2.8.5 Regulation of medical devices and aids
The procurement of medical devices and aids in England is conducted through
regional NHS bodies known as “collaborative procurement hubs”. These hubs
consist of NHS trusts (normally within the same regional boundary) and
they work with the centralized NHS Supply Chain service which manages
the procurement and delivery of a wide range of products. DHL Logistics
(a private company) operates the NHS Supply Chain on behalf of the NHS
Business Services Authority on a ten-year contract. The Innovative Technology
Adoption Procurement Programme (iTAPP) under the Department of Health is
responsible for the procurement process, with funding for purchases of medical
equipment being provided through central government funding. Decisions on
the purchase of equipment in England are made locally by NHS trusts and must
follow the same financial governance framework as any investment decision
(see below). Regulation of medical devices and aids occurs at United Kingdom
level. Additional incident investigations in Northern Ireland are undertaken by
the Northern Ireland Adverse Incident Centre, which is part of the DHSSPS.
In Scotland procurement is done by NHS National Services Scotland. The
Procurement and Logistics Service (PaLS), part of the Business Services
Organization, manages procurement in Northern Ireland. In Wales purchasing
is done at a local level; major items are funded from capital on a bidding process.
2.8.6 Regulation of capital investment
For NHS England there is no longer a formal central prioritization process for
large capital schemes. Instead, local providers are responsible for initiating local
investments, with their decisions subject to a regulatory framework specified
by HM Treasury and developed further by the Department of Health. This
indicates when NHS bodies may initiate capital investment without reference
to higher authorities, and provides rules for ensuring good business practice.
The majority of investment remains funded by central government. In the
past, at an aggregate level, funds for capital investment in the NHS in England
were allocated on a regional basis by the Department of Health from central
government resources with the aim of delivering an equitable distribution of
health care facilities. Capital investment by foundation trusts is financed locally,
either through the reinvestment of cash generated by each foundation trust
from income for activity or through interest-bearing loans. These loans may
come from the private sector (commercial banks) or from government through
the Foundation Trust Financing Facility. Monitor, the independent regulator,
Health systems in transition United Kingdom 37
allocates a “prudential borrowing limit” to each foundation trust, basing its
decision on the trust’s ability to pay back the money it borrows. Loans drawn
down from the Department of Health’s loan facility are on commercial terms.
For large infrastructure projects, capital investment remains centralized in
Scotland, Wales and Northern Ireland. As part of the annual spending round,
the NHS in Scotland is allocated a capital budget, part of which is distributed
to boards by formula, and the rest allocated to specific large projects whose
value is in excess of board-delegated limits. In Wales the allocation of capital
to the NHS is managed by the Welsh government via an All Wales Capital
Programme, which was established in March 2007. In Northern Ireland there
is a collaborative approach to capital investment planning in which all parties
are involved in agreeing priorities and approving the business cases for capital
investment programmes (see also Section 4.1.1).
2.9 Patient empowerment
2.9.1 Patient information
It is easier than ever before for patients to access information, both that
pertaining to themselves and that related to the NHS in general. NHS Choices,
SHOW Scotland, NHS Direct Wales, and NI Direct are sites that provide a range
of information, such as the location and contact information for GP practices,
public health programmes such as healthy eating, how to access social care,
and symptom checkers.
2.9.2 Patient choice
Patients in the United Kingdom are free to register with a GP of their choice,
and generally to choose any NHS hospital as long as their GP is willing to
refer them. However, while choice is seen as a driver of quality and efficiency
in England, choice is not emphasized in Scotland, Wales or Northern Ireland.
The Health and Social Care Act 2012 in England made patient choice a
priority, especially focusing on allowing patients to choose where they can
go for elective procedures. NHS England also uses personal health budgets in
long-term care (see Section 5.8) as a mechanism of patient choice, as well as
of independence.
38 Health systems in transition United Kingdom
2.9.3 Patient rights
Implementation of the WHO Declaration of Patients’ Rights in Europe (1994)
has been devolved from the United Kingdom level. The