1 can
be met.
The circular is available from www.dfes.gov.uk.
KINGS FUND
A new £1 million funding and development programme
to improve the health of Londoners was announced in February
by the King's Fund.
The new scheme, Partners for Health in London, will replace
the King's Fund's existing grants programme from June and
will focus the health charity's development efforts on four
areas where health needs remain unmet. These are end-of-life
care, sexual health, mental health advocacy and integrated
health care.
Partners for Health in London will offer total funding of
£1 million annually for organisations to work with the
King's Fund to improve the health of Londoners across these
four areas, as well as providing development support for those
partners.
On top of this, the King's Fund is setting up a Strategic
Development Fund to invest a further £500,000 a year
into additional work to test out new approaches to health
care in practice.
The King's Fund will take forward the following projects
in 2005:
Reviewing prescription charges later this year, the King's
Fund will look at prescription charges for people with long-term
conditions and review the fairness of the current arrangements,
which are widely acknowledged to be illogical, outdated and
inequitable.
Ensuring fairer access for black and minority ethnic communities.
Later in 2005, the King's Fund will conduct an audit into
the scale of inequalities in access to health care facing
Londoners from black and minority ethnic (BME) communities.
Analysing future health care funding. The NHS has received
unprecedented levels of funding over the last five years,
but the huge increases are unlikely to be sustained beyond
2007/8. So how will we know when enough is enough? This will
be the subject of a major report the King's Fund will publish
this autumn.
Examining public involvement in the NHS Foundation trusts
have been told that they should involve local communities,
but are the new arrangements working? The King's Fund will
publish the findings of its recent initiative to bring together
around 60 governors from first wave foundation trusts to hear
their views. Work in this area will continue with the culmination
of a year-long study into one foundation trust in London,
and its new governance arrangements.
Review of public health programme. Following the Government's
publication of its public health White Paper in November 2004,
the King's Fund is reviewing its public health programme.
This will continue to be a vital part of the King's Fund's
activities and the new programme will involve both monitoring
progress on public health and undertaking original work to
develop ideas that help people keep as healthy as possible.
For more details visit www.kingsfund.org.uk.
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LEARNING DISABILITIES SERVICES
Services for people with learning disabilities are set to
receive over £41 million in Government funding, Stephen
Layman, Minister with responsibility for community, announced
in February.
This boost in funding has been allocated to Primary Care
Trusts to provide services through the Learning Disabilities
Development Fund (LDDF) and is almost double the amount received
last year. The LDDF is an important mechanism for ensuring
that the NHS funding which would have supported residents
in long stay hospitals under earlier regimes is used to achieve
the objectives of Valuing People.
Priority areas earmarked for funding in previous years have
been:
- Advocacy - developing and expanding services to support
people to speak up,
- Person Centred Planning - a way of helping people get
what they want in their life, starting with the person,
their wishes and aspirations, and
- Leadership - developing and supporting leadership, including
people with learning disabilities, families and others providing
support.
For 2005-06 there are 3 additional priorities, which reflect
the significant increases in funding. These are:
- Day services modernisation
- NHS Campuses reprovision - redevelopment of the residential
services developed by the NHS as a result of the contraction
or closure of NHS hospitals, and
- Support for people with learning disabilities from black
and minority ethnic communities.
The third annual report on the progress Government departments
have made in implementing Valuing People and ensuring that
people with learning disabilities are more fully included
in society will be published later this year.
The white paper is available on the Department of Health
website at: www.dh.gov.uk/PublicationsAndStatistics/Publications.
In addition the capital allocations for the 2005-06 Learning
Disability Development Fund (LDDF) have been confirmed. Further
information and individual allocations are now available at
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/LearningDisabilities.
MENTAL HEALTH SERVICES FOR DEAF
PEOPLE
The NHS must provide specialised services for deaf people
with mental health problems, such as a sign language translation
in every GP practice, according to new guidance published
by the Department of Health in February.
The guidance, Towards Equity and Access: Mental Health and
Deafness sets out how mental health services for Deaf people
can be improved using the template of the National Service
Framework for Mental Health as a starting point, and is supported
by £2.5 million of funding for PCTs. Recommendations
include:
- front-line NHS staff being given deaf-awareness training;
- child protection committees reviewing their procedures
to ensure that Deaf children's needs are being met; every
primary care facility having access to sign language translation
services; staff in mental health facilities being encouraged
to learn sign language.
