Supplementary memorandum submitted by
the Minister of State, Department of Health
HEALTH SELECT COMMITTEE HEARING ON 20 MAY
2004 ON RESPONSIBILITIES OF THE MINISTER OF STATE FOR HEALTH
I attended the Health Select Committee on 20
May on specific areas of my responsibilities. Further to my appearance,
I had agreed to submit additional information on several points.
1. FIGURES ON
NHS FOUNDATION TRUSTS
MEMBERS
We discussed NHS Foundation Trust membership
issues. I agreed to provide the committee with an update on membership
numbers for NHS Foundation Trusts authorised as part of wave 1.
This is attached at Annex A. I am encouraged that membership is
increasing all the time. Governance arrangements for NHS Foundation
Trusts are new and the election results for wave 1 Trusts provide
a positive base from which to build and learn.
2. PATIENT FORUM
MEMBERS
The Commission for Patient and Public involvement
in Health has recently asked all forum members to consent to their
names being made public on the CPPIH website. This exercise is
almost complete and the names will be available at www.cppih.org
by the 9 July.
3. RESEARCH PROJECT
ON THE
WORK OF
OVERVIEW AND
SCRUTINY COMMITTEES
The Department has awarded a grant to the Centre
for Public Scrutiny (CfPS) of £2.25 million to manage a programme
of work to support health scrutiny by local authority overview
and scrutiny committees. The Programme, commencing April 2004,
is to run for a period of three years.
The Centre for Public Scrutiny will provide
the ongoing support, guidance, training, information and facilitation
for those involved in health scrutiny. It is a requirement of
the overall grant that the Centre should arrange for a specific
piece of evaluative research to be put in place at the outset
of the Programme—to measure the effectiveness of health
scrutiny in improving the health and well-being of local people.
Whilst the Department is clear that there should be a research
strategy built into the Programme it is content for the Centre
to decide how best to progress this aspect.
The Centre for Public Scrutiny will be giving
particular attention to the support of overview and scrutiny committees
in their role to consider substantial variations to services.
Work is currently underway to develop specific guidance to support
joint committees which are considering changes to health services
which impact across wider geographical boundaries.
4. KEY SERVICES
FOR PCTS
IN SPECIALISED
COMMISSIONING ARRANGEMENTS
PCTs through their specialised services commissioning
groups have made substantial progress in establishing effective
commissioning arrangements for eight national priority services.
These are:
— cleft lip and palate services;
— medium and high secure psychiatric
services;
— paediatric intensive care services;
— specialised services within the National
Service Framework for mental health services; and
— specialised services within the National
Service Framework for coronary heart disease services.
Other than the eight national priorities, commissioners
have expended a considerable amount of effort working on commissioning
arrangements for a wide range of other specialised services; most
commonly for:
— blood and marrow transplantation
services;
— burns (severe) care services;
— cystic fibrosis services;
— lysosomal storage disorders services;
— neonatal intensive care services;
— neurosciences services;
— newborn screening (laboratory) services;
— photodynamic therapy services;
— pulmonary hypertension services;
— spinal cord injury/deformity services;
and to a lesser extent:
— other children's tertiary services;
— cochlear implantation services; and
— gender dysphoria services.
5. RISK SHARING
AND FINANCIAL
ARRANGEMENTS FOR
SPECIALISED COMMISSIONING
INCLUDING THE
ISSUE OF
POOLED BUDGETS
Commissioning encompasses three main functions:
strategic planning, procuring/purchasing and audit/monitoring.
It is up to PCTs in their Specialised Commissioning Groups (SCGs)
or Local Specialised Commissioning Groups (LSCGs) to decide whether
to establish a commissioning consortium for an individual specialised
service and if so, what functions the consortium will encompass.
Where the SCG or LSCG decides to set up a commissioning
consortium that encompasses procurement, the PCT members may agree
a pooled budget is sensible. Frequently, the pooled budget will
be set up to support the establishment of a financial risk-sharing
mechanism between the PCT members. This is particularly likely
to be the case if the specialised service/treatment in question
is unpredictable, low volume and high cost. Such arrangements
help manage the financial risk to the commissioners. It is up
to the PCTS, in their SCG or LSCG, to decide whether they wish
to establish a risk-sharing consortium for an individual specialised
service.
6. THE ROLE
OF SHAS
IN MONITORING
THE ROLE
OF PCTS
IN SPECIALISED
COMMISSIONING
Strategic Health Authorities (SHAs) ensure that
all PCTs belong to appropriate collaborative commissioning groups
for specialised services. SHAs support and oversee these collaborative
commissioning groups and any service-specific consortia. in particular
SHAs assess, in the light of guidance and taking into account
local circumstances, whether commissioning arrangements are working
well.
In turn, SHAs are subject to a national process
for assessment which includes their processes for strategically
reviewing the commissioning of specialised services.
