Home Oxygen Therapy Services: Intended Benefits Not Yet Fully Realised

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The NHS in Wales was not sufficiently prepared for major changes to the way home oxygen services are provided, according to a new report published by the Auditor General for Wales.

Air Products Plc was awarded a five year contract, starting in February 2006, to integrate the supply of home oxygen services. In parallel with the new contract, the new arrangements envisaged specialist clinical assessment of patient need. But, according to today's report, the intended benefits of these changes have still not been fully realised.

The cost for the supply of home oxygen under the new contract is around ?6 million a year. This is significantly higher than the original estimate of ?2 million, which was based on inadequate information provided by the NHS on likely demand, but similar to the annual cost of the previous arrangements. Today's report says there may be potential to reduce costs in the longer term through the specialist clinical assessments, which would identify patients who do not have a clinical need for oxygen.

The report also found that the timescale for preparations for the new contract was tight and did not provide any contingency in the event of problems. There was poor information available on the numbers and details of patients affected by the changes, which resulted in late communication with patients about the changes to services. There were also mixed messages as to whether the Welsh Assembly Government intended the changes to be implemented in a phased way or as a 'big bang'.

The new arrangements failed almost immediately. Air Products Plc was unable to cope with the unprecedented and unforeseen demands placed on the new service by patients and health professionals. There were additional problems with the use of the new order form by GP practices which resulted in their submitting incomplete and duplicate orders.

The Assembly Government responded quickly to the crisis. It instructed local health boards to resume previous arrangements with community pharmacists in providing oxygen cylinders. This was initially for a six month period, but was extended to seven months. These arrangements were effective in restoring the supply of home oxygen services but came at an additional cost to the NHS.

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By September 2006, Air Products was the sole provider of home oxygen in Wales. There was a protracted period of dispute over charges being made by Air Products under the contract which led to some local health boards withholding payment. This dispute was resolved in October 2007.

Despite additional funding from the Assembly Government, there has been slow progress by local health boards and trusts in introducing effective clinical assessment of patients requiring oxygen. Without these specialist assessments of need, the new arrangements have not yet delivered the intended clinical benefits to patients.

The report makes four recommendations for improvement:

• for future similar England and Wales contracts, the Assembly Government should be able to vary new contractual arrangements within Wales to mitigate risks;

• the Assembly Government should make provision for possible problems when planning timescales;

• the Assembly Government should oversee the effectiveness of communications by health bodies when announcing changes to services; and

• the Assembly Government should direct LHBs and NHS trusts to prioritise the

development of specialist clinical assessments. The Auditor General for Wales said today: "The change in the arrangements for home oxygen services was not well managed and the reasons why those arrangements failed were foreseeable. It is disappointing that some of the intended benefits to patients have yet to emerge. It is even more disappointing that previous lessons around contingency planning, risk management and communication with those affected or responsible for delivering change were not applied in this case."

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