There is a higher incidence of mental health problems among
Deaf people compared to the hearing population - studies show
that 40 per cent of Deaf children have mental health problems,
compared to 25 per cent of hearing children. Many Deaf people
suffer from social exclusion and reduced educational and employment
opportunities, and there are well-documented links between
this and mental health problems. Deaf people with mental health
problems are also over-represented in prisons and the criminal
justice system.
The guidance - "Towards equity and access: mental health
and deafness" is the Department's response to the 2002
consultation on mental health and deafness, "Sign of
the Times” at www.dh.gov.uk/PublicationsAndStatistics/Publications.
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NATIONAL AUDIT OFFICE
The National Audit Office is conducting a report on Stroke
Care. The report will focus on the key question: Are the Department
of Health and the NHS providing a well managed and effective
stroke care service in England? and is due to be published
in November 2005.
The NAO also published in March that, four years into the
10-year NHS Cancer Plan, substantial progress has been made
in meeting the Plan’s targets. The thirty-four cancer
networks, which have been established, have achieved important
improvements in delivering cancer services across England.
However, the networks need to be more effective and to develop
partnership working further if the targets in the Plan are
to be fully met by 2010.
For more details visit www.nao.org.uk.
NHS FUNDING
In February the Health Secretary announced how £135
billion investment in the NHS will be allocated to English
Primary Care Trusts for the next two financial years 2006/07
and 2007/08.
The money will guarantee the NHS continues to deliver improved
services and make further progress in tackling the big killer
diseases like cancer and heart disease.
The allocation is based on the following principles:
- Increases for all. No PCT in England will receive less
than an average of 8.1% per year over the two years, 2006/07
and 2007/08.
- Improving access to services. Waiting times for operations
are being tackled, from long 18 month waits down to a maximum
18 weeks by 2008; Making prevention as important as cure.
The cash allocations will help to fund the Public Health
White Paper initiatives like school nurses, community matrons
and health trainers;
- Fairness. Those in greatest need have been allocated
more money. In November, John Reid announced the creation
of 88 spearhead PCTs as those most in urgent need of action
to tackle health deprivation and reduce inequalities in
life expectancy and infant mortality. These areas have received
a higher level of funding than other areas making the allocation
much fairer.
Three years ago PCTs had an average of £907 per head
of funding for patients. Today's announcement brings the average
across England up to £1,388 per patient and around £1,710
for the areas with greatest need. A full breakdown of the
PCT allocations is available from www.dh.gov.uk.
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NURSING CARE
Allocations for 2005/06 that take account of changes to the
arrangements for the funding of short-term respite care, centralised
in seven PCTs, are at www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/IntegratedCare/NHSFundedNursingCare
OLDER PEOPLES SERVICES
In March, Health Minister Stephen Ladyman announced funding
of £60m for councils to develop innovative ways to help
older people avoid emergency hospital visits and to live independently
longer.
The £60m Partnerships for Older People Projects (POPP)
grant aims to encourage councils in England with their NHS,
local government, voluntary and community sector partners
to devise innovative approaches to establishing sustainable
arrangements for supporting older people in active and healthy
living.
Successful projects will reduce reliance on hospitals and
other institutions by introducing new approaches which emphasize
healthy and independent living, including supporting older
people in their own homes, active rehabilitation and health
promotion such as falls prevention. They will also take account
of the ideas contained in the Green Paper on Adult Social
Care, due to be published shortly.
Successful projects will be notified in September 2005.
Further information about POPP and a prospectus of guidance
to support applicants is available from www.dh.gov.uk.
OSTEOPOROSIS SERVICES
People with suspected osteoporosis will be diagnosed more
rapidly and treated more quickly thanks to a £20m investment
in scanning equipment and service improvements announced by
Health Minister Stephen Ladyman in April.
One in three women over 50 suffer from osteoporosis, which
can lead to fractures and disability. DXA scanners measure
bone density and are used to diagnose osteoporosis. A cash
injection of £3m this year will quickly increase the
NHS's capacity to provide this key diagnostic service. And
a further £17m will be made available over three years
to build NHS capacity to improve access and reduce waiting
times.
For more details visit www.dh.gov.uk.
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PAYMENT BY RESULTS
The NHS Alliance, which speaks for primary care trusts and
providers, said these fundamental reforms to the health service
were under threat because they were badly designed.
