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Payment by Results 'not working well'

NHS Alliance survey reveals fear of exploitation of NHS hospital payment system

A recent survey of NHS staff has exposed fears that the government's payment system for hospitals is being exploited to maximise care providers' incomes.

In the survey, carried out by the NHS Alliance, the organisation representing primary care trusts, staff criticised Payment by Results (PbR), the system responsible for the way hospitals are paid for the care they provide.

All respondents said they felt that PbR was not working well, while 93 per cent feel it needs amending to be 'fit for purpose'.

Meanwhile, 80 per cent said they fear that the current system will result in 'gaming' a method used to artificially maximise providers' income.

Examples of 'gaming' are an upturn of unnecessary hospital admissions, longer stays, and anomalies in price coding that inflate the prices of treatment.

About 30 per cent of respondents said that 'gaming' may already be happening in their PCT and a further 53 per cent felt that `gaming' was possible, even though they had no evidence to support this.

An NHS Alliance spokesman called for ìurgent actionî, stating that ìa comprehensive set of rules that go beyond the recently published code of conductî is now needed.

PbR has had a rough time since its introduction despite strong support from both health staff and government officials for its underlying theory.

Universal roll out of the system was delayed last year due to ìfinancial volatilityî and the survey results have now identified more problems with the government's implementation of the scheme.

The NHS Alliance has stressed the need for an independent arbitration body and will now draw up a list of recommendations for the future of PbR. One recommendation will be for `split tariffs', which allows money for patients to be shared by primary and secondary providers, thereby encouraging innovation and close co-operation rather than competition for limited funds.

Results were collated from an e-mailed questionnaire answered by 109 primary care trust (PCT) managers, professional executive committee (PEC) members and clinicians, from 28 strategic health authorities (SHA). Questions revolved around their experience of the new payment system and asked for their thoughts on the future of the system.

The Department of Health declined to comment.

30th September 2008

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