Hunt reviews Payment By Results after CCGs call for abolition

Health secretary Jeremy Hunt has promised to review Payment by Results after commissioners called for it to be abolished and complained it rewarded activity rather than outcomes.

Mr Hunt: 'CCGs should have the freedom to do what’s in the best interests of patients.’ Pic: Alex Deverill

Mr Hunt spoke in central London this afternoon at a meeting of 150 CCG representatives organised by NHS Clinical Commissioners (NHSCC) entitled Building our future together.

Dr Johnny Marshall, GP and director of policy at the NHS Confederation, part of the NHSCC with the NHS Alliance, and National Association of Primary Care, summed up commissioners’ concerns for Mr Hunt.

Dr Marshall said: ‘Payment by Results doesn’t separate results from activity. We are not in the business of maintaining business as usual. We don’t have the flexibility to bring about the change we need.’

Mr Hunt said: ‘You’re absolutely right that this has created a focus on activity. That is something that NHS England is looking at. If the system isn’t always creating the right outcomes then that’s something we need to look at.’

Dr Marshall said other concerns included section 75 competition regulations, due to be debated in the Lords tomorrow, might prove a distraction from better integrating services to patients’ benefit.

Mr Hunt responded: ‘The purpose of reforms is to localise decision-making. CCGs should have the freedom to do what’s in the best interests of patients.’

He said the controversial aspects of section 75 were an unfortunate reflection of European procurement law that had to be followed but was not anything new.

Responding to criticism that his focus was too hospital based, Mr Hunt said: ‘The single biggest change I want to see in the next six months is how we look after the frail elderly and those with long-term conditions outside hospitals.’

He explained that since his health secretary appointment he had taken on work as a porter or healthcare assistant in the NHS where others were not aware of his identity.

Mr Hunt said: ‘I’ve been very struck by the fact that care for these groups is so disjointed. Sometimes it is unclear where responsibility lies for this absolutely critical group of people and I intend to lead public debate on that change.’

Mr Hunt said he had challenged representatives of CCGs in Surrey, where he is an MP, to be the first to introduce an electronic patient record that could be updated in real time and viewed in any NHS setting.

He said: ‘I thought it was utterly shocking that in one A&E a patient with advanced dementia attended after a fall but we knew nothing about her.’

He was aware of one area where a GP could write a prescription for a patient and hours later A&E staff could see it on their records.

Mr Hunt added that the arrival of a chief inspector for hospitals by the end of this year would have a beneficial effect for commissioners.

He said: ‘We want to massively increase transparency throughout the NHS. Hospitals will have Ofsted-style inspections led by current or former chief executives or medical directors from other parts of the country.’

He said the publication of results of hospitals in trouble would allow commissioners to build cases to persuade the public if controversial funding decisions had to be made.

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