GPs will refuse to take up practice-led commissioning because
the payment by results system is riddled with errors and there
is no means of rectifying mistakes according to the study,
Caveat emptor – Buyer beware in February. Its findings
suggest that the reforms, still in their infancy but central
to the government’s NHS modernisation plans, are already
failing.
The three-month study monitored all the payments going to
an anonymous foundation trust from one GP surgery.
It found that the coding system being used for PBR, which
so far has been implemented only by foundation trusts, is
not detailed enough to reflect accurately the costs of patients’
treatments.
PBR groups procedures and diagnoses into broad categories,
which each have a tariff attached. The alliance found that
conditions requiring routine treatment could cost more than
complex conditions because they fall in a category with a
higher tariff.
For more details visit www.nhsalliance.org.
PERFORMANCE RATINGS
In proposing performance indicators for 2004/2005, the Healthcare
Commission has reduced the burden of data collection on trusts
and PCTs. Accordingly; the number of indicators requiring
special data collection has been reduced. Six indicators require
addition of data lines to the Local Delivery Plan Return [LDPR]
Q4 exercise. Data for the Child Protection indicator will
be collected using a web based tool available on the Healthcare
Commission website.
For more details visit http://ratings.healthcarecommission.org.uk/indicators_2005/
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PERSONAL SOCIAL SERVICES
Personal Social Services expenditure and unit costs: England:
2003-2004 were published in February.
The main findings were as follows:
- In 2003-04, gross current expenditure by Councils with
Social Services Responsibilities in England on Personal
Social Services was £16.8 billion, an increase of
11% in cash terms (8% in real terms) on the previous year.
Part of this increase reflects expenditure funded from the
Supporting People grant. When this is excluded, expenditure
rose by 7% in cash terms (4% in real terms)
- In 2003-04, expenditure on services for children and
families accounted for 24% of total gross current expenditure,
whilst expenditure on services for older people accounted
for 44%
- In 2003-04, expenditure on residential provision accounted
for 43% of total gross current expenditure, whilst expenditure
on day and domiciliary provision accounted for 42%; assessment
and care management accounted for 15%
- Over the 10 years from 1993-94, gross current expenditure
on Personal Social Services more than doubled in real terms
For more details visit www.dh.gov.uk.
PRACTICE BASED COMMISSIONING
More cash could soon be invested in a range of GP services
as a result of the Government’s scheme to allow practices
to directly commission services.
Technical guidance on Practice Based Commissioning, published
by Health Minister John Hutton in February, encourages practices
to hold budgets for the full range of patient care, not just
elective care. This will give the best opportunity for clinicians
to redesign services to better meet the needs of the patients.
Mr Hutton also confirmed that GPs will be able to invest
savings gained under Practice Based Commissioning in premises
and other capital developments – such as new diagnostic
equipment – to develop a wider range of services in
a primary care setting.
Practice Based Commissioning will allow GP practices to
keep up to 100 per cent of any savings they make from the
direct commissioning of services. By directly commissioning
care, GPs could reduce prescribing costs, slash unnecessary
hospital admissions and create savings for investment in local
practices.
GPs must re-invest the savings in developing or providing
services for patients. Other options for re-investment include
more specialist care, diagnostics, equipment and staff.
The technical guidance clarifies the requirement, set out
in last December’s final guidance, that practices involved
in Practice Based Commissioning utilise Choose and Book.
It also confirms that healthcare practitioners other then
GPs, such as nurses, will be able to hold a Practice Based
Commissioning budget. In addition, the guidance provides GPs
and PCTs with recommendations on budget setting and management
costs.
Under the Practice Based Commissioning scheme, GP practices
will be incentivised for conducting x-rays, tests and outpatient
consultations within their practice or commissioning these
services from another provider.
From April 2005, practices will have the right to hold a
practice based commissioning budget. Participating practices
will receive a paper or ‘indicative budget’ from
PCTs that they can use to directly manage delivery of services
for their patients.
For more details visit www.dh.gov.uk
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PRIMARY CARE TRUSTS
AWP (06-07) PCT01 together with Notes to the initial resource
baseline (IRB) 2006-07 and the initial resource limits (IRL)
2006-07 & 2007-08 were published in March.
For more details visit www.dh.gov.uk.
