There is no doubt that targets are an important part of the contemporary health system, but figures regarding a series of fines for inadequate patient treatment have recently attracted criticism.
Hospitals in the NHS have been fined £600 million annually for missing the target in question, but managers in the health service claim that the system is shortsighted, needlessly punishes patients, and results in the NHS being pushed further into debt.
NHS Providers, which represents hospital trusts, says that the fines levied by GP groups are nonsensical, given that about 90% of trusts are in deficit and the sector is due to end the financial year later this week an estimated £2.8 billion in the red.
Chris Hopson, chief executive of NHS Providers, indicated that he has spoken to individuals in the hierarchy of NHS trust and that they consider the fining process to be utterly counter-productive.
“NHS trust chief executives tell us they are intensely frustrated by these fines and see them as shortsighted, counterproductive and reflecting a sense of denial about how serious the problems facing hospital, community, mental health and ambulance services really are.”
Fines are issued when trusts fail to treat patients within a specified period of time, and also when waiting lists are not reduced satisfactorily.
The fines are issued by Clinical Commissioning Groups, but trusts chiefs believe that the charges are hindering the ability to hire staff and deliver services to the general public.
One particularly damning figure relates to Barts Health; the NHS’s largest trust based in London.
This NHS trust was fined in excess of £52 million for missing targets at the four hospitals it is responsible for in England’s capital.
“This is not about condoning poor performance or poor clinical care for patients. Rather it is about recognising that fines are a blunt instrument for improving patient care,” the aforementioned Hopson commented.
Prof John Appleby, chief economist at the King’s Fund health thinktank, believes that fines are utterly perverse, and that the way they are implemented can often be completely unjust and unreasonable.
“The cause of some of these [waiting time] problems is lack of money [and so] to take away money from an organisation seems a bit perverse.”
Appleby added that there is a fundamental contradiction at the heart of this issue, and that the government should reassess the way that it deals with the problem.
“If a trust has admitted more emergency patients than it should, it could be because of a lack of investment in community services. It’s then a bit ironic to fine them for not meeting this target when the lack of community services is outside their control. You can see how these financial incentives might work in theory, but they may not be working in practice and they may be simply making problems worse in some cases.”
Responding to these comments, NHS England suggested that the fines are indeed justified, but also emphasised – in an apparent contradiction of this assertion – that they would not be imposed over the next 12 months, as the NHS attempts to ensure that finances are once more acceptable.
“For over a decade, well-established NHS practice has been that hospitals are incentivised to eliminate long waits for their patients, and rightly so. The successful result has been an enormous fall in typical long waits for an NHS operation – from over 18 months to well under 18 weeks,” a spokesman said. However, for next year we’ve already decided to suspend penalties and instead allocate an extra £1.8bn to incentivise hospital performance improvement.”
NHS trusts are expected to be collectively nearly £3 billion in deficit by the end of the fiscal year.