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Questions to ask PCTs about the development of provider services
Questions Overview & Scrutiny Committees and Patient & Public Involvement Groups should ask Primary Care organisations about the development of Provider Services Community services are undergoing major reforms. The changes proposed in the Transforming Community Services programme are far reaching and will fundamentally change the way in which community services are delivered. The changes are designed to enable staff to improve community services and deliver high quality care to their communities. The TCS Programme will see each Primary Care Trust in England separate their commissioning function from their provider function. In many cases, provider arms of PCTs are already operating as arms length trading organisations. Therefore, although legally still part of the PCT, the provider arm is functioning independently. Many PCT provider arms are exploring the options to enable them to develop into completely separate legal entities. The models available for PCT provider arms to develop into are listed below. Alongside the development of PCT provider arms, commissioning PCTs are putting many services out to tender. This may result in NHS services being delivered to patients by many different organisations other than the NHS. Provider organisation models Integration with another NHS organisation Integration with Social Care Social Enterprise: An independent company which sits outside the NHS and reinvests its profits back into the company. A Community Foundation Trust: An NHS organisation with additional freedoms Arms length Trading organisation: The NHS remains part of the PCT but operates as a separate business Managed dispersal: Services are systematically put out to tender and may be picked up by a variety of providers from both the NHS and the Independent sector. The key question to ask about any proposed model is: How will it improve patient care? Consultation is key to these changes. Patients, the public and staff must be consulted about future changes to health services. The basic legal principles for consultation are 4 fold and agreed in law: Consultation must be undertaken at a time when proposals are still being formed. Good reasons must be given, underlining why particular proposals are being suggested, in order to enable those consulted to given intelligent consideration to the proposals. Adequate time must be given. The results of consultation must be taken into account when the ultimate decision is taken about proposals. It is not acceptable to consult stakeholders and staff on decisions that have already been made. This is not a meaningful consultation. Questions you should ask 1. How will the proposed changes improve patient care? 2. Have they appraised all options available to them ? 3. Have they considered the impact these proposed changes may have on local health economy? 4. What will happen to patients if the new provider organisation can not continue to meet their contractual obligations? 5. How will commissioners monitor the performance of any new providers 6. How has the organisation consulted with staff and Trade Unions on these proposed changes? 7. Are staff and Trade Unions in agreement with theses proposed changes or do they have concerns? 8. In 2006, Section 242 of the Health & Social Care Act made it a duty for the NHS to involve the Public in decisions relating to changes in health services. This means that NHS organisations must make arrangements to ensure the public are involved in, and consulted on proposals relating to changes in NHS services. Therefore: Has the organisation consulted with Local Involvement Networks and/or patient groups in a meaningful way? What processes have they used to do this? What documents are available to support this? Please give examples. 9. Overview and Scrutiny Committees must be consulted where a local NHS body is considering any proposals to make a substantial variation in the provision of health services. Although there is no definition of what a substantial variation constitutes, is the local NHS organisation aware of its duties to consult the O&S committee? How would the NHS organisation describe what a “substantial variation” means? Is there an opportunity for the NHS and O&S committee to agree the type of service change that would count as a „substantial variation‟ ? 10. The duty to consult under Section 242 of the Health & Social Care Act is wider than the duty to consult Overview & Scrutiny committees as it is not limited to a “substantial variation” to services. How does the NHS organisation propose to clarify the difference in its duty to a) Consult the public under section 242 b) To consult the Overview & Scrutiny committee. 11. Is it possible for the NHS and OSC to agree a broad approach to the practical aspect of consultation, the form it will take, the time it will take, and the manner in which it will be done, so that when a consultation is needed, the process has been agreed in advance? 12. Can the NHS organisation demonstrate how any suggestions made by those consulted with, have been included in the proposals. If not, why not?
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