Maternity services. Volume II, Minutes of evidence.

  • Great Britain. Parliament. House of Commons. Health Committee
Date:
1992
Catalogue details

Licence: Open Government Licence

Credit: Maternity services. Volume II, Minutes of evidence. Source: Wellcome Collection.

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    6 November 1991] [Continued 4. Purchasers and Providers 4.1 The reorganisation of the NHS, with effect from 1 April 1991, into a system which has a clear demarcation between purchasers and providers will promote efficiency and give each set of managers a clearer focus on their aims and objectives, with particular reference to the health needs of the local population in the case of purchasers. Purchasers will need to ensure they obtain the most cost effective services available and will be more easily able to secure managerial objectives because of the clearer accountability for performance which contracts provide. 4.2 RHAs support purchasers in developing local strategies and producing purchasing plans which translate Regional and local priorities into action. They will agree standards for improvements in health with FHSAs and Districts against which performance in achieving health objectives can be monitored. 4.3 Districts have a duty to purchase a comprehensive range of high quality health care services within the resources available to meet the needs of their local populations and achieve optimum desirable health outcomes. This requires them to plan health promotion and disease prevention services in addition to services for diagnosis, treatment, care and rehabilitation. Directors of Public Health will need to collect, analyse and interpret information about the health of the population and prepare annual reports which contain analyses of current health problems in their areas. This will inform their purchasing strategy. 4.4 FHSAs also have responsibility for assessing local needs for family health services and for planning and developing services to meet those needs. They will work closely with Districts, particularly in tackling major local health priorities in an integrated way across primary, community and hospital care. 4.5 Provider units, whether directly managed, NHS Trusts, or in the private sector are those from which Districts will purchase health care services. Their primary contribution is to provide high quality services to patients as required by District and GP Fund Holder contracts. Their need to attract contracts is a powerful incentive to achieve greater efficiency. 4.6 The Department believes day to day management decisions should be made at local level. Effective targets for health outcomes must be set in the context of local resources, needs and priorities, taking into account local health problems and the profile of the local population. The ME therefore sets the general direction for service development (eg to reduce stillbirths and infant deaths) and discusses Regions’ objectives with them to ensure they are achievable, but challenging. Regions then set targets for individual Districts and FHSAs which reflect their current position and the health needs identified in their Director of Public Health’s annual report. Regions monitor the performance of Districts and FHSAs against their targets and the ME, in turn, monitors the performance of Regions. 5. Performance Management: Planning and Review 5.1 The ME has been working with NHS managers to develop new planning and review processes to reflect the changes introduced by the NHS and Community Care Act 1990. The ME will manage down the purchasing line through Regions. Planning and review are complementary elements within a single process of performance management; objectives (see section 2) will form the focus for performance management and review of Regions by the ME. 5.2 The ME isestablishing a new Performance Management Directorate (PMD). Its task will be to manage NHS purchaser performance by negotiating and agreeing annual corporate contracts with each Region, and monitoring their performance, both in achieving these and overall. As well as containing agreed targets, contracts will set out milestones by which progress towards those targets can be monitored. This will enable PMD to identify problems and seek remedial action before the year’s end. 5.3 PMD will conduct an ongoing programme of rigorous performance review, monitoring Regions’ overall performance against plan in year and year-on-year. This will enable problems to be identified and remedial action to be taken in year. This will involve regular face to face contact between PMD and Regions at all levels, including quarterly meetings between the Director of Performance Management (or his deputy) and individual RGMs. Where issues are identified which the ME considers should be addressed in greater depth, PMD will seek and disseminate solutions, using special task forces where appropriate. 6. Health Service Priorities 6.1 The consultative document, “The Health of the Nation”, lays out the Government’s priorities and targets for health. The future objectives which are set for the NHS will reflect the priorities which emerge from the consultation process. 6.2 One of the objectives for 1992/93 will be to reduce stillbirths and infant deaths. All Regions will be required to agree with the ME a specific objective to reduce stillbirths and infant deaths. Regions will need to ensure that Districts and FHSAs pay particular attention to specific problems (whether cultural or socio- economic) which might impede access to maternity services for certain groups of women, especially those from ethnic minorities.