The new NHS guidance on out of area treatments by abstraks

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									NHS Executive                                                                                     NHS Finance Manual



2 Out of area treatments

Content

Summary ........................................................................................................................ 1
Background .................................................................................................................... 1
Out of Area Treatments (OATs) .................................................................................... 2
Arrangements for treating patients ................................................................................. 3
Referral arrangements between NHS Trusts .................................................................. 3
Patient transport services ............................................................................................... 3
Developing new services ............................................................................................... 3
Out of Area Treatment referrals for specialised services ............................................... 4
Mechanisms for funding OATs...................................................................................... 4
Funding OATs: 2000/01 and beyond ............................................................................. 5
Information flows to support in-year monitoring........................................................... 6
Overseas visitors ............................................................................................................ 6
Arrangements with other UK countries ......................................................................... 7
Transitional arrangements .............................................................................................. 7
IGA (Previously IGA 19) ............................................................................................... 8
Directions by the Secretary of State ............................................................................... 9
     Schedule of main commissioners ......................................................................... 10
Schedule of cash limit adjustments .............................................................................. 19
Contacts........................................................................................................................ 21


Summary

2.1      This guidance builds on the arrangements for Out of Area Treatments (OATs)
         for 1999/2000 and future years set out in paragraph 9 of HSC(98)198

2.2      This revised guidance takes account of views expressed on the consultation
         paper, The new NHS: Guidance on out of area treatment and subsequent
         comments and enquiries. The detailed arrangements have been discussed with
         an Implementation Group drawn from NHS trusts, health authorities (HAs) and
         the NHS Executive.


Background


2.3      HSC(98)198 set out new arrangements for commissioning services through the
         introduction of long term service agreements, more effective arrangements for
         commissioning specialised services and the ending of ECRs in March 1999.




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2.4   NHS service agreements replaced annual contracts in April 19991. All
      commissioning in The new NHS takes place through service agreements,
      including that for specialised services and what were previously ECRs.


2.5   The new service agreements are intended to reduce bureaucracy and refocus
      clinical and management effort into the quality and cost effectiveness of patient
      care, not just the quantity. They mark a significant step in the abolition of the
      internal market.


Out of Area Treatments (OATs)


2.6   From 1 April 1999 patients will always be treated under service agreements.
      Emergencies and other situations which preclude the use of specific pre-
      arranged service agreements will be covered by arrangements termed Out of
      Area Treatments (OATs). These will be covered by a service agreement.


2.7   Each NHS Trust will have a main commissioner (normally the local HA with
      the highest total value of service agreements with the NHS Trust). The service
      agreement for OATs will normally be:


                       an extension to other agreements made between main
                 commissioners and NHS Trusts, and

                         for patients treated by an NHS Trust who are not covered by any
                 other agreements.


2.8   OATs will be funded by increasing the allocations to main commissioners and
      reducing the allocations of HAs whose patients are treated under OATs.


2.9   HAs may reflect OATs adjustments in Primary Care Group (PCG) budgets.
      Main commissioners should involve their PCGs in OATs commissioning
      arrangements.


2.10 This guidance does not affect arrangements made with non-NHS providers. It
     deals only with arrangements between HAs, PCGs and NHS Trusts.


2.11 OATs have been implemented through Directions. These confer the main
     commissioner function on HAs.


1
 Service agreements are NHS contracts for the purposes of section 4 of the NHS and Community Care
Act 1990


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Arrangements for treating patients


2.12 Services should only be funded through OATs where a specific pre-arranged
     service agreement would be impractical. HAs and their PCGs have included
     most former ECRs in service agreements for 1999/2000. The aim is to build on
     this to ensure that by 2000/01 OATs cover only the essential minimum of
     treatments.


2.13 The OAT arrangements are intended to be used primarily for emergencies,
     typically where an individual is admitted to hospital for treatment while they are
     away from home. Prior approval is not required from the patient’s relevant
     HA/PCG.


2.14 In the short term the OATs arrangements may be preferable to a large number of
     low value service agreements. However consortia or lead purchaser
     arrangements are the preferred means of minimising the number of service
     agreements. HAs and PCGs should work together to set up such arrangements.


2.15 OATs should normally take the form of an extension to the main
     commissioner's service agreements for its own population. All the main
     commissioner's patients will be treated on exactly the same basis and according
     to clinical priority; and will be covered by the same standards for quality and
     effectiveness.


Referral arrangements between NHS Trusts


2.16 Local arrangements exist in which one NHS Trust makes and pays for referrals
     to another NHS Trust (eg some tertiary referrals). These may continue where the
     parties involved agree that this is an effective and efficient way to deliver
     services. Invoicing between NHS Trusts for these purposes may therefore
     continue. These are outside the OATs arrangements.


