Tuesday, 21 January 2014

Hospitals to get more money for seeing A&E cases after funding rule is relaxed

Hospitals to get more money for seeing A&E cases after funding rule is relaxed NHS bosses make changes to payments system critics say wrongly denies emergency departments estimated £500m a year.

Hospitals are to receive more money for treating patients admitted as emergencies after NHS bosses relaxed a payments system which critics say has wrongly denied A&E units an estimated £500m a year.

Emergency departments have been struggling with a funding rule which means they receive only 30% of the cost of treating any patient admitted as an emergency over and above the number of patients treated in 2008-09.

So as many A&E units have been hit by sharp rises in emergency admissions – one of the service's most difficult challenges in the last 12 months – some hospital trusts have been losing up to £10m a year each, according to the Foundation Trust Network (FTN).

The remaining 70% was held back from hospitals and was supposed to be spent by local NHS organisations to set up initiatives to reduce avoidable trips to hospital, though there is little evidence that such schemes have been set up in more than a few places.

Hospitals believe they deserve the funding because they have provided the treatment when other parts of the NHS – primary care trusts and now GP-led clinical commissioning groups (CCGs) – have failed to offer alternatives.

The College of Emergency Medicine (CEM), which represents A&E doctors, and the FTN, which represents foundation trusts, which are semi-independent of NHS control, want the 30% rule scrapped. The Commons health select committee and the National Audit Office have also voiced reservations about it.

NHS bosses have now relaxed the system, though not axed it.

The health secretary, Jeremy Hunt, has told Dr Cliff Mann, the CEM's president, that Monitor, the NHS regulator that sets tariff rates, has decided that "where there have been significant local increases in emergency admissions outside the control of providers [hospitals], commissioners [CCGs] will be required to agree a revised baseline before the marginal rate kicks in."

That relaxation of the rule will see hospitals receive the full cost of treating more patients after they have agreed the details with their CCG. "Hospitals have been severely hamstrung because of this unfair rule," said Mann. "It also contributes to hospitals being overfull because the only way to pay for an older lady admitted with pneumonia is to get the man in for his knee replacement, and there is only a finite amount of beds in hospitals."

Matt Tee, chief operating officer of the NHS Confederation, welcomed the "adjustment" to the tariff but said it supported the intention behind it of treating more patients outside hospitals.

But the FTN called for the rule to be scrapped altogether. "This policy is not fit for purpose," it said. "It does not meet the core purposes of funding emergency care appropriately, or supporting the shift of care to out of hospital settings. With the pressures on the system increasing year on year, we urgently need abolition of this policy to ensure we have a safe, effective, appropriately staffed and high-quality emergency care service in future years."

Evidence collected by the King's Fund health thinktank shows that just over half of the finance directors of NHS trusts say they have lost money because of the rule. One said that "this policy has had almost the exact opposite effect as was apparently intended", another said it had bred "confusion and resentment amongst clinicians who are treating patients at a major loss", while a third said it had not reduced emergency admissions.

From April CCGs will also have to show NHS England that they are investing any money held back from local hospitals under the rule in plans to reduce the need for emergency admissions.

A Department of Health spokesman said: "The marginal rate, when used effectively, can help reduce pressures on A&E. But it's right there's sufficient flexibility in the system to support the hospitals which have experienced a significant rise in A&E patients.

"Importantly, any savings commissioners make from the tariff will be transparently reinvested in measures to reduce demands for emergency care." The Guardian

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