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Feature Emergency Care

How England’s emergency departments are being penalised

BMJ 2014; 348 doi: (Published 17 February 2014) Cite this as: BMJ 2014;348:g1604
  1. Jasmine Macnabb, assistant producer1,
  2. Lyndsay Rowan, researcher1,
  3. Carl Heneghan, director2,
  4. Igho Onakpoya, researcher2
  1. 1Dispatches, Channel 4, London, UK
  2. 2Centre of Evidence Based Medicine, Oxford, UK
  1. Correspondence to: carl.heneghan{at}

To try to stem the rise of emergency hospital admissions the government introduced a penalty system to incentivise health providers and commissioners to manage demand. But how much money is being withheld from hospitals? A team from Dispatches set out to investigate

Emergency departments in England are under pressure. This winter, to help head off a crisis, the government made an extra £400m (€490; $670m) available to help hospitals cope with winter pressures. At the same time, substantial sums of money are being withheld from hospital budgets under government policies, with targets, penalties, and incentives designed to help drive down numbers of emergency admissions and readmissions and to improve the flow of patients through hospital. The money withheld stays in the NHS.

There are no published data detailing how much money has been withheld from hospital budgets under these policies. Nor is there publicly available information on the level of fines imposed on hospital trusts since they were introduced for delays in clinical ambulance handovers in April 2013.

So Channel 4 television’s Dispatches programme sent freedom of information requests to 156 acute hospital trusts and 212 clinical commissioning groups asking for information on funds withheld. Dispatches, in conjunction with the Centre for Evidence Based Medicine at Oxford University, then processed and analysed the data they provided.

Increasing demand

In the past 15 years there has been a 47% increase in emergency admissions, and as a result an extra four million people a year use emergency services than in 2004. In 2012-13 a quarter (26%) of patients attending emergency departments were admitted, at a cost of £12.5bn to the NHS; most of those admitted stayed for two days or less.1

Many of these admissions are avoidable, but there is little consensus on how best to reduce the numbers. In 2010 …

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