Patient transport services


2.17 All patient transport services should be covered by service agreements between
     HAs and NHS Trusts. They will not be covered separately by OATs.


Developing new services




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2.18 ECRs were used in some instances to fund the development of new services.
     The OATs arrangements should not be used for this purpose.


2.19 HAs, PCGs and NHS Trusts will need to develop a new approach to the
     development of new services based on partnership. NHS Trusts should discuss
     proposals for new service developments with potential commissioners. Service
     developments funded by commissioners must be consistent with the objectives
     of their Health Improvement Programmes.


Out of Area Treatment referrals for specialised services


2.20 The aim in respect of referrals for specialised services is that they should be
     covered by consortia or lead commissioner arrangements. These will help
     ensure fair and appropriate access to specialised services when they are needed
     for patients. A referral outside such arrangements will be treated as an OAT.
     The aim is to establish specialised services so that the need to use the OATs
     arrangements is minimised.


Mechanisms for funding OATs


2.21 The main commissioner is funded for OATs through a non-recurrent adjustment
     to allocations. This is based on past referral levels. These adjustments are:


                       added to the cash limit of the HA which is the main
                 commissioner for the NHS Trust;

                           deducted from the cash limit of the HA responsible for the
                 patient.


2.22 Cash limit adjustments for OATs are part of the overall process for setting cash
     limits for a particular financial year. HAs and NHS Trusts should not make
     accruals in their accounts which anticipate future years' OATs adjustments.
     OATs are an extension to one or more of the service agreements which a main
     commissioner has with an NHS Trust. NHS Trusts should be paid by their main
     commissioners in line with the profile agreed for the service agreement(s) as a
     whole.


2.23




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      Income from OATs is subsumed in the agreed cost of extended service
      agreements. The management of activity above the level provided for in a
      service agreement is for local agreement. Additional OATs, unlike ECRs, are
      not a source of additional income for NHS Trusts. Over-performance within
      service agreements for more specialised services should not prejudice the
      delivery of more routine and locally based services. In managing their portfolio
      of service agreements (including those for OATs) NHS Trusts and HAs/PCGs
      should ensure that this does not happen.


2.24 OATs funding for 1999/2000 is based on 1997/98 NHS Trust ECR income,
     reduced by the amounts subsequently moved into service agreements. This sum
     was uplifted by 8.52% to cover:


                         GDP forecast uplift for 1998/99 (2.75%);

                         HA minimum general growth for 1998/99 (1.35%);

                         GDP forecast uplift for 1999/2000 (2.50%);

                         HA minimum general growth for 1999/2000 (1.67%).


Funding OATs: 2000/01 and beyond


2.25 Options for making the 2000/01 OATs adjustments are being considered and
     further guidance will be issued.


2.26 Adjustments made two years in arrears do not align clinical and financial
     responsibility. The aim over time will be to make adjustments reflecting more
     recent information. The general approach after 2000/01 will be:


                         Main commissioners will monitor levels of OATs taking place
                 under their service agreements with NHS Trusts. They will analyse their
                 OATs activity at the end of each financial year as recorded in the
                 Minimum Data Set (see below);

                          Initially the OATs adjustment will be based on these past
                 referral levels. OATs funding for 2001/02 will be based on 1999/2000
                 OATs activity;

                         Over time the aim will be to base OATs adjustments on the best
                 available balance of actual and forecast data. The reference costs schedule
                 will allow an average cost to be attached to this activity data.




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        Further work is being undertaken in this area and guidance will be issued.

Information flows to support in-year monitoring


2.27 HAs and PCGs will need to monitor referrals in-year in order to influence the
     pattern of future referrals and service agreements and to anticipate future OATs
     adjustments. Under existing arrangements NHS Trusts are required to send all
     inpatient contract data sets, including ECRs to the NHS-wide Clearing Service
     (NWCS) for onward transmission to HAs. Data are submitted at least monthly
     to support the commissioning process.


2.28 NHS Trusts will need to identify all relevant HAs and PCGs in addressing
     records sent to the NWCS. Initially HAs will be responsible for providing
     PCGs with access to records provided by the NWCS.


2.29 Data sets for some services (ie outpatient and accident and emergency) are
     outside the scope of the current mandatory arrangements for the NWCS but
     NHS Trusts may still choose to use the NWCS for these. Where the NWCS is
     not used, NHS Trusts will need to ensure that the information necessary to
     support OATs is sent to all appropriate HA organisations by alternative secure
     means on a monthly basis.


2.30 HAs and PCGs are responsible for validating OATs supporting data on arrival
     as this will be used as the basis for future OATs adjustments. Where any patient
     has been incorrectly attributed to them they should ensure that the treating NHS
     Trust is informed immediately so that appropriate corrections can be made.


