CONTRACTING FOR PALLIATIVE CARE

In this paper the role of purchasing authorities, as set out in the cu rrent U.K. policy literature, is reviewed in the context of recent dev elopments in palliative care. The notion of the purchasing cycle, from need assessment and strategic planning through to contracting and mon itoring is outlined, along with core features of recent health and soc ial care legislation in Britain: quality assurance, consumer choice an d value for money. The role of providers and service users in the purc hasing process is examined and the relationship between purchasers acr oss the health/social care divide is explored. The implications of con tracting for the voluntary sector provision of palliative care are als o assessed. The review highlights the difficulties under the new legis lation in reconciling the aim of efficiency with that of quality assur ance, and of separating out the roles of purchasers and providers in a context where palliative care service developments have been provider -led. These factors reinforce the requirement to turn the purchaser-pr ovider split into an effective partnership. Finally, the review highli ghts the need to address the current imbalances in the purchasing cycl e by giving adequate attention to aggregate need assessment and strate gic planning.