18 March 2005
The architect of the payment by results reform of NHS finance has warned the health sector to expect further delays to its full implementation.
Bob Dredge, former programme manager of financial reform at the Department of Health, claimed it was possible that PBR might not be applied to accident and emergency and outpatient financing when the government attempts to roll out the programme in 2006.
PBR was due to come into full force this year, but its application to 70% of treatments has been delayed until 2006 because of concerns across the NHS.
PBR groups procedures and diagnoses into broad categories, each with a standardised tariff. It aims to reduce variations in the cost of procedures, rewarding organisations for efficient resource use and improving patient choice over where they are treated. The DoH intends the system to cover 90% of NHS expenditure.
However, full implementation across foundation trusts has proved troublesome and doctors and NHS finance experts have warned that it might not reflect costs.
Addressing a CIPFA conference on NHS finance on March 15, Dredge questioned whether politicians would 'hold their nerve' and roll out PBR from next year and in full by 2008.
He said: 'It depends how rocky [the opposition] gets. Having made the decision to pull back once, it's a lot easier [for the DoH] not to do A&E, outpatients and to make a few more exceptions because of the noise coming from within the NHS.'
He added that he never believed it would cover 90% of NHS expenditure, even though he 'had to say it would' while working at the DoH.
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