2.31 A data set change notice has been issued governing all data flows from 1 April
     1999, including those relating to the management of OATs.


Overseas visitors


2.32 Similar arrangements to OATs will replace the present arrangements for direct
     reimbursement of NHS Trusts for treating charge exempt overseas visitors,
     including repatriation costs. The adjustments will be made on a similar basis to
     the main OATs adjustment.


2.33 After 31 March 1999 it will still be necessary for the Department of Health to
     monitor the treatment of overseas visitors to ensure that the UK can recover
     costs, where appropriate, from foreign governments. NHS Trusts should
     continue to send completed IGA forms to Leeds HA, accompanied by E112
     forms where appropriate. A revised copy of the IGA form is overleaf.


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Arrangements with other UK countries


2.34 The OATs system extends to referrals to and from Scotland, Wales and
     Northern Ireland. Arrangements for a central financial adjustment will be agreed
     by the NHS Executive with the other UK Health Departments.


Transitional arrangements


2.35 From 1 April 1999 all activity is covered by the new commissioning
     arrangements. These cover all activity including OATs. Activity which
     commenced as an ECR prior to 1 April 1999 but which has a finished consultant
     episode end date of 1 April 1999 or later will be counted as activity under the
     new commissioning arrangements. This is in line with past practice.




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IGA (Previously IGA 19)

                             Department of Health
Financial Monitoring of Overseas Visitors Episodes of Care for Recovery of UK Costs

All sections of this form MUST be fully completed

NHS trust :                                                         PGO No:
Lead commissioner organisation code :
                                                                    Total cost :
                                Patient Details
Date of arrival in UK (DD/MM/YYYY)                                     /   /
Postcode of usual address (use NHS User Postcode Directory – 5th
& 6th characters only. Note the codes may not be the same in both
sections)
Patients nationality
Inpatient & daycases
Start date (DD/MM/YYYY)                                                /   /
End date (DD/MM/YYYY)                                                  /   /
Diagnosis : Primary (ICD 10 code) :
Operative procedure : Primary operation (OPCS4 code) :
Specialty code :
Health care resource group (HRG) code :
Outpatient
Attendance date (DD/MM/YYYY)                                           /   /
Source of referral :
Reason for referral :
Outcome :
Specialty code :
Other contract details
Was the patient referred by an overseas authority ? (If YES
and the patient is from EEA a copy of the E112 must be
attached)
State quota number if appropriate :
Patient’s guide category under which treatment was given :
Contact for enquiries (staff member who completed the form)
Telephone number/extension

Please send this form to : Overseas Visitor Section, Leeds Health Authority, St Mary’s
House, St Mary’s Road, Leeds LS7 3JX. Tel 0113 295 2640/ 295 2359 Fax 0113 237 4559




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Directions by the Secretary of State

                       NATIONAL HEALTH SERVICE ACT 1977

Directions by the Secretary of State to Health Authorities as to Arrangements for
   Out of Area Treatments and Arrangements for the Treatment of Overseas
                                      Visitors


The Secretary of State for Health, in exercise of powers conferred on him by Sections
13 and 17 of the National Health Service Act 1977(a), regulation 4 of the National
Health Service (Functions of Health Authorities and Administration Arrangement)
Regulations 1996(b) and all other powers enabling him in that behalf, hereby gives the
following Directions:

Commencement, application and interpretation

1.2    These Directions shall come into force on 1 April 1999 and shall apply to
every Health Authority in England and Wales.

In these Directions
"designated main commissioner " means, in relation to an NHS trust, the Health
Authority designated as the main commissioner for that trust in the Schedule to these
Directions;

"extra-contractual referral" means an arrangement for the provision of services to a
patient who is referred to a trust for treatment where the referral is not pursuant to an
NHS contract between the Health Authority and the NHS Trust concerned.

Extra-Contractual Referrals

2.    Health Authorities shall cease to secure the provision of services for patients
by means of the arrangements known as extra contractual referrals.




2
    1977 C.49 SI. 1996/708


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Main Commissioner for Out of Area Treatments

3.      A Health Authority which is the designated main commissioner in relation to
an NHS trust shall secure that provision is included in its NHS contract or contracts
with the trust with regard to the provision of services to patients referred to the trust
who are not, in relation to such services, covered by an NHS contract made with the
trust by another health service body.

Overseas Visitors

4.      A Health Authority which is the designated main commissioner in relation to
an NHS trust shall also secure that provision is included in its NHS contract or
contracts with the trust with regard to the provision of services to patients referred to
the trust who are not ordinarily resident in the United Kingdom and who are exempt
from charges under the National Health Service (Charges to Overseas Visitors)
Regulations 1989 (a).




