Payment by Results – 2011 Update
Tim Heymann and Geoff Sandle - BSG Information Group
Payment by Results (PbR) describes the way in which hospitals are paid for what they do. The system was introduced for a limited number of hospital services in 2005/06 with the aim of providing a transparent, rules-based system for paying providers. Since then the scope of PbR has increase to cover approximately 70% of hospital services. In theory it should reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions. Payments are linked to activity and adjusted for casemix. One ambition has been to ensure a fair and consistent basis for hospital funding.
Payments are linked to the HRG (Healthcare Resource Group) derived for each patient's time in hospital (the period from admission to discharge) , the resources that they need and use such as staff time, bed days and consumables. Broadly the PbR tariff reflects the actual costs of each HRG. Those costs are calculated from the national average reference costs which every NHS provider submits. The tariff can then be adjusted at Department of Health (DH) discretion each year, for instance to encourage efficiency. This year tariffs have been set at 1% below the last year's mean reference costs. They have been adjusted to promote new ways of working: for instance the PbR tariff is set at zero for patients who are readmitted within 30 days of discharge following an elective admission. That is meant to encourage safe, appropriate discharge and the development of “re-enablement” services in the community. Tariffs are also adjusted to acknowledge unavoidable differences in operating costs in different parts of the country, so are higher for care in central London hospitals than in provincial centres such as Truro. Supra regional services such as transplants, and some specialist treatments e.g. chemotherapy, specialist rehabilitation and high cost drugs do not currently have mandatory national tariffs and are left for local negotiation.
Independent EWTD Review
Issued by the News Distribution Service on behalf of NHS Medical Education England (MEE)
Professor Sir John Temple has launched his report ‘Time for Training’, an independent review of the impact of the European Working Time Directive (EWTD) on the quality of training for doctors, dentists, pharmacists and healthcare scientists.
The report was commissioned by Medical Education England (MEE) at the request of the former Secretary of State for Health Alan Johnson.
Sir John’s report concludes that high quality training can be delivered within the reduced number of hours available but fails if trainees:
- have the major role in providing out of hours service;
- are poorly supervised; or
- have limited access to learning.
'Time for Training' focuses on the quality of training provided now and says any current problems will not be solved by either increasing hours or lengthening training programmes.The Review reveals that, despite an increase of more than 60 percent in consultant numbers over the past ten years, hospitals remain too reliant on junior doctors to provide out of hours services.
Bowel Cancer Deaths Halve
Deaths from bowel cancer have almost halved over the past 40 years in England, new official figures have shown. Mortality rates from colorectal cancer decreased by 47% for women and by 35% for men between 1971 and 2008, according to the Office of National Statistics.
In 2008, approximately 7,200 men and 6,100 women died from colorectal cancer in England. The figures also show that survival rates for colorectal cancer have doubled since 1971.
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