Memorandum submitted by the British Heart
Foundation (PCT 29)
1. The British Heart Foundation (BHF) is
the largest independent funder of heart research and cardiac care
in England. We play an important role in funding specialist heart
nurses to support people living in the community with coronary
heart disease. Our role is to pump prime these positions by contracting
with local trusts for a period of three years. We currently have
over 100 contracts with Trusts in England who employ over 200
specialist heart nurses.
2. There are two million people living in
England with heart disease. As the nation's leading heart charity
our main concern about Commissioning a Patient-Led NHS
is about the potential impact of these primary care reforms on
patient care.
3. These proposals could lead to the most
fundamental changes to the NHS since its foundation. Ninety per
cent of patient contacts are in primary care and the reorganisation
will have a significant influence over the effective management
of long term conditions including heart disease.
4. Given the scale and timeframe for these
changes we are concerned that the DH has failed to foster a vision
of future service delivery that is shared by central government,
PCTs, the voluntary sector and patients themselves. Without a
shared vision these changes will lead to a fragmentation of patient
care. We understand the current inquiry will focus on the mechanics
of the consultation process and we encourage the Committee to
consider a more in-depth inquiry that will consider the impact
of these proposed changes on patient care, particularly those
with long term chronic conditions.
5. The BHF is working hard to gather information
on what the proposed changes may mean for how we can best support
patients. We would be happy to share this information with the
Select Committee should a more in-depth inquiry be held.
6. The changes proposed in Commissioning
a Patient-Led NHS have significant implications for how the
BHF delivers quality care for heart patients. The document suggests
that there will be a progressive move towards greater use of other
providers, including those from the voluntary sector. Clearly
this will mean the BHF will need to seek new partners/models to
provide specialist heart nurse services. There may also be opportunities
for the BHF to become a national provider of other elements of
cardiac service provision.
7. These opportunities are not without risks.
The Foundation is concerned that these moves are being pursued
without proper consideration of the implications on the voluntary
sector.
8. The announcement appears to assume that
the voluntary sector is eagerly waiting in the wings to pick up
PCT functions and directly provide services. This is simply not
true. A decision to directly provide services is not one that
the BHF would take lightly. It would take a massive investment
for the Foundation to position itself to directly employ staff.
In addition we would need to carefully examine the impact of additional
government contracts on our independence. The BHF values our reputation
as an independent voice on coronary heart disease and would not
want service contracts to jeopardise this.
9. The Foundation is also concerned about
the influence that the private sector may have on the provision
of quality services for people living with heart disease. Private
companies may cherry pick the most profitable areas of cardiac
care and as the nation's heart charity we could be expected to
pick up the rest and potentially less profitable services.
10. The BHF has long advocated for better
cardiac services for people living with heart disease. Cardiac
rehabilitation has traditionally been the poor cousin to other
parts of the National Service Framework for CHD. It is not clear
from these announcements on whether the NSFs will gain in importance
or lose influence as decisions are devolved closer to the local
level.
11. Commissioning a Patient-Led NHS
has a strong emphasis on patient involvement. There are resource
implications to ensure that patients are recruited, trained and
supported to fulfil their role in local commissioning. The BHF
believes we can play an important role in encouraging people living
with heart disease to engage in local commissioning.
12. The Secretary of State for Health has
recently announced that PCTs can continue to directly employ staff
for as long as they wish. This can be interpreted as contradicting
the earlier Commissioning a Patient Led NHS announcement.
Whether or not it is a contradiction or simply a clarification,
it contributes to the air of uncertainty that makes it difficult
for voluntary organisations to plan for the future.
13. To reiterate, the BHF's chief interest
is to ensure that people living with heart disease are receiving
the best quality of integrated care possible. Regardless of any
changes we will continue to play a key role in funding specialist
heart nursing services as we believe they are the key to providing
heart patients with high quality integrated care. We welcome the
acknowledgement that the voluntary sector has a key role to play
in creating a patient-led NHS but we are concerned that the lack
of collective vision will undermine and fragment patient care.
Peter Hollins
British Heart Foundation
7 November 2005
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