Final Report > Chapter 8: Paediatric Cardiac Surgical Services > The planning and funding of paediatric cardiac surgery for children under 1 year of age (neonatal and infant cardiac surgery) > The system of supra regional services

The system of supra regional services

2 The vast majority of hospital services in England between 1984 and 1995 were funded through allocations of money from the Department of Health (DoH) to regional health authorities (RHAs). However, in the 1970s, policy-makers in the NHS were faced with the problem of how to fund and support the development of a number of specialised services, including PCS. In 1974 a Joint Working Party was set up between the DoH's Medical Policy Division and representatives of the medical profession to consider how specialised clinical services should be delivered. This Working Party met regularly and, in 1983, it was agreed between the DoH, the RHAs and the Joint Consultants Committee that new arrangements would be introduced for what were to be called `supra regional services' (SRS). [2]

3 The SRS system was intended to protect, nurture and support the development nationally of highly specialised and financially vulnerable services. The services were vulnerable in the sense that there was a relatively low volume of patients who required particular clinical expertise or experience and on occasions particular facilities and equipment for which the cost was high. The disparity between cost and demand was such that they could not economically be provided even on a regional basis in each of the then fourteen NHS regions in England. The SRS system worked, therefore, by designating certain centres (SRCs) at which the particular service would be provided as part of the SRS system.

4 It was thought that by providing a special funding system which would aim to ring-fence money for the designated services, any proliferation of these services could be limited. Thus, they would develop in controlled and protected conditions until they were strong enough to be integrated into the mainstream of the NHS.

5 In one sense, the SRS arrangements should not greatly occupy the Inquiry. They were to do with protecting funds so that very specialised areas of care could be developed. We devote attention to them here because they are an essential element in setting the scene for what went on in Bristol. This is because the SRS arrangements created certain assumptions and conditions which in turn affected the way PCS services were provided in Bristol. First, there was a real sense in which the process of designation was perceived as a recognition of the designated centre as a place of excellence. In the minds of parents of children needing care this was undoubtedly the case. In the minds of the clinicians, it was a feather in their cap to be sought and won. Second, and following on from that, designation as an SRC constituted a green light to the clinicians in the UBH/T to continue and seek to develop its PCS service. Third, designation brought a secure stream of funding, so that senior management might come to the view that the service was taken care of financially and could be left to get on with things. These are some of the reasons why we must attend to the system of SRS in some detail.

6 Dr Norman Halliday, Medical Secretary to the Supra Regional Services Advisory Group (SRSAG) from 1983 to 1994 and one of the `architects' of the SRS system, told the Inquiry that:

`The reason for setting up the supra-regional service and the reason for selecting any particular service was principally funding ... But of course from the Department's point of view, we recognised that there was also a benefit in that. There was a benefit in that we could control the development of the services, which would be beneficial in terms of cost, but also beneficial in terms of benefits to the patients, because the experience worldwide was that the more a doctor does a particular form of treatment, the better are his results. So by controlling the development of these services, we would be giving benefits to the patients.' [3]

7 The SRS arrangements came into effect at the beginning of the financial year 1983/84 and applied initially to four designated services:

• paediatric haemodialysis and transplantation;
• spinal services;
• services for the management of chorioncarcinoma; and
• the National Poisons Information Service.

Over time it extended to 16 designated services, including a particular subdivision of PCS termed NICS.

Footnotes

[2] `Supra regional' means covering more than one region

[3] T13 p.12-13 Dr Halliday