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Baroness Andrews: Cancer registries supply data to the Office for National Statistics (ONS) in accordance with the national core contract, notified to Directors of Cancer Registries in England in NHS Executive Letter number 7 in February 1996, and the supporting Cancer Registry Standards, published in September 2001. The mechanism for reporting to the Office for National Statistics is agreed between each regional cancer registry and ONS, and data are provided in a standard agreed format. There are no plans to make this a statutory requirement.
Which, if any, National Health Service organisations, other than strategic health authorities, were involved in brokerage arrangements for 200203; and what amounts were involved.[HL3061]
Baroness Andrews: Information on the reason for brokerage between National Health Service bodies is not collected centrally. The latest information held centrally on inter-year flexibility (brokerage) between NHS bodies in 200203 has been placed in the Library.
Baroness Andrews: The Department of Health remains committed to improving the rights, independence, choice and inclusion of disabled people through ongoing health and social care policy development, in partnership with all interested parties, enabling disabled people to play a full part in the community.
We have asked survey and evaluation colleagues to assess the report before deciding what further action may be required. We are already taking action to improve services for disabled people through the long-term conditions national service framework due to be published next year for implementation from 2005; the Valuing People White Paper on learning disabilities, currently in a five-year implementation phase; and our general investment in social services which will raise standards for all in need including disabled people.
RAP Table P1.1
Note: Community-based services include services such as home care, day care, meals, respite, short term residential care, direct payments, professional support, transport, equipment and adaptations.
In light of the recent Department of Health guidance on specialised commissioning, whether collaborative commissioning groups are intended to
12 Jun 2003 : Column WA66
Whether regional specialised commissioning groups will continue, either in their current or in a modified form; and[HL3114]
What might constitute "good reasons for change" to existing commissioning consortia.[HL3117]
Baroness Andrews: The recent guidance requires the development of Level 2 collaborative commissioning groups for specialised services. These will often cover the same geographical area as, and have similar functions to, the former regional specialised commissioning groups (RSCGs). However, collaborative commissioning groups' exact remit, powers and rules of engagement will be decided by their member primary care trusts (PCTs), as will the Level 1 collaborative commissioning groups for specialised services. It is therefore open to member PCTs to decide that these groups act as a direct replacement for RSCGs, but it is a matter for local decision. What might constitute good reasons for change to existing commissioning arrangements is a matter for local determination.
Baroness Andrews: The remit, powers and rules of engagement of collaborative commissioning groups for specialised services are agreed by the member primary care trusts (PCTs) and the decisions of these groups are binding on all members. Strategic health authorities performance manage such arrangements and ensure all PCTs belong to an appropriate collaborative commissioning group.
Baroness Andrews: Strategic Health Authorities (SHAs) have a responsibility to performance manage the local National Health Service and could intervene if performance is inadequate. The Department of Health will hold SHAs to account for performance against the priorities set out in the priorities and planning framework and can intervene where "Directions" are not being adhered to. It will not however routinely intervene in matters of guidance as it is up to the NHS to implement best practice locally.
Baroness Andrews: NHS foundation trusts will have freedom to put in place the staffing and management structures that ensure the necessary mix of skills to provide the best standard of care to patients. Modern matron posts have been a very successful innovation.
Baroness Andrews: In 1999 the Department of Health asked the Royal College of Physicians to lead a multidisciplinary working party to devise new clinical guidelines for the use of domiciliary oxygen. Although the working party's terms of reference precluded making specific recommendations about alterations in service provision, a number of the guidelines had implications for the content of the existing domiciliary oxygen service and for the way in which the service is delivered. It was clear, therefore, that this vital resourcethat has seen only one significant change, the introduction of oxygen concentrators, in the past 50 yearshad become out of date, both in terms of the service offered to patients and its cost effectiveness. It was against this background that the then Parliamentary Under-Secretary of State, my noble friend Lord Hunt of Kings Heath, directed that a review of the domiciliary oxygen service should take place.
At present domiciliary oxygen is ordered for patients by general practitioners. The service consists principally of the provision of oxygen either from large cylinders supplied by community pharmacies, or delivered by way of an oxygen concentrator, installed in the patient's home by a contractor.
The modern, integrated service that is proposed represents a considerable advance on this organisational and service model. The new model will transfer responsibility for ordering oxygen for long-term oxygen therapy from general practitioners to specialist consultants in hospital. This will relieve general practitioners of the bureaucratic burden of writing prescriptions, effectively on the direction of
Once the hospital consultant or general practitioner has discussed and determined the patient's need for oxygen, it will be the responsibility of contractors to work closely with the patient and decide what technologythat is, what type and method of oxygen supplywill best suit the patient's therapeutic need, and to provide it. These specialist contractors will be well placed to keep pace with developments in the technical aspects of service delivery, so patients will benefit from advances in technology as they are developed.
Thus the modernised integrated service represents a sensible division of responsibility in the provision of domiciliary oxygen services. It places clinical responsibility for assessing oxygen need with doctors, and places technical decisions on the best and most up-to-date method of delivery with service contractors.
Over the next few months a specification for the provision of the integrated service will be drawn up. Contractors will be invited to tender against this specification and contracts will be let. It is expected that the integrated service will be fully operational early in 2005. The current arrangements for the provision of domiciliary oxygen will continue as at present to cover this transitional period.
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