1. CURRENT ISSUES
1.5 Spending on patient and public involvement
in healthcare
1.5.1 In Committee on 15 May 2003, David
Lammy MP stated that £69 million was being spent this year
on patient and public involvement in the NHS. Could the Department
provide a detailed breakdown of this figure, and estimates for
next year's costs, specifying:
Amount allocated for establishing and running
Overview and Scrutiny Committees
Amount allocated for establishing and running
Patient Advice and Liaison Services
Amount allocated for establishing and running
Independent Complaints Advocacy Services
Amount allocated for establishing and running
Commission for Patient and Public Involvement in Health
Amount allocated to CPPIH for establishing
and running Patient and Public Involvement Forums
PATIENT AND
PUBLIC INVOLVEMENT
IN THE
NHS
1. Mr Lammy was attempting to give reassurance
to a member of the Health Select Committee that far from there
being a lessening of funding in patient and public involvement
in the future, there would be a significant increase in support
and activity.
2. Mr Lammy's comment that three times as
much money would be spent to support patient and public involvement
was an estimate, based on the greatly strengthened system. Much
of the funding to support the new system is at local level—Patient
Advice and Liaison Services (PALS), local authority overview and
scrutiny committees and NHS bodies meeting the duty to consult
and involve patients, the public and their representatives. The
Department does not monitor centrally and is not in a position
to give figures on levels of local funding.
3. The Department is making £35.4 million
available directly to the Commission for Patient and Public Involvement
in Health to fund its activities, the costs involved in setting
up and supporting patients' forums and for the delivery of Independent
Complaints Advocacy Services (ICAS).
4. To provide an indication of money being
spent locally, indicative PALS expenditure is £24 million
per year.
OVERVIEW AND
SCRUTINY COMMITTEES
5. The allocation of funding to support
the activities of local authority overview and scrutiny committees
is a matter for local authorities to decide. Local authorities
should weigh up local priorities and direct their activities accordingly.
6. The Department is currently considering
making additional funds available to support overview and scrutiny
committees in their specific role to review and scrutinise health
services.
PATIENT ADVICE
AND LIAISON
SERVICES (PALS)
7. An additional £10 million was made
available to support the establishment of PALS. In 2001-02 this
funding was managed centrally for the early implementation of
over 100 Pathfinder PALS. From April 2002, the £10 million
funding was added to the NHS baseline allocation, with the expectation
that it would be used for PALS. This new funding has provided
the foundation for PALS development, with trusts contributing
extra resources to tailor development in order to respond to local
need.
INDEPENDENT COMPLAINTS
ADVOCACY SERVICES
8. The funding of Independent Complaints
Advocacy Services (ICAS) is the responsibility of the Commission
for Patient and Public Involvement in Health (CPPIH). Primary
care trust patients' forums, will in due course have delegated
power to commission or provide ICAS under the NHS Reform and Healthcare
Professions Act 2002.
9. Section 12 of the Health and Social Care
Act (2001) places a legal duty on the Secretary of State to make
arrangements to provide independent advocacy services to assist
individuals making complaints against the National Health Service.
To allow primary care trust patients' forums time to establish
their networks and capacity, the Secretary of State has exercised
his legal duty and as a result of a tendering process, interim
arrangements have been made to deliver national ICAS from 1 September
2003. The new service will be provided by four contractors who
will deliver ICAS across England. We have worked with the CPPIH
to set in place these arrangements and the CPPIH will act as the
Department's agents to manage these interim contracts on our behalf.
The value of the contracts awarded for ICAS provision for one
year from 1 September 2003 is £7.57 million. It will be for
CPPIH, in liaison with PCT patients' forums, to make the necessary
provision of ICAS beyond these interim arrangements.
COMMISSION FOR
PATIENT AND
PUBLIC INVOLVEMENT
IN HEALTH
10. The funding allocation to CPPIH in 2004-05
will be £34.5 million. This figure includes funding for establishing
and running patients' forums.
1.5.2 What was the total amount last
year paid to CHCs, to include redundancy costs?
1. The amount paid to CHCs in 2002-03 was
£23 million. This figure did not include provision for redundancy
costs (see 3.8.2) as redundancies will take place during 2003-04.
A separate budget of £12 million is available in 2003-04
for redundancy costs and will be paid via Strategic Health Authorities.
