Responsible Commissioner Cross Boundary and Cross Border Issues
Scottish Guidance, SEHD 2004 - Focus on Ordinary Residence
General Principles
Item 4 - NHS Boards have responsibility for commissioning services for all patients living within their geographical boundaries i.e. usually resident. Exceptions are designated national specialist services and highly specialised services that are commissioned by NSD.
Article 2, Functions of Health Boards (Scotland) Order 1991 states – where it is unclear where a person resides he or she will be treated as ordinarily resident at the address that he or she gives to the Health Board. If no evidence of his / her present address the most recent established address will be treated as the address of ordinary residence. If still not established he or she will be treated as residing in the area in which he or she is present.
Item 9 - Patients who move Cross Boundary within Scotland originating board must liaise with the receiving Board to ensure continuity of care.
Needs to be interpreted on a case-by-case basis as dependent on whether treatment started before patient moves and usually the Board where patient usually resident before treatment began is responsible and will remain so until a trigger date occurs. Triggers are:
3 months after change of address The 1st of April after change of address The completion of a course of treatment
However patients who entered system prior to the 1st April 1999 remain the responsibility of their original health board until they are discharged. Patients who entered after that date will transfer to new host commissioner after 6 months.
Item 13-20, Cross Border Moves
Again originating NHS board must liaise with the receiving PCT in England to ensure continuity of care - continuity of care is paramount. Patients who move cross border would be expected to register with a GP and responsible commissioner would be determined as the NHS body in whose area he / she takes up residence. However for a person moving cross border to England, the originating NHS Board will remain the responsible commissioner until the person de – registers with GP in Scotland. Items 19.1 19.6 need to be interpreted and applied case on case.
Item 20 covers Community Care. Out of area treatment Cross Boundary and Cross Border
Items 21-25 deals with SLAs for planned and unplanned and UNPAC activity. Items 26- 42 covers State Hospital, Mental Health Restriction and Detention under Mental Health Act, Prisoners and Immigration (Unlawful Immigrants Guidance 2010/11)
Boarding Schools, Special Schools and Looked After Children
Item 43 - Boarding Schools - States children considered resident at the school therefore responsible commissioner considered to be the Board where school is located. Note: not clear if this is Cross Boundary
Item 44 & 45 Special Schools - Covers day or residential special school that caters exclusively for children with special needs including LDs. Often complex healthcare needs and therapy intervention requirement. These kids remain the responsibility of their home boards derived from the resident address of their parents or guardians except for general school medical services that are provided within such independent schools.
Items 46-48 Looked After Children - Continuity of Care essential and notification by LA to health board and shared responsibility re ensuring a full health assessment but outdated needs to be GIRFEC proofed and of course CEL LAC health assessments by 2015. The responsible NHS Board should be established by usual means as set out in Item 4 so address of Foster Carer or children’s home.
Department Health, 2007 Guidance – Who Pays? Establishing the Responsible Commissioner
General Principles
2007-2008: New contractual arrangements in England where hospital trusts have a single contract with a single co-ordinating PCT.
In general the responsible commissioner will be determined on the basis of GP registration with a GP Practice or where a patient is not registered, their place of residence. So the responsible commissioner will be the PCT who holds the GP contract (? Health Board if cross border)
However for Looked After Children there is additional clause / guidance
Where a Local Authority names a special school in a child’s statement of special educational needs (ASL Plan) and the child is then placed in the area of another PCT or Local Health Board the responsible commissioner remains the originating PCT or Health Board. Case Scenarios to Consider
1. Outline NHS Cumbria Position Letter May 2011 to NHS Scotland Originator Boards Did LAs and originator NHS Boards act in accordance with SEHD 2004? Did we think to consider DH Guidance and 2010 updates? Did we ensure continuity of care for child moving out with area? Were children sent out of area cross border without health assessments and care plans? Did NHS Cumbria have the right to bill us without negotiation? Who should pay - NHS Board / CHP where child resides? Who did pay?
2. Royal Blind School Edinburgh - All residing in Scotland, Boarders from out with NHS Lothian Primary Medical - named GP in Lothian children assigned through practitioner services Therapies - SLA between RBS and LUHD Head of AHPs / Therapies Secondary Care – Originator HB
Discussion and Potential Recommendations
Guidance Interpretation - Does this need to be resolved by Scottish Government and Department Health or is it a matter for negotiation between the originator Scottish NHS Board and the North West Strategic Health Authority and /or new provider in this case NHS Cumbria – other Strategic Health Authorities where appropriate.
Is Scottish Guidance still fit for purpose? – Does it need updated in respect of various other reports and recommendations and to include the GIRFEC Principles and reflect responsibilities of named person and lead Professional and requirement that All Looked After Children will have up to date Physical and Mental Health Assessments and a Single Childs Plan.
Sally T Egan Associate Director & Child Health Commissioner Strategic Planning, Modernisation & Primary Care Directorate NHS Lothian e.mail: [email protected]
OfficeTel: 0131 465 5550