Emergency Departments (EDs) in England provide an essential service for our communities. EDs are under increasing strain as a result of chronic under-resourcing, rising demand, increasing age and acuity of patients, crowding, and higher expectations.
To provide high quality care, EDs need to be properly resourced so that they can meet the demand they face in a safe and effective way.
To drive further improvements in the quality of care, the financial framework should incentivise best practice within EDs, along the same lines that the Best Practice Tariffs operate in other spheres of medical practice.
A paradigm shift is needed. EDs are generally resourced to cope, rather than to deliver safe, high quality care. The accepted image of EDs, reinforced by popular culture, is of fast-paced and even chaotic departments, where rushed staff struggle to cope in the face of adversity. This image, and the underpinning reality, should not be accepted:
- EDs see the most critically ill, vulnerable, and risky patients: 24 hours a day, 7 days a week, all year round.
- Patients have as much a right to be treated in a calm, orderly environment, by staff with the time to care, as they do, for example, in an operating theatre or intensive care unit.
- Staff have a right to offer appropriately paced care to their patients in properly equipped clinical areas, within a workforce that is adequate to deal with the demand faced. The current intensity of ED working, combined with the shift patterns needed to sustain a 24/7 service in the UK, is thought to be behind an emerging crisis in recruitment and retention of staff. This crisis will have a negative impact on patients, and will be more expensive to fix later, than now
The current funding system for Emergency Care is not working:
- Tariffs do not accurately or adequately reimburse EDs to provide patients with the care they need. Hospitals are therefore forced to either regard EDs as “loss leaders,” and to fund them in a discretionary way using resources veered from elsewhere in the system, or leave them significantly underfunded.
- Tariffs do not incentivise best practice or admission avoidance
- Block or managed contracts, where reimbursement for activity is effectively capped, are common
EDs have the ability to function as the powerhouse for effective emergency care by gate-keeping access to hospitals, and by ensuring that patients are diagnosed early, treated correctly from the outset, and sent to the right place for ongoing care. Failure to resource EDs adequately is a waste of a valuable asset. Supporting EDs to do what they should be doing is the only way to deliver round-the-clock, safe, effective, front-loaded care, to our patients. It would also provide true value for money.
There are a few important documents I found in the college and DOH website. Individual links to the pages given below.
Main College resource for payment
Payment by Results in the NHS: tariff for 2012 to 2013
Payment by Results in the NHS: tariff for 2013 to 2014
The King’s Fund. Payment by Results: How can payment systems help to deliver better care.
With input from CEM and DOH website.
How your Emergency Department is paid?