7. AVAILABILITY
OF SPECIALISED
SERVICES AND
PROVISION OF
THIS INFORMATION
TO PATIENTS
The 35 headings in the Specialised Services
National Definitions Set incorporate many individual specialised
services, The total number of specialised services is likely to
be over a thousand different services. To illustrate: definition
no: 23, Specialised Services for Children, divides into 24 subsections
(eg. paediatric oncology) and these subsections divide again into
individual services (eg. paediatric oncology for eye cancer).
It would be a huge task to compile an accurate, national list
of providers for each specialised service and to keep it up-to-date
on an ongoing basis thereafter.
It is true that PCTs produce annual guide to
local services for their populations but these service lists are
relatively general and where they do identify the specialised
services available at their local providers are unlikely to do
so with any degree consistency, hence making comparisons impossible.
Another approach might be to look at the national
data collected on diagnostic and procedure codes to try and identify
specialised service providers. However specialised services cannot
be easily be identified via the Hospital Episode Statistics data
collection without substantial additional work. This is partly
due to the inadequacy of the current procedure codes (currently
a revision is underway, led by the NHS Information Authority).
To conclude, to compile a national directory
of specialised services providers would require a substantial
effort to produce and would then require revision on a regular
basis thereafter.
8. SPECIALISED
COMMISSIONING FOR
SERVICES FOR
HEAD INJURIES
Specialist services for people with head injuries
are managed by PCTS, and frequently through Local Specialist Commissioning
Groups. This is most commonly seen at a county level of financial
risk sharing where some budgets may be pooled and one organisation
takes the lead. Local planning incorporates clinical knowledge
and patient and public views, The recent publication of guidelines
for the triage, assessment, investigation and early management
of head injury commissioned through the National Institute for
Clinical Excellence has been beneficial in supporting commissioning
decisions. Local Commissioning Groups have also developed close
working relationships with Social Care when commissioning specialist
residential placements.
9. E-BOOKING
DEMONSTRATION
I said at the Committee hearing that I should
be very happy to arrange for Members to see a working demonstration
of e-booking, and how the care record is prepared. I think this
might be most conveniently done by holding a demonstration in
a "training" environment, to take place in the Department
of Health offices in Richmond House. The demonstration will show
the interface between the Web application available to GPs and
the hospital environment used to "refer" and "book"
an appointment for a patient in a hospital, and the associated
security for a user to lg on. Subject to time constraints and
practicalities it may be possible to demonstrate the iSOFT and
IDX software solutions which will be deployed across England as
part of the Care Records Service.
I have asked my officials to make the necessary
arrangements with the Clerk, and hope that, subject as ever to
diary commitments, this can be organised very soon.
10. PROGRESS
ON THE
PICTURE ARCHIVING
AND COMMUNICATIONS
SYSTEM (PACS) AND
ELECTRONIC ORDERING
OF PATHOLOGY
TESTS AND
X-RAYS IN
HOSPITALS
Currently 26 hospitals in England have installed
and are using PACS to a greater or lesser extent. Except where
there is planned delay, for example because a Trust is physically
moving to a new site, all NHS Trusts plan to have implemented
PACS solutions by 2007.
Order Communications Modules (OCMS) are currently
used in 46 NHS Trusts to order and report on pathology tests.
I understand that only very limited use is as yet being made of
this technology to order other clinical services including X-Rays
and therapy services.
Annex A
WAVE 1 NHS FOUNDATION TRUSTS—MEMBERSHIP
AT 30 JUNE 2004
| Group 1: Authorised 1 April 2004
| Total
Members |
Group 2: Authorised 1 July 2004
| Total
Members |
| Basildon and Thurrock General Hospital NHS Foundation Trust
| 7,693 | Cambridge University Hospital NHS Foundation Trust (formerly Addenbrooke's NHS Trust)
| 16,575 |
| Bradford Hospitals NHS Trust | 2,579
| Derby Hospitals NHS Foundation Trust (formerly Southern Derbyshire Acute Hospital Services NHS Trust)
| 8,386 |
| Countess of Chester NHS Foundation Trust |
3,588 | Guy's & St Thomas's NHS Foundation Trust
| 14,127 |
| Royal Devon and Exeter Healthcare NHS Foundation Trust
| 9,288 | Gloucestershire Hospitals NHS Foundation Trust
| 15,013 |
| Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| 7,211 | Papworth Hospital NHS Foundation Trust
| 5,657 |
| Homerton University Hospital NHS Foundation Trust
| 3,637 | Queen Victoria Hospital NHS Foundation Trust
| 12,000 |
| Moorfields Eye Hospital NHS Foundation Trust
| 11,657 | Sheffield Teaching Hospitals NHS Foundation Trust
| 7,000 |
| Peterborough and Stamford Hospitals NHS Foundation Trust
| 8,750 | City Hospitals Sunderland NHS Foundation Trust
| 5,976 |
| The Royal Marsden NHS Foundation Trust |
1,482 | University College London NHS Foundation Trust
| 8,365 |
| Stockport NHS Foundation Trust | 5,675
| University Hospital Birmingham NHS Foundation Trust
| 88,070 |
| | |
|
| 
