A new payment system for the National Health Service will increasingly see hospital funding linked to patient experience, as the government attempts to accelerate service improvement and efficiency to better weather the tough times ahead.

Health Secretary Andy Burnham announced last week that, over time (as yet undefined), 10% of hospital pay will depend on patient satisfaction, under a package of measures unveiled in his five-year vision for NHS that aim to make the service more “people-centred” and “productive”.

According to Burnham’s report, “a high-quality and productive NHS needs a payment systems that offer the right incentives”, and as such should encourage providers to maximise efficiency, provide the best quality care, and divert hospital care into the community to reduce costly admissions.

Maximising efficiency, he claims, can be achieved by changing the national tariff payment system so that the amount awarded to hospitals for each procedure they carry out is limited or frozen over the next four years, as well as by setting increasingly quality-specific targets, which, he said, will “drive all providers to become as efficient as the highest performers”. However, the proposal to increase the tariff by a “maximum of 0%” over the next four years suggests it might actually trimmed, leaving hospitals with significantly less cash in their coffers.

Furthermore, Burnham stressed that the system “must not reward poor quality or unsafe care”, and so, as of April next year, primary care trusts will be handed the power to withdraw payments when “care does not meet the minimum standards patients can expect”, further embedding the motto quality not quantity into NHS culture.

However, those opposing the policy will no doubt question the logic of taking funds away from hospitals that are underperforming, as this may end up being counterproductive. And while the NHS Confederation said it supported a more patient-centred health service, its chief executive Steve Barnett warned: “Calculating payments to providers based on patient satisfaction is very challenging to put into practice”.

“Variations in people’s expectations of what kind of service they should receive can be considerable and factors like geographical location, age, gender and ethnicity can all impact on the kinds of responses received – enormous care and detail would be needed to make this kind of assessment work,” he stressed.

Maximising efficiency is crucial if the NHS is to achieve previously targeted savings of £20 billion by 2014, at a time when demands on the service are rising but the purse strings are tightening considerably, and so “the challenge to the NHS and to NHS leaders and staff around the country, is to reshape services further and faster than ever before”, Burnham said.

This will also involve a 30% target for reducing management costs in PCTs, but, as Barnett warns, this move could reduce management capacity in the NHS by so much that it becomes “even more difficult to find the savings needed in the rest of the system”.

Prevention key
Another central strand of Burnham’s NHS roadmap is to focus even more on prevention as a means of reducing the strain on services in future. “With an ageing population and the increased prevalence of lifestyle diseases, preventing illness and keeping people healthy is our best long term insurance policy for the nation’s health and managing the financial challenges ahead,” he said, and added that the NHS “should intervene earlier to help people lead healthier lives and prevent more disease”.

In line with this, the health secretary re-iterated plans to give everyone aged 40-74 years the legal right to an NHS Health Check every five years to gage their risk of developing serious conditions such as heart disease, stroke, diabetes and kidney disease, which the government believes could help to prevent up to 1,600 heart attacks and strokes each year.

In addition, as previously announced, from April next year patients will have the legal right to start treatment by a consultant within 18 weeks of GP referral and to being seen by a cancer specialist within two weeks to help achieve earlier detection of disease and therefore increase the chance of treatment success.

Health think-tank The King’s Fund has broadly welcomed the government’s move to promote prevention as a much higher priority during the difficult financial climate, and its Director of Policy Dr Anna Dixon said: “While many of the ideas in this paper have been announced before, there are promises to undertake new work on conditions such as heart failure and diabetes, which lead to unnecessary hospital admissions if not looked after properly”.

However, she added that the themes set out in the document “now need to be translated into clear priorities and instructions for the NHS to implement,” and that the new NHS operating framework “should set out how this vision can be translated into reality”.