Daily Insight: Backed by unpopular demand

In official terms, at least, the argument over payment by results is now settled and the health service has returned to a model aimed squarely at elective waiting lists.

But documents released to HSJ reveal the extent of opposition from some of the service’s biggest trusts – and suggest concerns were effectively ignored by NHS England.

The mooted revival had attracted strong lobbying but, following the usual consultation, NHSE confirmed PbR would be going ahead without any substantive changes – though it decided not to publish an analysis of responses, as is normally the case.

This may be because the submissions, which were released following a freedom of information request, show most trusts expressing a view were opposed to the return of the pre-pandemic payment model.

Awkwardly for NHSE, this included major trusts such as Barts, which said PbR would “set systems up to fail”, and Leeds Teaching Hospitals, which said it felt “like a step in the wrong direction”.

Concerns centred around trusts losing out if they were unable to rattle through elective work due to emergency pressures or delayed discharges, but their calls for a funding floor or minimum income guarantee look to have fallen on deaf ears.

About time

Around 10 per cent of the 1.2 million accident and emergency attendees in February waited 12 hours or more, newly published NHS England data has revealed, laying bare the true extent of the NHS’s emergency care crisis.

The long-awaited data – which NHSE has collected for years but has only now started to publish – shows 125,505 patients waited 12 hours or more from their arrival at A&E to be admitted, transferred or discharged.

This is more than double the highest figure under the existing metric of around 55,000, which only starts the clock from when the patient has received a decision to admit.

NHSE’s decision to publish the data for 12-hour breaches from time of arrival follows a concerted campaign by the Royal College of Emergency Medicine, which has long raised concerns the measure from decision to admit has significantly masked the true extent of long waits in A&E.

The greater transparency on longer A&E waiters is of course welcome, albeit a long time coming. The harder issue will be reducing the numbers of trolley waits, the number of which has mushroomed since the pandemic.