Signed on behalf of the Secretary of State




Date: 30 March 1999


M A Harris CBE
Head of Resource Allocation & Funding Team
NHS Executive Finance and Performance Directorate

Schedule of main commissioners


NHS trust                                         Main commissioner HA
Addenbrooke's                                     Cambridgeshire
Aintree Hospitals                                 Sefton
Airedale                                          Bradford
Alexandra Healthcare                              Worcestershire



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NHS trust                                     Main commissioner HA
Andover District Community Health Care        North & Mid Hampshire
Ashford & St Peter's Hospitals                West Surrey
Avon Ambulance Services                       Avon
Avon and West Wiltshire Mental Health         Avon
Aylesbury Valen Community Healthcare          Buckinghamshire
Barnet Healthcare                             Barnet
Barnsley Community & Priority Services        Barnsley
Barnsley District General Hospital            Barnsley
Basildon & Thurrock General Hospitals         South Essex
Bassetlaw Hospital & Community                North Nottinghamshire
Services
Bath & West Community                         Avon
Bay Community                                 Morecambe Bay
Bedford Hospital                              Bedfordshire
Bedfordshire & Luton Community                Bedfordshire
Beds & Herts Ambulance & Paramedic            Bedfordshire
Service NHS Trust
BHB Community Healthcare                      Barking and Havering
Birmingham Children's Hospital                Birmingham
Birmingham Heartlands & Solihull              Birmingham
(Teaching)
Birmingham Women's Health Care                Birmingham
Black Country Mental Health                   Sandwell
Blackburn Hyndburn & Ribble Valley H          East Lancashire
C
Blackpool Victoria Hospital                   North West Lancashire
Blackpool Wyre & Fylde Community              North West Lancashire
Hlth
Bolton Hospitals                              Wigan and Bolton
Bournewood Community & Mental                 West Surrey
Health
Bradford Hospitals                            Bradford
Bradford Community Health                     Bradford
Brent Kensington Chelsea & Westminster        Kensington, Chelsea and Westminster
MH NHS Trust
Brighton Health Care                          East Sussex, Brighton & Hove
Bromley Hospitals                             Bromley
Burnley Health Care                           East Lancashire
Burton Hospitals                              South Staffordshire
Bury Health Care                              Bury and Rochdale
Calderdale Healthcare                         Calderdale and Kirklees
Calderstones                                  East Lancashire
Camden & Islington Community Health           Camden and Islington
Services
Cardiothoracic Centre Liverpool               Liverpool
Carlisle Hospitals                            North Cumbria
Central Manchester Healthcare                 Manchester
Central Nottinghamshire Healthcare            North Nottinghamshire


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NHS trust                                     Main commissioner HA
Central Sheffield University Hospitals        Sheffield
Chelsea & Westminster Healthcare              Kensington, Chelsea and Westminster
Cheshire Health Care                          South Cheshire
Chester & Halton Community                    North Cheshire
Chesterfield & North Derbyshire Royal         North Derbyshire
Hospital
Chorley & South Ribble                        South Lancashire
Christie Hospital                             Manchester
City & Hackney Community Services             East London and the City
City Hospital                                 Birmingham
City Hospitals Sunderland                     Sunderland
Clatterbridge Centre for Oncology             Wirral
CommuniCare                                   East Lancashire
Community Health Care Services, North         North Derbyshire
Derbyshire
Community Health Services Southern            South Derbyshire
Derbyshire
Community Health Sheffield                    Sheffield
Community Health South London                 Lambeth, Southwark & Lewisham
Community Healthcare, Bolton                  Wigan and Bolton
Cornwall Healthcare                           Cornwall and Isles of Scilly
Countess of Chester Hospital                  South Cheshire
Coventry Healthcare                           Coventry
Croydon Community                             Croydon
Dartford & Gravesham                          West Kent
Dewsbury Health Care                          Calderdale and Kirklees
Doncaster Healthcare                          Doncaster
Doncaster Royal Infirmary                     Doncaster
Dorset Ambulance                              Dorset
Dorset Community                              Dorset
Dorset Healthcare.                            Dorset
Duchess of Kent Military Hospital             North Yorkshire
Dudley Group of Hospitals                     Dudley
Dudley Priority Health                        Dudley
Durham County Priority                        County Durham
Ealing Hospital                               Ealing, Hammersmith and Hounslow
Ealing, Hammersmith and Fulham MH             Ealing, Hammersmith and Hounslow
East Anglian Ambulance NHS Trust              Norfolk
East Berks Community                          Berkshire
East Berks LD Trust                           Berkshire
East Cheshire                                 South Cheshire
East Gloucestershire                          Gloucestershire
East Hertfordshire                            East and North Hertfordshire
East Kent Community                           East Kent
East Kent Hospitals                           East Kent
East Midlands Ambulance Service               Nottingham
East Midlands Ambulance Service               Nottingham
East Somerset Hospital                        Somerset


