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Minerva's digest of the HSJ piece on financially challenged hospitals
sets out one of the major problems for hospitals - that while they are
trying to maximise income by generating more referrals, GPs are trying to
minimise these. It may be possible to reduce expenditure somewhat by
ruthless pruning of non-essential staff but there are are threats that
"loss-making" services may not survive in individual hospitals. What is
not clear, necessarily, is why they are loss-making, but if we assume they
truly are then it seems likely that many hospitals will find the same
services are financially not to their advantage to pursue, and they run
the risk of being abandoned altogether.
It is dreadful to suggest (but it has been) that consultants should
see all unnecessary referrals, and not give telephone advice, because only
patients who attend will be paid for. It will be tempting also to arrange
unnecessary procedures because they will attract extra cash. Such things
may be unethical, but they may save a hospital from closure. At best
hospitals will be vying for custom, and dog will eat dog. Indeed in our
area one hospital has explicitly stated that it will be trying to poach
business from others nearby.
Further pressure has been applied by the recent withdrawal of the
Department of Health's tariffs for Payment by Results (PbR). Our hospital
(which has had a turnaround team in place) has spent four weeks of
intensive work by managers and clinicians to construct a recovery plan
based on the expected income from the introduction of PbR. Yet suddenly
the PbR income levels are unknown. For the Department to insist that
recovery deadlines are met when it has screwed up the whole process by
blanking out the income figures is little short of scandalous. Worse
still, what if the hospital(s) cannot match income to expenditure? Will
they be closed? If several neighbouring ones face the same problems,
which one will go? Will private Finance Initiative hospitals survive at
the expense of others because they are contractually bound in to interest
payments (many exhorbitant)?
The secondary sector faces meltdown. We should be very afraid.
Turnaround teams
Minerva's digest of the HSJ piece on financially challenged hospitals
sets out one of the major problems for hospitals - that while they are
trying to maximise income by generating more referrals, GPs are trying to
minimise these. It may be possible to reduce expenditure somewhat by
ruthless pruning of non-essential staff but there are are threats that
"loss-making" services may not survive in individual hospitals. What is
not clear, necessarily, is why they are loss-making, but if we assume they
truly are then it seems likely that many hospitals will find the same
services are financially not to their advantage to pursue, and they run
the risk of being abandoned altogether.
It is dreadful to suggest (but it has been) that consultants should
see all unnecessary referrals, and not give telephone advice, because only
patients who attend will be paid for. It will be tempting also to arrange
unnecessary procedures because they will attract extra cash. Such things
may be unethical, but they may save a hospital from closure. At best
hospitals will be vying for custom, and dog will eat dog. Indeed in our
area one hospital has explicitly stated that it will be trying to poach
business from others nearby.
Further pressure has been applied by the recent withdrawal of the
Department of Health's tariffs for Payment by Results (PbR). Our hospital
(which has had a turnaround team in place) has spent four weeks of
intensive work by managers and clinicians to construct a recovery plan
based on the expected income from the introduction of PbR. Yet suddenly
the PbR income levels are unknown. For the Department to insist that
recovery deadlines are met when it has screwed up the whole process by
blanking out the income figures is little short of scandalous. Worse
still, what if the hospital(s) cannot match income to expenditure? Will
they be closed? If several neighbouring ones face the same problems,
which one will go? Will private Finance Initiative hospitals survive at
the expense of others because they are contractually bound in to interest
payments (many exhorbitant)?
The secondary sector faces meltdown. We should be very afraid.
Competing interests:
None declared
Competing interests: No competing interests