The Department of Health is to develop a tariff for community services - paving the way for foundation trusts and the private sector to offer services until now provided by primary care trusts.
DH director general of commissioning and system management Mark Britnell told HSJ that NHS primary care providers had been lobbying the department for the tariff. They felt it would better reward their increased workload as care shifted out of hospitals.
“We are listening very carefully to arguments put by clinicians in the NHS who are saying that they want information on quality and activity and that they want a tariff,” Mr Britnell said.
“We are hoping that something will be included in [junior health minister Lord Darzi’s] primary and community care strategy.”
HSJ understands the DH is committed to developing a tariff for£15bn a year of community services. These include district nurses, health visitors, intermediate care and physiotherapy and make up around 20 per cent of a primary care trust’s spend. Work is already under way to quantify inputs and outcomes, but a final tariff setting out typical episodes of care and their price could be two or three years away.
News of the DH’s commitment was welcomed by potential alternative providers. Clinovia chief executive Robbie Burns told HSJ: “Any form of tariff will be an enormous benefit to delivering care closer to home because the independent and third sector can look at the tariff and see where they can provide services for better value for money.”
“We would be very keen to look at the whole area of what is currently PCT provision,” he continued. “We think some of it could be provided with a different model and with a different structure of workforce.”
Central Manchester and Manchester Children’s University Hospitals trust director of finance Adrian Roberts said a tariff would also provide clarity for foundation trusts interested in providing some of these services. They might be particularly interested in services such as post-operative rehabilitation in a patient’s home.
Croydon PCT director of community health services Maggie Ioannou acknowledged the threat of competition from foundation trusts and the private sector but said it did not worry her.
“I’m not bothered about that because I know the current situation is wrong. I’m not interested in perpetuating an organisational structure that’s not delivering. Care closer to home is not going to happen without this,” she said.
She said that the shift to care closer to home had seen an 80 per cent increase in the workload of her district nurses, yet this was not reflected in funding. She hoped a tariff measuring the workload of community services would fix that.
But she warned that private providers would not be interested in the most vulnerable patients cared for by community services as there was no profit to be gained. “The PCT as commissioner has an absolute role to play in stopping the private sector cherry picking,” she said.
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