Annex A > Chapter 6 - Funding and Resources > Supra regional funding for the under-1s > The effect of the cessation of supra regional funding
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The effect of the cessation of supra regional funding
116 Following de-designation and the cessation of SRS funding on 31 March 1994, the SRSAG funds were reallocated to the various purchasing health authorities. Mr Nix stated that decisions about purchasing then rested with individual health authorities. [169] The UBHT entered into contracts directly with each of the health authorities, just as it did for other services provided by the Trust.
117 Mr Nix stated that `in simple terms', when a child was referred from outside the area of the Avon HA, the health authority in whose area the child lived would be sent an invoice for the cost of the treatment. [170] The cost of treatment for those patients who lived within the Avon HA's boundaries was included in the block contract between the Avon HA and the UBHT. [171]
`For the years 1994/95 and 1995/96, neo-natal and infant cardiology and cardiac surgery was no longer a designated supra-regional service. The terms under which services became de-designated were that health authorities received a sum of money relating to their usage of the service and were required to purchase an equivalent level of service in Year 1 (1994/95). In other words, they had to spend the same amount of money with the same NHS Trust for the same volume and type of service.' [172]
119 Miss Lesley Salmon stated:
`Following de-designation the Unit had to be more concerned about the number of referrals and where referrals were coming from in order to maintain income levels to sustain the service. In effect, the health authorities were responsible for purchasing the services they wanted and had to make sure they had enough money to continue the service. Financing of the service after de-designation was less certain, and the business side of paediatric cardiac surgery had to be more actively managed. The ongoing daily management issues that had to be actively managed all of the time were trying to get the right number of cases through, for the right health authority, for the right cost. ... Every case counts because contracts are agreed at a cost per case. This was a high risk area financially for the Trust.
`After de-designation it became clear that the amount of money that the Trust had been getting for the under 1 contract was quite generous. I was aware that there was an issue about recovering enough money from purchasers to continue to fund the service after de-designation. This was a financial issue I was not involved in negotiating.
`... There was some concern amongst clinicians that contracts might take precedence over clinical need, but this was not a problem in practice as urgent cases still took priority.' [173]
120 Dr Ian Baker stated in his written evidence to the Inquiry:
`De-designation placed the planning and commissioning of cardiac services for the neonates and infants with individual Health Authorities with little by way of specific guidance. The volume of service required by any one Health Authority was small although the range of defects presenting and the range of treatment required could be large in any one year. Determining the range of care required and a level of investment for acceptable outcomes became difficult ...
`There appeared to be no handover advice from the DoH or their clinical advisors.' [174]
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Footnotes
[169] WIT 0106 0032 Mr Nix
[170] WIT 0106 0009 Mr Nix
[171] WIT 0106 0009. The agreement between the Bristol and Weston Health District Authority for 1994/95 is at HAA 0156 0383. The agreement between the UBHT and Avon Health Authority for 1995/96 is at HAA 0161 0001
[172] WIT 0159 0015 Ms Evans
[173] WIT 0109 0003 Miss Salmon
[174] WIT 0074 0030 Dr Baker