Payment by Results has inflated NHS costs and needs radical overhaul, an influential body has claimed.
NHS Alliance is calling for PBR to be seen as a maximum price rather than an absolute price in order to deliver savings to the taxpayer during the downturn. PBR was introduced in 2003 and is a rules-based approach for paying for hospital services in the NHS. A national rate, or tariff, is set annually for each type of service and commissioners are then required to pay for the healthcare provided to their patients at this tariff.
Dr Michael Dixon, chairman of the NHS Alliance, said PBR had encouraged acute trusts to become “profit centres”.
He also questioned the accuracy of PBR data. Recent Audit Commission results have suggested that errors in estimating PBR costs may vary by up to 10%.
“We are talking about quite a large margin, which means that the level of error, up to 10%, may well be the equivalent of total savings required at a time of deficit,” he said.
Although the NHS Alliance welcomes the move from ‘average cost’ to ‘best value cost’ when pricing PBR, the organisation said this is not enough.
The NHS Alliance believes that if PBR represented a maximum cost many trusts would be able to offer services at considerably less than the tariff and thus benefit patients and the taxpayer.
Commissioners would, however, have to guard against being duped by market tactics such as loss leading or skimming. Dixon said: “These risks must be faced if the NHS is to keep within budget. If last year the focus was on quality, then the focus for the future must equally be on cost. Cost has now become the business of every clinician and manager seeking to provide the best value in health and care for patients.”
Tags: Commissioning, PBR
