NHS: Payment by bureaucracy

Filed under: Assets,Governance,Outcomes,Policy — lenand @ 9:10 am
Tags: ,

Actually it’s called Payment by Results (PbR).  It is a huge part of the NHS £100 billion budget.

A friend of mine reported unexpected behaviour in a hospital when going in for a simple procedure.  They offered (or insisted on) a blood test.  He feels perfectly fit, with no other symptoms but was referred to two more departments.  They went through the motions of a few appointments, most involving delays in waiting rooms.  The specialists, in the end, said that he was perfectly in the normal range, but he could request further investigations.  It seems that administration bureaucracy will charge the full tariff, even though there was no treatment.

Then my suspicious, and somewhat cynical, friend heard about PbR.   Apparently tariffs are set for each procedure and I downloaded a copy of arrangements for 2010-11.  We may stand to be corrected, but his two unnecessary set of referrals will earn the hospital several thousand pounds.  No treatment was undertaken, but the hospital (or perhaps the consultants?) will earn the full fee.

It has become clearer why we need so much administration in the NHS. This is one of the thousands of tariffs:

AA04Z: Intracranial Procedures Except Trauma with Non-Transient Stroke or Cerebrovascular Accident, Nervous system infections or Encephalopathy Category 4

  • Combined Daycase / Elective tariff (£): 11,033
  • Elective long stay trimpoint (days): 87
  • Non-elective spell tariff (£): 11,035
  • Non-elective long stay trimpoint (days): 87
  • Per day long stay payment (for days exceeding trimpoint) (£):  248

A few questions spring to mind:

  • How much effort went into collect these numbers?
  • How time is spent by clinicians and administrators trying to understand the subtle differences?
  • What if a better procedure is not on the list?
  • How variable are the true costs in different parts of the country?
  • How susceptible are these figures to accidental upgrading of an AA03Z to an AA04Z and the gaining of £10,400 income for the hospital?
  • Is this what GP surgeries are now expected to control?
  • Are the same tariffs going to be paid to private sector health suppliers?
  • Is it possible to pick through this list and only provide procedures that can clearly make a profit?

Governance Matters.  Policy should be reviewed for all possible outcomes before massive change should be implemented.  I just don’t know who is sufficiently wise and neutral to reconstruct the payment regime for the guardians of the nation’s health and public purse.

Quarkside thinks there must be a more economical way of controlling the cost of quacks.

1 Comment »

  1. […] by the citizen for medical treatment.  The tariffs are well documented.  A percentage is taken from the PEA for every access to NHS services – […]

    Pingback by IDs for a UK Citizen Account « Quarkside — 08/12/2011 @ 10:29 am | Reply

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