FOR THE BENEFIT OF PATIENTS

1. Introduction

1.1. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.

1.2. The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.

1.3. The concordat focuses initially on three areas of joint working:

  • elective care;
  • critical care;
  • intermediate care facilities;

This is not meant to be an exhaustive list nor interfere with existing working relationships and further partnerships locally may follow.

2. Working Together

2.1. The concordat is an enabling framework. It leaves the detailed decisions about service delivery to be made locally by those who understand the needs and best interests of patients.

2.2. The first fruits of this partnership will be seen during the coming months when closer co-operation in Local Winter Planning Groups will provide additional health and social care options for the winter period.

2.3. The concordat also signals however, a commitment towards planning the use of private and voluntary health care providers, not only at times of pressure but also on a more proactive longer term basis where this offers demonstrable value for money and high standards for patients. These, like NHS contractual arrangements, can, where appropriate be reflected in Long Term Service Agreements.

2.4. Successful partnership will need locally agreed protocols for referral, admission and discharge into and out of NHS and private and voluntary health care provider facilities. There will also be a need for effective agreements on care planning and discharge arrangements with social services departments (this includes determining the most appropriate approach to the development of joint information systems around patient based episodes).

2.5. Wherever services are delivered, the appropriate clinical standards must be maintained. It will be the responsibility of the relevant NHS body commissioning the service to ensure that appropriate quality standards such as the National Institute for Clinical Excellence guidelines which apply to NHS Trusts, the appropriate National Service Frameworks and other expert advisory group standards are adhered to. It will be the responsibility of the private and voluntary sector provider to deliver these standards.

Elective Care

2.6. There is a wide range of options available to local health communities for working together to deliver elective care. This concordat is not intended to negate arrangements designed to meet local needs, however the following examples are offered as a guide to involvement:

Primary Care Group or Primary Care Trust commissioning or renting accommodation from the private and voluntary health care sector with the service delivered by NHS consultants and other NHS staff under their NHS contract.

An NHS Trust “sub-contracting” the provision of a service to the private and voluntary health care provider. In this case the NHS Trust would be fulfilling its obligation under a service agreement with the Primary Care Group (PCG) or Primary Care Trust (PCT) but would meet the cost of the “sub-contracted” service from the resources received from the PCG/PCT;

Primary Care Groups or Primary Care Trusts commissioning directly from a private and voluntary health care provider;

2.7. This is not an exhaustive list and local health communities can explore ideas for effective partnership working relevant to their local circumstances, as long as they can demonstrate high standards and value for money.

Critical Care

2.8. By working together the NHS and private and voluntary health care providers can often support each other in delivering critical care services.

2.9. NHS Trusts and local private and voluntary health care providers should work together under network arrangements that cover all providers of critical care services in a given geographical area. Planning together should ensure agreement on the levels of care provided by each NHS and private and voluntary health care provider, the circumstances in which transfer of patients to and from the private and voluntary health care provider will take place and the standards of care to be maintained during transfer. Cost arrangements should also be agreed as part of this process.

Intermediate Care

2.10. Intermediate care is a whole system approach to a range of multidisciplinary, multi-agency services designed to promote independence by:

  • reducing avoidable hospital admission;
  • facilitating timely discharge from hospital;
  • promoting effective rehabilitation;
  • planning innovative new services in non-hospital environments;
  • minimising premature dependence on long term care.

2.11. In some cases the level of care required does not need to be the full acute nursing care delivered in a hospital setting. It is for this reason, partners should consider the supporting role private and voluntary nursing homes, residential homes and home care could play in providing these services. Intermediate care is not long term care and must be distinguished by its emphasis on rehabilitation and the move to independent living wherever possible.

2.12. It is important that clear protocols for the use of intermediate care services are agreed in advance with all partners, including social services.

