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5 Structures Necessary and Organisation of Services 5.1 Regional Framework 5.2 Partnerships 5.3 Responsibilities of Primary, Secondary and Tertiary Care 5.4 Local Management 5.5 Information Technology and Audit 5.6 Human Resources 5.6.1 NHS Workforce Planning Reforms 5.6.2 Future Staffing Requirements 5.7 Finance 5.8 Organisation of Services 5.8.1 Managed Clinical Networks and Shared Resources 5.8.2 Infrastructure of Renal Centres 5.8.3 The Private Finance Initiative (PFI) and Private Provision of Renal Services 5.4 Local Management The Resource Management Initiative (RMI) in the late 1980's suggested that discrete clinical services would benefit from self-management and responsibility for their own budgets. The purchaser/provider split embodied in the 1991 NHS Reforms accelerated the movement towards Clinical Directorate structures within provider Trusts. The Home Dialysis Administrator of old became the Business Manager of the Renal Directorate. These changes helped to establish renal services management as a career path for senior nurses and managers. While 'competition' for contracts to provide inpatient and dialysis services has now given way to a more co-operative way of working strict financial management remains important. Responsible and appropriately costed service level agreements (SLA's) between Trusts and commissioners are essential if medical, nursing, paramedical and administrative posts are to be maintained and expanded. Expertise in renal services management is a valuable resource. While serving provider Trusts well, objective medical/management advice proved difficult to recruit into HA planning in the last decade. This was one of the disadvantages of the 'market' with each provider in quasi competition with its neighbour for dialysis contracts and spheres of influence. With the abolition of the market it should be easier for RSCGs and PCTs to access more objective provider based expertise in planning.  |