This report examines the NHS's experience with Payment by Results (PbR) since it was introduced. It builds on our previous two publications on the subject, by drawing on recent experience, looking at how PbR has affected the NHS and in turn how the NHS has responded.
The future development of PbR requires four steps to be taken:
- The information infrastructure needs to be strengthened, including diagnosis, procedure and casemix classifications
- The national tariff should be made more flexible
- It would be helpful to introduce some normative tariffs for selected HRGs
- Separate funding streams for capital and quality, for example, as is the case internationally
Included in this report are recommendations for:
- The Department of Health
- all providers of acute NHS services
- all Primary Care Trusts
- Strategic Health Authorities
All Primary Care Trusts, trusts and Strategic Health Authorities should develop genuine partnerships across the local health economy and with local government, working towards a consistent strategy
In addition, we consider the future direction of PbR and the challenges to the NHS over the period to 2010/11, based on the Department of Health's recent consultation.