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Welfare Reform on the Web (March 2004): National Health Service - Funding

AIR APPARENT

P. Smith

Health Service Journal, vol.114, Feb.19th 2004, p.14-15

Bristol health services are suffering from serious financial deficits. Financial recovery will mean an increase in community-based services, two rather than three main hospitals for South Gloucestershire and Bristol, the replacement of the dilapidated Bristol General Hospital and the transfer of many services out of Bristol Royal Infirmary. Either Frenchay or Southmead Hospital will have to be downgraded to create a single specialist and emergency services centre. Article assesses the chances of the reconfiguration being pushed through.

BOTHER IN LAW

N. Plumridge

Health Service Journal, vol.114, Feb.19th 2004, p.39

NHS trusts have a statutory duty to achieve a financial balance. If they do not, they could be subject to a special report under Section 19 of the Audit Commission Act 1998, which deals with unlawful expenditure by NHS bodies.

CHOICE CATCHES

D. Conlon

Health Service Journal, vol.114, Feb.5th 2004, p.33

Discusses the implications of patient choice for financial flows within the NHS in the light of the London pilot. This has highlighted the question of how the NHS should account for unused capacity in the new regime. Real patient choice is possible only if there is spare capacity in the system, but some of this will be unused.

DECENTRING THE NHS: A CASE STUDY OF RESOURCE ALLOCATION DECISIONS WITHIN A HEALTH DISTRICT

C. Deeming

Social Policy and Administration, vol.38, 2004, p.57-72

New Labour has proclaimed a decentralised NHS, but there are doubts about the extent to which local experience matches the tone of government policy announcements. Article reports on a case study that examined the autonomy that purchasers had over budget allocations in a single district in 2001/02. Purchasers approach a new financial year with a starting position that matches the previous year's allocation (the baseline) and that is adjusted for inflation and increased by "growth funds" for service modernisation and government initiatives. In practice, the bulk of funds continued to be allocated on the basis of previous decisions. Each service, without review, tended to receive the same as in previous years plus an allowance for inflation. Growth funds were in practice ringfenced for named initiatives and not at the discretion of purchasers.

DOCTORS WANT ALL PATIENTS TO BUY INSURANCE

N. Hawkes

The Times, February 25th 2004, p.1

A new pressure group, Doctors for Reform, is calling for the introduction of compulsory health insurance instead of funding the NHS out of general taxation.

FAILING HOSPITAL SERVICES WILL HAVE TO CLOSE UNDER PAYMENT-BY-RESULTS

N. Timmins

Financial Times, February 6th 2004, p.3

Hospitals will have to close services that fail to cover their costs under the "payment-by-results" system, which the government is introducing into the National Health Service, according to John Hutton, the Health Minister. The system, under which by 2008 all hospitals - both public and private - will be paid a fixed price for all treatments is a crucial element of the government's health reform.

HOSPITALS MAY CUT PATIENT CARE TO PAY CONSULTANTS

O. Wright

The Times, February 23rd 2004, p.11

Hospitals may have to cut services to cover the costs of implementing the new consultants' contract. The problem has arisen because doctors who signed the contract have a right to get their pay backdated to April 2003. Because of long delays in implementing the contract, hospitals have not saved on overtime payments as expected.

PAYMENT BY RESULTS: A MARKET FORCES RETHINK IS ON THE CARDS

S. Brown

Primary Care Report, vol.6, no.1, Jan.28th 2004, p.15-16

The Department of Health is considering ways of removing an adjustment for local cost variations from the new national tariff for hospital treatments amid concerns that it will induce primary care trusts to commission services based on price. The change would mean all hospitals being paid the national rate for treatments, but being compensated for unavoidable extra costs through some kind of national levy.

PRIVATE HOSPITALS PAID 44% PREMIUM TO CARRY OUT SURGERY ON NHS PATIENTS

N. Timmins

Financial Times, February 5th 2004, p.1

Independent hospitals have been paid 40 to 50 per cent more than the cost of operations on the National Health Service for surgery performed for the public sector, according to Department of Health figures expected today. The premium means taxpayers have paid millions above official NHS prices for the 80,000 operations bought annually from private hospitals. The figures will be revealed as ministers publish a new "NHS price list", or tariff, which signals the re-introduction of a more sophisticated form of the NHS market that Labour said it had abolished. Starting this year, NHS hospitals will be paid a fixed price for each patient they treat, with money following the patient in a "payment by results" system. It is intended that by 2008 these standard NHS prices will also apply to treatment bought from private hospitals. Today's figures, however, will show that the service has been paying the private sector way above these rates. They confirm the work of the Commons Health Select Committee, which showed that in 2001 the NHS paid an average of £922 for a cataract in a private hospital, surgery that would have cost £632 in and NHS hospital. Health ministers argue this is the result of "spot purchasing" of NHS operations and will be reduced by the long-term contracts it is signing with overseas-owned independent treatment centres.

PRIVATE UNITS QUERY NHS PRICE LIST

N. Timmins

Financial Times, February 6th 2004, p.3

Private hospital operators have challenged the accuracy of the new National Health Service price list, but predicted that they could, in time, match NHS prices for treating patients. Their comments came as the government conceded it had paid a 43 per cent premium on average for operations bought for NHS patients from private hospitals, at a cost last year alone of an extra £30m. John Hutton, the Health Minister, said the high prices resulted from "piecemeal and spasmodic" end of year purchasing. The government had had to pay the higher price to "fill gaps in NHS capacity", argued Mr Hutton.

A SICKNESS IN THE SYSTEM

S. Lawlor

Guardian, Feb.13th 2004, p.27

Argues that the NHS needs to be fundamentally reformed along European lines. Advocates introduction of compulsory health insurance, additional co-payments and a mix of public and private providers.

UP THE AGENDA

M.-L. Harding

Health Service Journal, vol.114, Feb.5th 2004, p.15

The implementation of the Agenda for Change NHS pay modernisation scheme is running late in the 12 pilot sites. The Royal College of Nursing has launched an advertising campaign designed to ensure that trusts give implementation due priority. Article investigates reasons for the delays

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