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Sunday 27th May 2018

Lessons of PbR

19th July 2006

19072006_childrens_ward1Q.jpgMinister of State for Health Lord Warner has announced a package of developments around Payment by Results (PbR) covering specialist children's hospitals, PBR supporting White Paper implementation in 2007/08 and the 2007/08 tariff.

Lord Warner said "I am announcing measures which address problems being faced by specialist children's hospitals; support the White Paper vision of care closer to home; and bring greater transparency and planning predictability to tariff setting. I am also publishing early evaluations which will aid the future development of PbR."

In a letter sent to strategic health authority chief executives, directors of finance and PbR leads as well as foundation regulator Monitor, Sir Ian Carruthers, NHS acting chief executive, has set out plans for the 2007-08 tariff and a action timetable leading up to the start of the next financial year.

The 2007/08 tariff will be published in mid-December with "no substantial changes to the scope and structure of the tariff for 2007/08 in order to minimise year-on-year price volatility."

To address the problems that have been faced by specialist children's hospitals the Department of Health has agreed to give the Liverpool's Alder Hey Hospital £4.9m this year, London's Great Ormond Street Hospital £3.4m and Sheffield's children hospital £900,000. Lord Warner said that if needed, similar arrangements will be put in place for 2007/08. The announcement comes after children's hospitals started to lobby government, warning services may have to be but because they were not receiving enough money under Payment by Results.

Chief Executive of Alder Hey, Tony Bell, said he was 'very pleased', adding "The £4.9m shortfall this year has come about because much of Alder Hey’s work is very specialised and, as such, costs more than the national pricing structure." Angela Jones, Chair of the Trust said that the Payment by Results issue had been "concerning for our staff, who work so hard to provide the best care possible, and for patients and parents".

The Lawlor report, carried out by Harrogate and District foundation trust chief executive John Lawlor following the temporary withdrawal of tariff earlier this year, has also been released and calls for;

- greater transparency

- greater clinical engagement

- more resource for the calculation process

- earlier indication of next year's tariff

- road-testing and piloting of new tariffs where possible

Dr Gill Morgan, Chief Executive of the NHS Confederation said that she was pleased that 'the Department of Health (DH) is leading the drive for openness and transparency by publishing this report in its entirety.'

Dr Jonathan Fielden, deputy chairman of the BMA’s consultants’ committee said: “The Lawlor report is rightly critical of the initial implementation of PbR. It supports many of the criticisms expressed by the BMA, and others, and highlights the significant deficiencies of the PbR process." He added that the commitment to greater clinical involvement should allow PbR to become fit for purpose and match the needs of patients.

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