Payment by Results has little impact on NHS efficiency

Payment by Results (PbR) has had little impact on NHS efficiency and tariff prices should be cut to achieve real improvements, says the Audit Commission.

In a report on the policy's four-year roll out period, the Commission finds that PbR has given hospitals a better understanding of their costs and helps them improve their financial management.

It also finds evidence that the NHS was providing care more efficiently, through shorter hospital stays and wider use of day treatments.

But it adds that PbR had ‘at most contributed to these positive trends', which could also be credited to policies such as waiting time targets. It finds that PCTs had proved less adept at redesigning inefficient services than acute trusts, in part because of poor cost data.

Dr Jonathan Fielden, chairman of the BMA's consultants' committee, said: ‘We need better mechanisms to ensure that quality is the driver and financial activity is aimed towards improving patient care.'

RCN general secretary Dr Peter Carter said: 'In order to drive up standards it is essential that we move away from a crude cost and volume payment towards a system that rewards and incentivises improvements in the quality of care patients receive.

'To achieve this we need to have a much better understanding of the contribution of different members of the health care team. Nursing staff will, for example, be critical to the success of providing more care in the community and closer to where people live but currently there is very little information about the contribution required of nursing to achieve this.'

Audit Commission

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