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NHS trust                                  Main commissioner HA
East Wiltshire Health Care                 Wiltshire
East Yorkshire Community Healthcare        East Riding
East Yorkshire Hospitals                   East Riding
Eastbourne & County Healthcare             East Sussex, Brighton & Hove
Eastbourne Hospitals                       East Sussex, Brighton & Hove
Enfield Community Care                     Enfield and Haringey
Essex & Herts Community                    North Essex
Essex Ambulance Services                   North Essex
Essex Rivers Healthcare                    North Essex
Exeter & District Community Health         North and East Devon
Service
First Community Health                     South Staffordshire
Forest Healthcare                          Redbridge and Waltham Forest
Foundation                                 South Staffordshire
Frimley Park Hospital                      West Surrey
Gateshead Healthcare                       Gateshead and South Tyneside
Gateshead Hospitals                        Gateshead and South Tyneside
George Eliot Hospital                      Warwickshire
Glenfield General Hospital                 Leicestershire
Gloucestershire Ambulance Service          Gloucestershire
Gloucestershire Royal                      Gloucestershire
Good Hope Hospital                         Birmingham
Grantham & District Hospital               Lincolnshire
Great Ormond Street Hospital for           Camden and Islington
Children
Greenwhich Healthcare                      Bexley & Greenwhich
Guild Community Healthcare                 North West Lancashire
Guy’s & St. Thomas’                        Lambeth, Southwark & Lewisham
Halton General Hospital                    North Cheshire
Hammersmith Hospitals                      Ealing, Hammersmith and Hounslow
Hampshire Ambulance Service                North & Mid Hampshire
Haringey Health Care                       Enfield and Haringey
Harrogate Health Care                      North Yorkshire
Harrow & Hillingdon Community              Brent and Harrow
Hartlepool and East Durham                 Tees
Haslar                                     Portsmouth and South East Hampshire
Hastings & Rother                          East Sussex, Brighton & Hove
Havering Hospitals                         Barking and Havering
Heatherwood and Wexham                     Berkshire
Hereford & Worcester Ambulance             Worcestershire
Service
Hereford Hospitals                         Herefordshire
Herefordshire Community Health             Herefordshire
Hillingdon Hospital                        Hillingdon
Hinchingbrooke                             Cambridgeshire
Homerton Hospital                          East London and the City
Horizon                                    West Hertfordshire
Hounslow & Spelthorne Community &          Ealing, Hammersmith and Hounslow


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NHS trust                                   Main commissioner HA
MH
Huddersfield Health Care Services           Calderdale and Kirklees
Hull and Holderness Community Health        East Riding
Invicta Community Care                      West Kent
Ipswich Hospital                            Suffolk
Isle of Wight Healthcare                    Isle of Wight
James Paget                                 Norfolk
Kent & Sussex Weald                         West Kent
Kent Ambulance                              West Kent
Kettering General                           Northamptonshire
Kidderminster Health Care                   Worcestershire
King’s Lynn & Wisbech                       Norfolk
King's Healthcare                           Lambeth, Southwark & Lewisham
King's Mill Centre for Healthcare           North Nottinghamshire
Services
Kingston & District Community               Kingston & Richmond
Kingston Hospital                           Kingston & Richmond
Leeds Comm.& Mental Hlth Servs              Leeds
Teaching
Leicester General Hospital                  Leicestershire
Leicester Royal Infirmary                   Leicestershire
Leicestershire & Rutland Health Care        Leicestershire
Lewisham Hospital                           Lambeth, Southwark & Lewisham
Lifespan                                    Cambridgeshire
Lincoln & Louth                             Lincolnshire
Lincoln District Healthcare                 Lincolnshire
Lincolnshire Ambulance                      Lincolnshire
Liverpool Women's Hospital                  Liverpool
London Ambulance Service                    Lambeth, Southwark & Lewisham
Luton & Dunstable                           Bedfordshire
Manchester Children's Hospitals             Manchester
Mancunian Community Health                  Manchester
Mayday Healthcare                           Croydon
Medway                                      West Kent
Mental Health Services of Salford           Salford and Trafford
Mid Cheshire Hospitals                      South Cheshire
Mid Essex Community & MH                    North Essex
Mid Essex Hospital                          North Essex
Mid Kent Healthcare                         West Kent
Mid Staffordshire General Hospitals         South Staffordshire
Mid-Sussex                                  West Sussex
Milton Keynes Community                     Buckinghamshire
Milton Keynes General                       Buckinghamshire
Moorfields Eye Hospital                     Camden and Islington
Morecambe Bay Hospitals                     Morecambe Bay
Mount Vernon & Watford                      West Hertfordshire
New Possibilities                           North Essex
Newcastle City Health                       Newcastle and North Tyneside