PROFESSIONAL EXECUTIVE COMMITTEES
The Secretary of State has decided to uplift Professional
Executive Committee Allowances by two per cent for 2004/05.
For more details visit www.dh.gov.uk.
SEXUAL ASSULT REFERRAL CENTRES
Government grants of £70,000 are available to help
PCTs set up new SARCs in partnership with police forces and
the voluntary sector. SARCs offer an integrated service to
victims of rape/sexual assault, meeting their various medical,
forensic, advice and support needs quickly and sympathetically.
Many SARCs are located in hospitals and a health contribution
is crucial to their efficacy. SARCs can relieve pressure on
health services, such as GUM, GPs, A&E and mental health
that are frequently accessed by rape victims but are rarely
equipped to provide the specialist care required.
Further funding information at www.homeoffice.gov.uk.
WANLESS SOCIAL CARE REVIEW
The Kings Fund launched a major investigation in January
into the long-term demand for and supply of social care for
older people in England. This is led by former NatWest Group
chief executive Sir Derek Wanless, and follows the two independent
reviews that Sir Derek conducted for the Government on future
health care spending in the United Kingdom and on public health
in England.
The terms of reference for the Wanless Social Care Review
are:
- to examine the demographic, economic, social, health,
and other relevant trends over the next 20 years that are
likely to affect the demand for and nature of social care
for older people (aged 65 and over) in England
- in the light of this, to identify the financial and other
resources required to ensure that older people who need
social care are able to secure comprehensive, high quality
care that reflects the preferences of individuals receiving
care
- to consider how such social care might be funded, bearing
in mind the King's Fund's commitment to social justice
- to report by Spring 2006.
For more details visit www.kingsfund.org.uk/healthpolicy/wanless.html
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SCOTLAND
CAPITAL INVESTMENT
Capital investment of £426 million for health services
across Scotland and allocations to the 15 Health Boards from
April was announced in February.
The capital allocations announced today are calculated using
the Arbuthnott formula adjusted for cross boundary flow and
weighted for specialist services.
The formula itself, takes account of the population in the
NHS board area, the age of the population, gender, level of
deprivation and the proportion of population living in remote
and rural areas.
The additional £426 investment is for the financial
year 2005-2006 and is a 21.6 per cent rise in capital funding
compared with 2004-05. NHS Boards will receive an average
increase of 10 per cent.
The funding comprises £220 million for NHS boards
and £206 million for special NHS boards and national
projects such as Phase II of the Beatson Oncology Centre,
improving NHS IT systems and the modernisation of GP surgeries
to deliver a wider range of care.
A total of £220 million of capital allocation funding
is available to NHS boards for 2005-06 and this will increase
to £264 million (2006-07) and £317 million in
2007-08.
There is a £20 million increase in funding for NHS
boards in 2005-06 compared with 2004-05.
For more details visit www.scotland.gov.uk
PERSONAL CARE
The Scottish executive has pledged to revisit the cost of
providing free personal care in Scotland after research found
that providing such care could cost the executive £130
million more than first envisaged.
In the research, authors Margaret and Jim Cuthbert claimed
they were “primarily concerned” with the estimations
for care in the community that the introduction of free personal
care in Scotland was based on.
They went on to say that they were not content with the
estimates for residential care and care provided in nursing
homes, but that the figure for community-based personal care
was based on a “misreading” of evidence.
As a result the research concludes that the base cost of
£70 million for providing personal care in the community
should be increased by £18 million.
Based on revised estimates, the research also suggests that
original estimates could have been out by as much as £60
million per year and recommends increasing the longer-term
cost of care for older people by around £130 million
by 2022.
For more details visit www.communitycare.co.uk
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WALES
OLDER PEOPLE'S SERVICES
The Health Minister outlined in February how older people
in Wales will benefit from £3million during 2005-06,
as part of the Welsh Assembly Government's £10million
Strategy for Older People.
The money is being allocated to local authorities and other
partners to help improve services for older people and to
develop policies and plans which better reflect their needs.
For more details visit www.wales.gov.uk
WAITING TIMES
An additional £32million is to be made available to
the NHS in Wales to help them meet waiting times targets Health
Minister announced in February.
The funding will be made available in 2005/06 to help meet
the targets that no patient will wait over 12 months for inpatient
treatment or an outpatient appointment by March 2006.
For more details visit www.wales.gov.uk
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