Annex A > Chapter 6 - Funding and Resources > Supra regional funding for the under-1s > The process of contracting

The process of contracting

112 With the introduction of the internal market in the NHS in April 1991, the SRSAG became a `purchaser'. It indicated that its role would be: `... to advise Ministers on the units with which contracts should be placed...'. [156] At its meeting in July 1990 it was noted that the National Health Service Management Executive (NHSME) was to provide arrangements for monitoring contracts. [157]

113 On 13 December 1990, a discussion took place about the draft contract with Bristol for the year 1991/92. [158] The discussion was between Mr Cameron, [159] Mr Nix, Mr Wisheart, Dr Joffe, Mr Barrington and three Department of Health representatives. The contract, which was in draft, [160] provided that the Unit: `... will ensure that the quality of the service is clinically and socially satisfactory, and will seek constantly to improve it.' It was to monitor regularly: `... all relevant aspects of the service, and make the results available to the purchaser.' [161] The Unit was to provide an Annual Report, dealing with matters such as `quality of service' and 'statistics' as well as information on waiting lists and copies of the standards on quality agreed with the major purchaser(s). There was also an obligation to supply to the Department of Health a copy of the relevant part of the return to the UK Cardiac Surgical Register (UKCSR). [162]

114 In October 1991, the DoH commissioned a study by a management consultancy of the cost of the SRS. [163] By this time, removal of the NICS service from the supra regional system, or `de-designation', was under discussion by the SRSAG. [164] De-designation took place with effect from 31 March 1994 and raised complex financial issues. [165] The funding previously made available directly from the DoH for neonatal and infant paediatric cardiac surgical services was instead apportioned by it amongst the regions, on the basis of past usage. Regional general managers promised to ensure a period of `steady-state' for such services in the year following their removal from the supra regional arrangements. [166] Mr Nix gave evidence that at the time he was concerned about the proposed method to be used for the distribution of funds to the local purchasers. But he stated that, in the event, the possibility of losing funding through the reorganisation of funding arrangements did not materialise. [167]

115 As regards the effect which the de-designation of Bristol alone (without the de-designation of the other centres) would have had on the Bristol Unit, Dr Roylance stated in his written evidence to the Inquiry:

`Although I did not know it at the time, I now understand that the possibility of the unilateral de-designation of Bristol was being considered by the Supra-Regional Services Advisory Committee. It is right to point out that the unilateral withdrawal of centrally allocated funds for neonatal and infant paediatric cardiac surgery would have had no significant impact on the institution as a whole. The reduction in funding would have been addressed in negotiations for contracts for the successive year, presumably allowing an immediate increase of adult cardiac surgery within the resources at the BRI.' [168]

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Footnotes

[156] UBHT 0064 0091; January 1991

[157] DOH 0002 0194; minutes of meeting on 26 July 1990

[158] UBHT 0277 0254; draft contract

[159] Mr Ewan Cameron, Assistant Treasurer, Senior Assistant Director of Finance

[160] The final version of the contract is at DOH 0004 0001, signed at DOH 0004 0009; the version signed incorporated the points discussed above

[161] DOH 0004 0004; contract

[162] DOH 0004 0007; contract. For the Register, see Chapter 19

[163] UBHT 0064 0182 - 0183 ; UBHT 0277 0141

[164] This topic is addressed, in detail, in Chapter 7

[165] UBHT 0064 0292 - 0316 : UBHT 0277 0006 - 0007

[166] DOH 0002 0249; detailed figures are at DOH 0002 0253

[167] WIT 0106 0033 Mr Nix. See Chapter 7

[168] WIT 0108 0017 Dr Roylance