The government is dishing out a greater portion of next year’s healthcare budget to health services on the frontline, in a move designed to drive forward local accountability and personalised care.

Health Secretary Alan Johnson announced that primary care trusts have been allocated a cash pile of £74.2 billion out of the healthcare pot for the year 2008/9, marking an above-inflation increase of 5.5% over the current year.

Furthermore, PCTs will receive an extra £1.7 billion from central budgets, giving them control of 82% of the total NHS revenue budget, a marked increase over previous years and a sign that the government is putting its money where its mouth is with regard to championing greater flexibility for primary care services to meet the demands of their patients.

“However,” as Andy Cowper, editor of British Journal of Healthcare Management and Commissioning Health commented to PharmaTimes UK News, “quite a few commentators don't think that money is the main solution to the NHS' problems”.

“Government policy has bet that 'world-class commissioning' will drive service improvement and better value and quality, and it's probably the right idea. But when it comes to commissioning, the NHS is starting from a low base of skills - data are poor and the IT programme won't help matters any time soon.”

"To make best use of this resource, PCTs are going to need to focus on much better data and information, value for money, quality and outcomes in everything they commission - and indeed that they do themselves,” he said.

New operating framwork
The rise in allocated funds is also intended to help PCTs meet the challenges laid out in the latest Operating Framework for the NHS, which was published alongside details of the budget and outlines the key priorities for service improvement.

High on the agenda for next year, which will see the NHS celebrate its 60th birthday, is improving the cleanliness of hospitals and slashing rates of hospital-acquired infections. The issue of infections, such as with the notorious superbug MRSA and Clostridium difficile, is very close to the public’s hearts, and is often used by patients as a yardstick when judging hospitals’ service quality.

The latest quarterly figures (April-June 2007) from the Health Protection Agency indicate that the fight is slowly being won against MRSA and C. difficile, with infections dropping 10% to 1,303 cases and 13% to 13,660, respectively, but many hospitals are still failing to achieve the minimum standards of cleanliness. Consequently, the government announced earlier this year the establishment of a new watchdog - The Care Quality Commission - to help regulate the situation.

Improving access to GP services and reducing waiting times via the 18-week referral to treatment target were also flagged as priorities. In his interim report on the NHS, Lord Ara Darzi announced a stream of new GP surgeries and health centres to help reduce the current inequalities in primary care across the nation, which remains a key goalpost for the Service.

To help deliver improved access to GP services, Lord Darzi last week introduced a new procurement framework for NHS commissioning and a new GP-led health centre in each PCT, “to provide strategic health authorities and PCTs with the practical tools and guidance they need to manage high-quality, open and transparent procurements”.

“There have been significant improvements in access to primary care in recent years,” he said, but stressed the need for “a more ambitious vision for primary care and community services, based on more personalised care, more equitable access to services, and a stronger focus on promoting health.”

Also on the wish list is: the provision of a better patient experience, and greater staff satisfaction and engagement; keeping adults and children well and improving their overall health, to help reduce the demands on the already-stretched system, particularly given the expected obesity, diabetes and heart disease epidemics; and the preparation of a response to a state of emergency, which has likely been thrown to the forefront on fears of a potential outbreak of bird flu in humans.

Mixed response
Response to the operating framework from different factions within in the NHS has been somewhat mixed.

"The national priorities in the operating framework reflect what matters to patients and the public and NHS management is clear it must deliver on this agenda,” commented Gill Morgan, chief executive of the NHS Confederation. She also welcomed the move towards greater autonomy at the local level, but stressed that the proposed "indicators" or "vital signs” - from which local PCTs can choose where they want to focus their efforts - “do not turn into national targets for performance management”.

Steve Barnett, director of NHS Employers, said he welcomed the “acknowledgement that the workforce is at the heart of improved patient services and that staff satisfaction is fundamental to this,” highlighting “well-established links between trusts that have high staff satisfaction levels and those that deliver the highest quality services for their patients".

But David Stout, director of the Primary Care Trust Network, said: "PCTs might control more of the NHS budget but the level of prescription means the space for discretion is limited. The framework confirms that SHAs can set contingency reserves at any level they like when we believe this should be the responsibility of PCTs".

Nevertheless, NHS Chief Executive Alan Johnson insists that the new framework “sets out a truly ambitious programme for the NHS to deliver even more improvements in care for patients over the next three years. It also provides a real platform from which local NHS organisations - and the patients and communities they serve - will have a much stronger voice in determining their own priorities”.