Saturday, October 28, 2006

The Payment by Results tariff has created perverse incentives for NHS trusts
to manipulate demand above levels warranted by clinical need, research concludes.
The study by the York Centre for Health Economics found hospitals may encourage unnecessary referrals or follow-up procedures and expand medical staffing into
sub-specialty areas in order to maximise their income. A consequence of the tactics
could be to stop co-operation between providers and hinder growth of primary care
as an alternative to hospital care. The research concluded: 'The Payment by Results
policy may make it difficult to attain major shifts in provision from the acute to
community sector.' It added: 'The collective impact of many of the potential actions
and behaviours induced by Payment by Restults will increase radically the degree of
financial risk and potential instability in the health care system.'

Troubleshooter is given job of quelling hospital revolts.
The health secretary, Patricia Hewitt, has called in a powerful troubleshooter
to quell a public rebellion against NHS hospital closures. Sir Ian Carruthers,
who was until recently acting head of the NHS, will conduct a six-month review
of all plans around the country to cut services or close units, to see if more can
be done to win public support for change. He is expected to deliver a blunt message
to local NHS chiefs that there is no point in announcing closures without first winning the backing of hospital consultants and GPs.
But Hewitt has insisted the review should not delay reforms that are expected
to include the downgrading of many A& E departments and maternity departments.
Public concern about local closures has contributed to the government's dismal showing
in a Guardian/ ICM poll, which identified health as an electoral problem for Labour.
Only 14% of voters think the trebling of the NHS budget since 1997 has been money
well spent. The Department of Health said Hewitt's response will be to redouble her
efforts to persuade patients and voters that hospital reorganisations are designed to
improve services, not cut them. Sir Ian faces a formidable groundswell of suspicion.
This month 7,000 marched through Haywards Heath to defend the A& E department
at Princess Royal hospital. 5,000 formed a human "circle of defiance" around Worthing
and Southlands hospital to protest at cuts they fear will result from the health authority's "reconfiguration" of services. They are two of the 50 most active local campaigns which show how the NHS reform programme is causing political fall-out in every corner of England.
Sir Ian's review would not override the normal rules for consultation with the public, and local authority scrutiny committees would retain the right to object. The government will produce further guidance shortly on how NHS organisations can consult most effectively.