1.5.3 What is the estimated annual cost
for one:
Overview and Scrutiny Committee
Patient Advice and Liaison Service
Local Independent Complaints Advocacy Service
Trust Patient and Public Involvement Forum
Primary Care Trust Patient and Public Involvement
Forum
PATIENT ADVICE
AND LIAISON
SERVICE
1. From 2002-03 Trusts were responsible
for establishing and funding their own PALS and from April 2002,
the £10 million funding was added to the NHS baseline allocation,
with the expectation that it would be used for PALS.
2. We do not keep central records detailing
the amount spent on PALS nationally. Strategic Health Authorities
are responsible for monitoring the implementation of PALS and
report over 98% of trusts have an active PALS. Current estimates
of the total spend on PALS 2003-04 equates to £23.4 million.
On this basis, it is estimated that total expenditure on PALS
for 2004-05 would be in the region of £24 million.
LOCAL INDEPENDENT
COMPLAINTS ADVOCACY
SERVICE
3. From 1 September 2003, ICAS has been
provided across England by four contractors (see above 1.5.1).
Although the new arrangements will provide a service locally,
it is not possible to identify a specific cost for a local ICAS
eg by NHS Trust or PCT area.
TRUST PATIENT
AND PUBLIC
INVOLVEMENT FORUM
AND PRIMARY
CARE TRUST
PATIENT AND
PUBLIC INVOLVEMENT
FORUM
4. The funding of Patients' Forums is the
responsibility of the CPPIH. We have been informed by CPPIH that
the average local cost of each forum is expected to be just over
£26 thousand. In addition, CPPIH has established a regional
network of resource centres, as well as its HQ function, to support
this local forum structure.
1.5.4 What is the estimated cost per
Trust of establishing and running new governance systems for Foundation
Trusts, including consultation, election and running of Boards
of Governors?
1. The costs involved in the governance
arrangements for NHS Foundation Trusts should be seen in the context
of the Government's requirement that patients and the public are
kept informed about what is going on locally in the NHS. With
a member-led organisation, the membership infrastructure becomes
the main centre of focus for that activity. In other words, much
of the membership activity will involve adapting current processes
(and transferring current funded activity) to reflect the different
constitutional status of NHS Foundation Trusts.
2. The Government has made clear (in Commons
Committee consideration of the Health and Social Care Bill) that
the transition to NHS Foundation Trust status should not have
a negative impact on clinical care. The Department intends to
provide financial support to applicant NHS Trusts to ensure that
clinical services do not suffer as a result of the costs of preparing
applications for NHS Foundation Trust status, including setting
up the initial governance arrangements. NHS Foundation Trust will
be under a duty to improve the quality of healthcare, taking account
of the same national standards as other NHS providers. Indeed
NHS Foundation Trust status provides the means and tools to raise
the quality of clinical care, through operational and other freedoms
and public engagement. The Wanless report on the long-term future
of the NHS saw public engagement as a way of making the NHS more
responsive to patients' requirements and ensuring efficient use
of resources.
3. Consultation with the local community,
staff and key stakeholders is expected to cost approximately £50,000
per Trust. Experience of other organisations is that the cost
of running a membership organisation is in the region of £4
per member per year. This sum includes the cost involved in running
structures akin to the Board of Governors. The total cost to each
Trust will depend on the size of their membership. Similarly,
the cost of elections will vary according to the size of the electorate.
Again, experience from other organisations suggests that elections
involving an electorate of up to 10,000 people cost around 80
pence per member. For electorates above this size, the cost can
reduce to 50 pence per member.
1.5.5 What is the estimated cost of establishing
and running the independent regulatory system for Foundation Trusts?
1. The direct costs of establishing and
running the office of the Independent Regulator are estimated
to be in the region of £2.3 million in the first full financial
year—2004-05. This includes estimated staffing, legal and
financial costs, accommodation and IT expenditure and the running
costs for both the Independent Regulator and the Office of the
Regulator. The extent of these costs and the staff and support
required will depend on the number of NHS Foundation Trusts.
2. Subject to legislation, the Office of
the Independent Regulator will be established as a non-Ministerial
Department which will be accountable to Parliament but not subject
to direction from the Secretary of State. The Independent Regulator
is responsible for employing his or her own staff, however, he
or she must consult the Minister for the Civil Service on the
number of staff and their terms and conditions. The costs described
above are estimated by the Department of Health. The Regulator,
once appointed, will develop more detailed cost proposals for
discussion with Ministers.
| 
