A crucial time for one of the main mechanisms to cut NHS services is now upon us.
From April 2016, the ability of NHS Foundation Trusts to stop providing certain NHS services will increase.
From next April, because of licence changes planned by Monitor, some services that used to be compulsory for Trusts to provide, and have been protected since April 2013, can lose their protection.
The worry is that as pressure on NHS funding increases, unprotected services would be at risk, down the line, if not immediately.
The NHS Bill would stop these changes going ahead, but under a Conservative Government, the Bill is highly unlikely to pass and so will not change the law in time to prevent the changes. More detailed information on the technicalities is available at the end of this page.
But we don’t have to accept this as a fait accompli. We can at least try to find out exactly what’s going on in our local areas and which services are at risk; make our views known and object where necessary.
Below is an example of a letter that, health lawyer Peter Roderick has sent to his clinical commissioning group (CCG) that you can adapt to send to your own CCG.
CCGs have an obligation to respond under the Freedom of Information Act.
Find your Clinical Commissoning Group address here.
Dear Sir/Madam,
Re: Designation of Commissioner Requested Services
As you will be aware, Monitor told CCGs in March 2013 that your responsibilities include “designating a range of services that local commissioners believe should continue to be provided locally if any individual provider is at risk of failing financially. We call these Commissioner Requested Services…”, and issued Guidance and a Designation Framework.
You may also be aware that from April 2013 until April 2016 services that NHS Foundation Trusts were required to provide under their old authorisations were automatically designated as Commissioner Requested Services in their new licences. But Monitor has also said that “[o]ver time, commissioners should review this automatic classification and we expect the number of services that are designated as Commissioner Requested Services to decrease as a result.”
I am concerned about the expected reduction in services and would like to be informed of the progress the CCG has made in the process of reviewing and re-designating services as Commissioner Requested Services from April 2016.
In particular, I would be grateful if you would:
(1) specify which services that are currently provided by each NHS Foundation Trust with whom you contract and which are designated as Commissioner Requested Services at that trust, will not be so designated on completion of that process. (If the process has already been completed, please specify the services that have not been so designated.);
(2) explain why you have decided, or will decide, not to designate those services as Commissioner Requested Services;
(3) inform me where those services will be available in the future. I look forward to hearing from you as soon as possible.
Yours faithfully,
Further Action
- Another option would be to send to local councillors a copy of the letter to the CCG, asking them to use their review and scrutiny powers to assess which local services could potentially be cut under the new April 2016 licences, whether the correct procedure has been followed and if necessary to object. The document here is a template that can be modified and used to ask the local health scrutiny committee if they will review the re-designation process.
- Here you can watch Peter Roderick addressing his local health scrutiny committee, in Camden, North London. (On the right hand menu click on the ‘3 Deputations (If Any)’ – the section is six minutes long in total – it starts at 2.40 mins and ends at 8.30 minutes.)
Please do let us know how you get on – by emailing <info@nhsbill2015.org>
Under the Health and Social Care Act 2012, clinical commissioning groups (CCGs) buy services from providers, especially from NHS Foundation Trusts. Since April 2013, services provided by NHS Foundation Trusts fall basically into two categories: Commissioner Requested Services (CRS), and the rest. Services that are designated as CRS are subject to “continuity of service” conditions in a trust’s licence – these are typically in section 5 of the licence. The conditions place restrictions on cutting or altering these services – though they do not stop them being cut. For example, the trust must have an Asset Register that lists the buildings and equipment used to provide CRS, and selling off these needs Monitor’s consent. Services that are not CRS are not subject to any such restrictions. So the more services that are not designated as CRS, the more freedom an NHS Foundation Trust has to do what it likes – so long as 51% of its income comes from NHS services. In April 2013, the services that NHS Foundation Trusts had to provide under their old authorisations were automatically designated CRS in their new licences for 3 years. But Monitor told CCGs in March 2013 that their planning and purchasing responsibilities include “designating a range of services that local commissioners believe should continue to be provided locally if any individual provider is at risk of failing financially. We call these Commissioner Requested Services…”. At the same time Monitor issued a four-stage Designation Framework that CCGs are supposed to use to come up with a new list of CRS by April 2016 on the assumption that the trust would go bust. Monitor said “Over time, commissioners should review this automatic classification and we expect the number of services that are designated as Commissioner Requested Services to decrease as a result.” In other words, services which were mandatory until April 2013, and which for 3 years afterwards have some protection from “continuity of service” conditions, are expected to decrease.
Cutting NHS services at Foundation Trusts - find out more on the technicalities
