Catch 22 - hospitals to be fined for treating patients fast, or slowly!

The latest absurd idea to emanate from the Department of Health includes fining hospitals which are too effective in cutting waiting times by treating patients faster.

The plans were leaked to MPs this week: the Department of Health says that there will be an official announcement early in the new year. But it appears that hospitals will be fined if they either perform significantly more operations than originally planned, or if they do not perform enough, and waiting lists go up as a result.

It appears that the fines would be imposed at the discretion of the Primary Care Trust, subject to appeal to the Strategic Health authority, and could be up to 2% of the mean value of a hospital contract - which could easily be £2 million for a typical acute hospital.

The justification for this barmy idea is that if hospitals are too efficient and treat many more patients than planned, the system of "payment by results" would otherwise mean that they get more money, which may destabilise the budgets of the NHS trusts which have to fund these payments.

While it is clear that there has to be a finite limit on the funds potentially available to any given hospital, giving NHS Trusts the power to find hospitals for being too efficient in responding to patient need is absolutely the wrong way to go about it. Any such limits should instead be built into the contracts in a clear and transparent manner, so that doctors and hospital managers responding to a medical need can do so with a clear idea how much money is available to them and know that they will not be subject to arbitrary fines.

We will have to see what the new proposals say when they are announced early in 2007, but it looks like hospitals trying to cut waiting lists or respond to an outbreak of illness face a situation where they are fined if they do and fined if they don't.