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NHS trust                                      Main commissioner HA
Newcastle upon Tyne Hospitals                  Newcastle and North Tyneside
Newham Community Health Services               East London and the City
Newham Healthcare                              East London and the City
Norfolk & Norwich                              Norfolk
Norfolk Mental Health                          Norfolk
North Bristol                                  Avon
North Durham Health Care                       County Durham
North East Essex Mental Health                 North Essex
North East Lincolnshire                        South Humber
North Hampshire Hospitals                      North & Mid Hampshire
North Hampshire, Loddon Community              North & Mid Hampshire
North Hertfordshire                            East and North Hertfordshire
North Lakeland Healthcare                      North Cumbria
North Manchester Healthcare                    Manchester
North Middlesex Hospital                       Enfield and Haringey
North Sefton & West Lancashire                 Sefton
Community
North Staffordshire Combined Healthcare        North Staffordshire
North Staffordshire Hospital                   North Staffordshire
North Tees Health                              Tees
North Warwickshire                             Warwickshire
North West Anglia                              Cambridgeshire
North West London Hospitals                    Brent and Harrow
Northallerton Health Services                  North Yorkshire
Northampton Community                          Northamptonshire
Northampton General                            Northamptonshire
Northern Birmingham Community Health           Birmingham
Northern Birmingham Mental Health              Birmingham
Northern Devon Healthcare                      North and East Devon
Northern General Hospital                      Sheffield
Northgate and Prudhoe                          Northumberland
Northumberland Mental Health                   Northumberland
Northumbria Healthcare                         Northumberland
Norwich Community                              Norfolk
Nottingham City Hospital                       Nottingham
Nottingham Community Health                    Nottingham
Nottingham Healthcare                          Nottingham
Nuffield Orthopaedic Centre                    Oxfordshire
Oxford Radcliffe                               Oxfordshire
Oxfordshire Ambulance                          Oxfordshire
Oxfordshire Community                          Oxfordshire
Oxfordshire Learning Disability                Oxfordshire
Oxfordshire Mental Health                      Oxfordshire
Oxleas                                         Bexley & Greenwhich
Papworth Hospital                              Cambridgeshire
Parkside Health                                Kensington, Chelsea and Westminster
Pathfinder                                     Merton Sutton & Wandsworth
Peterborough Hospital                          Cambridgeshire


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NHS trust                                      Main commissioner HA
Phoenix Trust                                  Avon
Pilgrim Health                                 Lincolnshire
Pinderfields & Pontefract Hospitals            Wakefield
Plymouth Community Services                    South and West Devon
Plymouth Hospitals                             South and West Devon
Poole Hospital                                 Dorset
Portsmouth Health Care                         Portsmouth and South East Hampshire
Portsmouth Hospitals                           Portsmouth and South East Hampshire
Premier Health                                 South Staffordshire
Preston Acute Hospitals                        North West Lancashire
Princess Alexandra Hospital                    North Essex
Princess Royal Hospital                        Shropshire
Priority Healthcare Wearside                   Sunderland
Queen Mary's, Sicup                            Bexley & Greenwhich
Queen Victoria Hospital                        West Kent
Queen's Medical Centre                         Nottingham
Radcliffe Infirmary                            Oxfordshire
Ravensbourne Priority                          Bromley
Redbridge Healthcare                           Redbridge and Waltham Forest
Riverside Community                            Ealing, Hammersmith and Hounslow
Robert Jones & Agnus Hunt District             Shropshire
Orthopaedic Hospital
Rochdale Health Care                           Bury and Rochdale
Rockingham Forest                              Northamptonshire
Rotherham General Hospitals                    Rotherham
Rotherham Priority Services                    Rotherham
Royal Berkshire & Battle                       Berkshire
Royal Berkshire Ambulance                      Berkshire
Royal Bournemouth & Christchurch               Dorset
Hospital
Royal Brompton & Harefield                     Kensington, Chelsea and Westminster
Royal Cornwall Hospitals                       Cornwall and Isles of Scilly
Royal Devon & Exeter Healthcare                North and East Devon
Royal Free Hospital                            Camden and Islington
Royal Hull Hospitals                           East Riding
Royal Liverpool & Broadgreen Univ'y            Liverpool
Hosp
Royal Liverpool Children's Hospital            Liverpool
Royal Nat. Hosp. for Rheumatic Diseases        Avon
Royal National Orthopaedic Hospital            Brent and Harrow
Royal Orthapaedic Hospital                     Birmingham
Royal Shrewsbury Hospitals                     Shropshire
Royal Surrey County Hospital                   West Surrey
Royal United Hospital, Bath                    Avon
Royal West Sussex                              West Sussex
Royal Wolverhampton Hospitals                  Wolverhampton
Salford Community Health Care                  Salford and Trafford
Salford Royal Hospitals                        Salford and Trafford


