18 Payment by results or poor results?
Matter for discussion submitted by the RCN Sutton and Merton Branch
That this meeting of RCN Congress debates the inequalities of Payment by Results for patient care in the NHS
Work led by the RCN Public Policy Committee
The debate highlighted how Payment by Results (PbR) had created a focus on costs which had at time distracted from the process of care. In addition members reported that PbR had also created some perverse incentives leading NHS trusts to invest in outdate models of care or avoid changing models of care because they would not be reimbursed.
As a member of the external advisory group on Payment by Results (PbR) the RCN has contributed to the design of future tariffs. In January 2009, HRG4 was released; the improvements in matching classification and case mix activity to clinical practice should create more effective commissioning and resource allocation to care services. However, the nursing contribution at the patient level remains largely invisible.
The RCN partnered with the Healthcare Finance Managers Association (HFMA) to deliver a series of regional workshops - Not just numbers and money - which aimed to equip delegates with a broad understanding of NHS finance and how it underpinned patient care. These have been highly evaluated by members.
The RCN has also worked with the Audit Commission and others to publish a joint statement on the importance of clinical engagement in finance matters; recommendations included appropriate training and support, better guidance for clinicians, and more engagement with business planning.
Finally, the RCN has made a significant contribution to the debate around nursing metrics for quality of care, which will ultimately tie in with payments under the new framework for Commissioning for Quality and Innovation (CQUINN).
All these activities have helped to increase awareness of the role of finance in the NHS and its connection with patient care, and raised the RCN's profile in policy areas traditionally viewed as non-nursing. Gradual change has been effected to PbR, resulting in higher clinical visibility, but more needs to be done. A report, Making the invisible visible: understanding the cost of nursing care outlining the real cost of care within PbR is due for launch around Congress 2009, and further links between quality and cost need to be explored in the future. The RCN can play a key role in delivering on metrics for quality of care, which ultimately will connect with payments received.