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Government’s NHS competition policy poses new threat to Wiltshire PCT’s budget

If a ruling on the way Wiltshire NHS – the primary care trust – manages the money it provides for elective surgery (such as hip replacements) is upheld by the health secretary, Andrew Lansley, the trust’s budget could take a multi-million pound hit.

The trust’s AGM and board meeting at its Devizes headquarters (left) on Wednesday, September 21, was told that soon, for this sort of surgery, the “Flow of funds could be driven entirely by patients’ choice” and there would be no controls to even treatment out over the year.

The ruling came after a complaint to the Cooperation and Competition Panel (CCP) by Circle Health Limited which runs a new non-urgent hospital near Bath.  Circle complained that Wiltshire PCT and Bath & North East Somerset PCT were ‘managing the market’ by setting minimum waiting times and a cap on the money it spent at CircleBath.

The panel ruled in Circle’s favour – a ruling that could affect seventy other PCTs which use similar management techniques.  And the panel took the opportunity to issue some national rules in favour of the private sector which also have to be signed off by Andrew Lansley.

Depending on how many of the panel’s remedies are accepted and when they have to be implemented, Wiltshire NHS’s 2011-2012 budget could be hit by anything between £8m and £4m in consequential expenditure. This comes as the director of finance forecast that on present forecasts there could be a £6m underspend which could help pay off the large debt the PCT inherited and still carries on its books.

In the worst case for which the PCT’s experts have made calculations, these extra costs would wipe out the government’s much-trumpeted ‘real terms’ increase to this year’s NHS budget for Wiltshire.

The CCP was set up by the Labour government. However, as the King’s Fund has pointed out, it is no longer just advisory, but will be a statutory decision-making body and will “place a lot more emphasis on competition than cooperation.”  The CCP has suggested to Lansley that the new local Clinical Commissioning Groups that take over from the PCTs, should only be approved if they abide by CCP principles.

It will be interesting to see whether in announcing his decision, Mr Lansley will make it clear that two of Circle Health’s main financial backers have been significant donors to the Conservative Party.  And that, just before the election, he himself accepted £21,000 to fund his private office from the chairman of another private health care firm, John Nash of Care UK.  The CCP is now chaired by Lord Carter who made his fortune in the private healthcare industry.

Ambulance service:
NHS Wiltshire’s board was told that the response time of the area’s ambulance service (Great Western Ambulance Service) for immediately life threatening emergencies in Wiltshire was met in July for 70.98 per cent of such call outs.  Under the target set for these cases, they should be reached within eight minutes.  In August the figure was up almost a point at 71.92 per cent of such call outs.

GWAS, which covers Gloucestershire, Wiltshire, North and North East Somerset, Bristol, Bath and Swindon, will eventually be overseen by the new clinical commissioning groups. This will involve these groups in some complex co-operation and coordination beyond their own borders and beyond county boundaries.

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