Workforce Issues

2.13. The dedication and professionalism of the workforce is one of the major assets of both the NHS and the private and voluntary health care sector. However, there are a finite number of suitably qualified professionals regardless of where they work. Therefore, in order to support effective partnership working, NHS and private and voluntary health care employers should seek to:

  • Identify existing and future local staffing requirements;
  • provide information on workforce supply and demand across both public and private and voluntary health care sectors to support planning for basic professional training;
  • provide information on adverse clinical effects in line with the new procedures to be adopted in the NHS (following the Chief Medical Officer’s report ‘Learning from Experience’);
  • develop local HR strategies where appropriate.

2.14. To help achieve this, the Department of Health consultation document “A Health Service of all the talents” proposed that local Workforce Development Confederations are established to build on the best examples of existing education consortia. This will mean local NHS and private and voluntary health care employers working with the new confederations to produce overall workforce plans.

2.15. In the recent winter planning guidance NHS and social care organisations were asked to include the immunisation of staff against influenza as part of their planning arrangements for the coming year. Private and voluntary health care employers should also consider offering immunisation to all staff involved in the delivery of care and/or support to clients.

3. Planning for the Future

3.1. As well as helping to manage winter pressures there should be a move towards a more collaborative and proactive approach to long term capacity planning.

3.2. In order to support the planning and care management processes for NHS patients, it is essential that information is shared appropriately between the sectors. For private and voluntary health care providers this means:

  • providing information relating to NHS patients, to be incorporated into the patients record, and to the commissioner of the services, as specified (including using the HES or other minimum data formats);
  • providing information (within the usual parameters of confidentiality) to assist the process of revalidation of clinicians by ‘national’ bodies;
  • providing information, to be agreed locally, in order to support planning of health provision for the purpose of the HImP.

3.3. Resources commissioned by the NHS from private and voluntary health care providers should be included in the Service and Financial Frameworks, Primary Care Investment Plans and Joint Investment Plans. This will enable clear monitoring of expenditure and the development of a whole systems approach to service development and the reduction of waiting times. Where community care health needs can be met using local private and voluntary health care providers, this should be reflected in the Community Care Plan and demonstrate best value.

3.4. Local commissioners should be able to demonstrate that where appropriate, they have involved private and voluntary health care providers in their planning processes. As a consequence, commissioners will be able to make clearer and more open decisions on NHS service development issues.

4. Focusing on Patients

4.1. The safety and well being of patients is paramount. Regardless of where NHS patients are treated, existing charter and quality standards will apply.

4.2. Private and voluntary health care providers delivering services to NHS patients will also be subject to the NHS complaints procedure. It is for the Primary Care Group or Primary Care Trust commissioning the service to ensure that the provider is aware of its responsibilities under the complaints procedure, regardless of the sector involved.

4.3. The Independent Healthcare Association has introduced a Complaints Code of Practice for its acute and mental health members which seeks to ensure patients treated in private and voluntary health care providers hospitals have access either to the NHS or the Independent Healthcare Association complaints procedures. The Independent Healthcare Association Code has a three stage process namely:

  • Internal resolution
  • Internal appeal
  • Independent External Adjudication

4.4. The Government is introducing a new regulatory system for the private and voluntary health care sector, through the Care Standards Act. A new independent body, the National Care Standards Commission (NCSC), will be established to regulate services provided by private and voluntary health and social care establishments and services from April 2002. The new regulatory system proposed will provide safeguards and quality assurance for all patients, including NHS patients receiving treatment and care in private and voluntary health care establishments or from other service providers.

4.5. The Commission for Health Improvement will be able to exercise its powers in the private and voluntary health care sector where patients are receiving NHS treatment or care at a private and voluntary health care establishment or from other service providers.

5. Further Development

5.1. Both the Government and the Independent Healthcare Association are committed to continue working together to broaden the aims of the concordat and to look at how the two sectors can work together.

5.2. This can be achieved by the continued development of a long-term relationship at a national level and by ensuring that private and voluntary health care providers are brought into local discussions at an early stage of the planning process.

Released 31/10/2000

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