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NHS trust                                    Main commissioner HA
Salisbury Health Care                        Wiltshire
Sandwell Healthcare                          Sandwell
Scarborough & NE Yorkshire Healthcare        North Yorkshire
Scunthorpe & Goole Hospitals                 South Humber
Scunthorpe Community Health                  South Humber
Severn                                       Gloucestershire
Sheffield Childrens Hospital                 Sheffield
Shropshire's Community & Mental              Shropshire
Health Services
Solihull Healthcare                          Solihull
Somerset Partnership NHS and Social          Somerset
Care Trust
South Beds Community                         Bedfordshire
South Birmingham Mental Health               Birmingham
South Buckinghamshire                        Buckinghamshire
South Devon Healthcare                       South and West Devon
South Downs Health                           East Sussex, Brighton & Hove
South Durham                                 County Durham
South Lincolnshire Community & Mental        Lincolnshire
Health Services
South London & Maudsley MH                   Lambeth, Southwark & Lewisham
South Manchester University Hospitals        Manchester
South Tees Acute Hospitals                   Tees
South Tees Community & Mental Health         Tees
South Tyneside Healthcare                    Gateshead and South Tyneside
South Warwickshire Combined Care             Warwickshire
South Warwickshire General Hospitals         Warwickshire
South Yorkshire Metropolitan                 Sheffield
Ambulance Service
Southampton Community Health                 Southampton & South West Hampshire
Services
Southampton University Hospitals             Southampton & South West Hampshire
Southend Community Care Services             South Essex
Southend Healthcare                          South Essex
Southern Birmingham Community Health         Birmingham
Southern Derbyshire Acute Hospitals          South Derbyshire
Southern Derbyshire Mental Health            South Derbyshire
Southport and Ormskirk Hospital              South Lancashire
St Albans & Hemel Hempstead                  West Hertfordshire
St Helens & Knowsley Hospital                St Helen's and Knowsley
St James's and Seacroft Univ'y Hosps         Leeds
St Mary's Hospital Paddington                Kensington, Chelsea and Westminster
St. George's Hospital                        Merton Sutton & Wandsworth
St. Helens & Knowsley Community              St Helen's and Knowsley
Health
Staffordshire Ambulance Service              South Staffordshire
Stockport Acute Services                     Stockport
Stockport Healthcare                         Stockport


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NHS trust                                  Main commissioner HA
Stoke Mandeville                           Buckinghamshire
Suffolk Local Health Partnership           Suffolk
Surrey & Sussex Healthcare                 East Surrey
Surrey Ambulance Service                   East Surrey
Surrey Hampshire Borders                   West Surrey
Surrey Oaklands                            East Surrey
Sussex Ambulance Service                   East Sussex, Brighton & Hove
Sussex Weald & Downs                       West Sussex
Swindon and Marlborough                    Wiltshire
Tameside and Glossop Acute Services        West Pennine
Tameside and Glossop Community             West Pennine
Taunton & Somerset                         Somerset
Tavistock & Portman                        Camden and Islington
Teddington Memorial Hospital               Kingston & Richmond
Thames Gateway                             West Kent
Thameside Community Health                 South Essex
The Barnet & Chase Farm Hospitals          Barnet
The Epsom & St Helier                      Merton Sutton & Wandsworth
The North Mersey Community                 Liverpool
The Oldham                                 West Pennine
The Royal Hospitals                        East London and the City
The Royal Marsden                          Merton Sutton & Wandsworth
The South West London Community            Merton Sutton & Wandsworth
The Whittington Hospital                   Camden and Islington
The Wirral Hospital                        Wirral
Tower Hamlets Healthcare                   East London and the City
Trafford Healthcare                        Salford and Trafford
Two Shires Ambulance                       Buckinghamshire
United Bristol Healthcare                  Avon
United Leeds Teaching Hospitals            Leeds
University College London Hospital         Camden and Islington
University Hospital Birmingham             Birmingham
Wakefield & Pontefract Community           Wakefield
Health
Walsall Community Health                   Walsall
Walsall Hospitals                          Walsall
Walsgrave Hospitals                        Coventry
Walton Centre for                          Sefton
Neurology/Neurosurgery
Warrington Community Health Care           North Cheshire
Warrington Hospital                        North Cheshire
Warwickshire Ambulance Service             Warwickshire
West Berks Priority Care                   Berkshire
West Cumbria Healthcare                    North Cumbria
West Dorset General Hospitals              Dorset
West Hert Community Health                 West Hertfordshire
West Middlesex Hospital                    Ealing, Hammersmith and Hounslow
West Midlands Ambulance Service            Birmingham


