Memorandum submitted by the National Council
for Palliative Care (PCT 28)
1. BACKGROUND
The National Council for Palliative Care (NCPC)
is the umbrella organisation for all those involved in providing,
commissioning and using hospice and palliative care services across
England, Wales and Northern Ireland. It promotes the extension
and improvement of palliative care for all who need it across
all sectors and in all settings.
The aims of the new arrangements announced by
the NHS Chief Executive in July are:
— To ensure the commissioning of services
that improve population health.
— To enable real patient choice.
The principal proposals are:
— To bring forward by two years the
introduction of practice-based commissioning for all general practices.
— To reconfigure Primary Care Trusts
to reflect the progressive transfer of major elements of the commissioning
function to general practice level.
2. LIKELY IMPACT
ON THE
COMMISSIONING OF
SERVICES
For palliative care the principal question arising
from the proposals is whether they will lead to more effective
commissioning than is possible within current arrangements. The
Council's present conclusion is that there is no evidence to suggest
that they will.
2.1 The essential requirements for commissioning
palliative care services are as follows:
— Population-based needs assessment
involving analysis of the epidemiological, demographic and socio-economic
factors that influence palliative care need.
— An understanding of all the potential
domains of palliative care need in individual patients and their
families.
— A knowledge of what models of service
delivery are most effective in meeting palliative care need.
— A knowledge of how patients would
wish to see services delivered.
— An understanding of the areas of
care and support in which patients would wish to exercise choice
eg over place of death.
— An assessment of the service volumes
that may be needed to meet population needs and the exercise of
patient choice.
— Development of service specifications
that would guarantee delivery to good practice standards.
— Accreditation of providers who can
deliver to such standards.
— An agreed price for service delivery.
2.2 All of these requirements are being
met within the current arrangements for commissioning palliative
care services.
1. Population-based needs assessment—This
is being undertaken at Cancer Network and PCT levels in all 34
Cancer Networks using a nationally developed methodology.
2. Domains of patient and family need—The
NICE Guidance on Supportive and Palliative Care Need published
in March 2004 contains a comprehensive description of the potential
domains of need. It was put together with the involvement of service
users.
3. Effective models of service—The
NICE Guidance sets out evidence-based recommendations for the
essential core service components for any population.
4. How services should be delivered—User
groups have been set up at Network level and more locally to capture
patient and carer views.
5. Patient choice—Use of tools
such as the Gold Standards Framework for Primary Care, the Liverpool
Care Pathway for the Dying Patient, the Preferred Place of Care
model and the development of common approaches to individual patient
and carer assessment are all helping to identify and meet patient
choice.
6. Service volumes—The methodology
for needs assessment referred to above includes guidance on how
to estimate service volumes.
7. Service specifications, accreditation
of providers, national tariffs—A programme of work has been
established for the introduction of Payment by Results for specialist
palliative care services in both the NHS and the voluntary sector.
It covers all these subject areas.
In general, palliative care providers in both
the NHS and the voluntary sector are supportive of the current
and developing arrangements for commissioning and would be concerned
if they are disturbed by the new proposals.
2.3 The Importance of Managed Clinical Networks
Although Cancer Networks have no formal responsibility
for commissioning services, they have taken the lead in assembling
the information necessary for commissioners to carry out their
function eg through needs assessment, establishment of user groups.
Cancer Networks should continue to take that lead and we recommend
their role should be strengthened for the future. Neither general
practices nor individual PCTs (current or reconfigured) are well
placed to take it over.
2.4 Commissioning Specialist Palliative Care
Services
In order to function efficiently and effectively
services need to be based on and organised for populations that
are greater in size than most current PCT populations. As a result
it is now common practice for two or more PCTs to be clustered
to provide a population of appropriate size. Consequently the
proposal to reduce the number of PCTs is to be welcomed. Also
welcome is the proposal to align PCT and local authority boundaries
which would facilitate enhanced integration of health and social
services.
However, the proposal to transfer much of the
commissioning function to general practice level is generating
concern. The fear is that the current arrangements for commissioning
that work well may be disturbed, that commissioning could become
fragmented with the loss of collaboration and continuity between
services.
Eve Richardson
Chief Executive, The National Council for Palliative
Care
7 November 2005
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