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Welfare Reform on the Web (May 2009): National Health Service - funding

Fair for all, not free for all

NHS Confederation

London: NHS Confederation, 2009

Report argues that hospitals should continue to charge patients and visitors to park their cars. The fees, which can range from 2 a day to 3 an hour, are said to be necessary because running car parks is expensive. However it is argued that staff and some patients who have to visit the hospital regularly for treatment should be offered reductions.

In the balance

N. Plumridge

Public Finance, Apr. 10th-16th 2009, p. 20-23

The English NHS has succeeded in re-establishing sound financial management and has accumulated substantial reserves. However major changes to the funding system threaten to destabilise the service again. A new resource allocation formula, a new way of calculating the payments by results tariff and a fresh approach to the controversial 'market forces factor' geographical weighting are being introduced at the same time. No-one knows what the impact of these changes will be.

Not NICE

A. Chisholm, K. Briggs and J Askham

Picker Institute, 2009

This is a study of how Primary Care Trusts (PCTs) tackle the issue of engaging patients and the public in commissioning decisions about new drugs and treatments. It reveals that PCTs are failing to involve the public effectively in decisions about funding treatments that have not yet been approved by the National Institute for Health and Clinical Excellence, but that most people are reticent about involvement in such decisions. It suggests that citizens' juries and advisory panels could be effective ways of addressing these issues.

(See also National Prescribing Centre. Supporting Local Decision-Making about Medicines (and Treatments): a Handbook of Good Practice with Guidance and Tools to help PCTs. 2009)

PCTs' acute spending 1.2bn in red

H. Crump

Health Service Journal, Apr. 16th 2009, p. 4-5

A survey asked 20 primary care trusts across all strategic health authority areas in England how they had performed against what they had planned in their 2008/09 acute contracts. Results show that they have overspent significantly, raising questions over the success of efforts to deliver care more cheaply in the community. PCTs are covering the extra costs by using their surpluses or by dipping into next year's funds.

Trusts bank on increase in NHS funds after 2011

N. Timmins

Financial Times, Apr. 14th 2009, p. 3

Primary care trusts, the key purchasers of NHS care for their patient population, are still planning for a bigger rise in the NHS budget after 2011 than now looks likely. The Institute of Fiscal Studies calculates an 80bn hole in the government's budget will have to be filled by tax rises or spending cuts after April 2011 if there is to be a credible prospect of bringing government finances back in balance. But according to a survey of 15 primary care trusts, while PCTs are revising plans downwards, on average they still expect a 2 per cent a year real terms growth after April 2011, the date after which current government NHS spending promises expire.

Use of economic evaluation in local health care decision-making in England: a qualitative investigation

O. Eddama and J. Coast

Health Policy, vol. 89, 2009, p. 261-270

In England primary care trusts (PCTs) control up to 80% of the NHS budget and are responsible for implementing national policy at the local level. This research explored decision-making processes and use of economic evaluation at the local level through 29 in-depth interviews with a range of decision-makers, 13 observations of decision-making meetings, and analysis of documents. National Institute of Health and Clinical Excellence (NICE) guidance was found to be the main way in which economic evaluation is used locally, even when following it conflicts with local priorities. Other than through NICE guidance, economic evaluation is not used in local decision-making.

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