Proposed NHS fixed payment scheme change ‘puts services at risk’, campaigners say
Campaigners have gone to the Court of Appeal to challenge a proposed new payment scheme for NHS services which they claim could put the quality and safety of services at “serious risk”.
They are challenging NHS England’s proposed change to a “fixed payment system” for providers of health services called the “whole population annual payment” (WPAP), which they say “will inevitably mean that hospitals will be underfunded”.
Campaign group 999 Call for the NHS argues the WPAP means contractors will receive a single payment for the delivery of all services under the contract “regardless of the number of patients provided with services or the complexity of services needed by patients”, and is “not a lawful method of paying for NHS services”.
The High Court dismissed the group’s claim in May, but at a hearing in London beginning on Tuesday three senior judges will be asked to rule on whether the proposed changes are lawful.
The group’s barrister David Lock QC said that, under the current payment regime, “hospitals are paid a sum for each patient that requires treatment, with the level of payment being dependent on the complexity of the treatment provided”.
The current system meant “hospitals are fairly remunerated based on the services they provide” but, he added, “changing from a tariff payment to a fixed payment system will inevitably mean that hospitals will be underfunded”.
Mr Lock said that “if hospitals are underfunded, hospitals will be able to afford fewer medical staff, fewer nurses and the costs of expensive drugs will be paid by the hospital rather than being passed on to the CCG”, referring to clinical commissioning groups which commission services for local areas.
He said NHS England’s proposed change was “an attempt to use the limited flexibilities of the NHS rules… to do a complete U-turn and go back to block contracting”, where providers receive a fixed sum regardless of the number or types of services provided.
Mr Lock added mental health services, which he said “have been ‘block funded’ under a WPAP-type arrangement for many years”, provided a “clear precedent” for campaigners’ concerns.
NHS England, however, submits the use of “block payments, from which the WPAP has developed, is already permitted” under NHS rules and are “widely used” by CCGs.
In written submissions, NHS England’s barrister Fenella Morris QC said: “A significant proportion of all payments made by CCGs for mental health services, community health services and some acute services are made via block contract arrangements.”
She pointed to a recent National Audit Office report which stated “block contracts and risk-sharing arrangements” had increased from 29% of the total value of contracts in 2016/17 to 37% in 2017/18, adding “in monetary terms, this is likely to amount to tens of billions of pounds”.
Ms Morris said Mr Lock’s concerns in relation to mental health services were “not justified” as the proposed WPAP would be different both in terms of scope and “how the price for the services provided is calculated”.
She also said it was “wrong to say that the WPAP will be paid ‘regardless’ of the number of patients provided with services”, adding that the payment “will be determined having regard to the size and needs of the population to be served by the provider”.
Speaking before the hearing, 999 Call for the NHS spokesman Steve Carne said the group was “determined in our fight to reverse the government’s decision” to introduce the changes, which he said was “contrary to the core principle of the NHS to provide care to all”.
Sir Andrew McFarlane, Lord Justice Haddon-Cave and Lady Justice Nicola Davies will hear submissions over two days and are expected to reserve their judgment.
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