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NHS trust                                  Main commissioner HA
West Suffolk Hospital                      Suffolk
Westcountry Ambulance                      South and West Devon
Weston Area Health                         Avon
Weston Park Hospital                       Sheffield
Wigan & Leigh Health Services              Wigan and Bolton
Wiltshire Ambulance Services               Wiltshire
Wiltshire Health Care                      Wiltshire
Winchester & Eastleigh Healthcare          North & Mid Hampshire
Wirral & West Cheshire Community           Wirral
Wolverhampton Health Care                  Wolverhampton
Worcester Royal Infirmary                  Worcestershire
Worcestershire Community Healthcare        Worcestershire
Worthing & Southlands Hospitals            West Sussex
Worthing Priority Care                     West Sussex
Wrightington Hospital                      South Lancashire
York Health Services                       North Yorkshire

Schedule of cash limit adjustments
Health authority                           Cash limit adjustment (£000s)
Bradford                                   -808
Calderdale and Kirklees                    -1,783
County Durham                              -1,354
East Riding                                -626
Gateshead and South Tyneside               -1,266
Leeds                                      -753
Newcastle and North Tyneside               458
North Cumbria                              345
North Yorkshire                            -408
Northumberland                             752
Sunderland                                 -1,037
Tees                                       -447
Wakefield                                  -656

Barnsley                                   -507
Doncaster                                  -702
Leicestershire                             -1,016
Lincolnshire                               -568
North Derbyshire                           -784
North Nottinghamshire                      -1,167
Nottingham                                 1,876
Rotherham                                  -151
Sheffield                                  1,923
South Derbyshire                           -1,533
South Humber                               -842

Bedfordshire                               -1,418
Berkshire                                  -381


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Health authority                            Cash limit adjustment (£000s)
Buckinghamshire                             728
Cambridgeshire                              1,459
Norfolk                                     928
Northamptonshire                            -1,705
Oxfordshire                                 2,876
Suffolk                                     -1,142

Barking and Havering                        -1,232
Barnet                                      -822
Brent and Harrow                            1,664
Camden and Islington                        4,805
Ealing, Hammersmith and Hounslow            1,124
East and North Hertfordshire                -1,125
East London and The City                    -590
Enfield and Haringey                        -584
Hillingdon                                  -175
Kensington, Chelsea and Westminster         8,023
North Essex                                 -507
Redbridge and Waltham Forest                -1,494
South Essex                                 -1,124
West Hertfordshire                          289

Bexley and Greenwich                        -972
Bromley                                     -1,302
Croydon                                     -1,077
East Kent                                   805
East Surrey                                 266
East Sussex, Brighton and Hove              -31
Kingston and Richmond                       -473
Lambeth, Southwark and Lewisham             699
Merton, Sutton and Wandsworth               2,628
West Kent                                   -270
West Surrey                                 1,662
West Sussex                                 295

Avon                                        -349
Cornwall and Isles of Scilly                1,994
Dorset                                      2,041
Gloucestershire                             -355
Isle of Wight                               537
North and East Devon                        679
North and Mid Hampshire                     -829
Portsmouth and South East Hampshire         -801
Somerset                                    -549
South and West Devon                        1,029
Southampton and South West Hampshire
935
Wiltshire                                   -908


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Health authority                               Cash limit adjustment (£000s)

Birmingham                                     5,185
Coventry                                       -474
Dudley                                         -787
Herefordshire                                  -234
North Staffordshire                            -620
Sandwell                                       -792
Shropshire                                     -343
Solihull                                       -830
South Staffordshire                            -553
Walsall                                        -965
Warwickshire                                   -456
Wolverhampton                                  -468
Worcestershire                                 -906

Bury and Rochdale                              -1,075
East Lancashire                                -931
Liverpool                                      1,685
Manchester                                     645
Morecambe Bay                                  188
North Cheshire                                 -934
North West Lancashire                          175
Salford and Trafford                           -1,130
Sefton                                         1,670
South Cheshire                                 -848
South Lancashire                               174
St Helen's and Knowsley                        -99
Stockport                                      -859
West Pennine                                   -1,357
Wigan and Bolton                               -1,304
Wirral                                         164


Contacts
Enquiries about these allocations by Health Authorities should be addressed to their
respective Regional Allocation Contacts as detailed below:

Regional Allocation Contacts:

Northern & Yorkshire                           Tom Poolton
Trent                                          Terese Paskell
Eastern                                        Dave Self
London                                         Jonathan Wise/Alister Williams
South East                                     Ilyas Malick
South West                                     Neil Brent
West Midlands                                  Rupert Davies
North West                                     Steve Marshall


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