How are funds withheld from emergency departments being used?

IghoSubstantial funds are being withheld from hospital budgets under government policies, with targets, penalties, and incentives designed to help drive down numbers of emergency admissions and readmissions and to improve the flow of patients through hospital. There are no published data showing how much money has been withheld fromhospital budgets under these policies, and information on the level of fines imposed on hospital trusts since they were introduced for delays in ambulance handovers is not publicly available.

Dispatches sent freedom of information requests to 156 acute hospital trusts and 212 clinical commissioning groups in England asking for information on funds withheld because of the marginal tariff, the readmissions policy, and fines for breaching handover times and ambulance waiting times.

From the information obtained from 132 trusts, we found that the total amount of money withheld under the marginal tariff was £848,302,105 from 2010-11 to 2013-14. Thirteen trusts reported no withheld funds at all; 63 reported more than £5m in withheld funding and 14 more than £15m.

The 143 trusts that supplied cost information on funds withheld for readmissions had a total or £390,477,765 withheld. Twenty four had no funds withheld, while 15 trusts had more than £6m withheld.

For ambulance handover times we obtained data on 503,730 patient episodes from 45 trusts. Three quarters (71%) of patients were handed over within 15 minutes, 20% were handed over between 15 and 30 minutes, 7% between 30 and 60 minutes, and 9810 patients (just under 2%) waited longer than 60 minutes.

Impact
60 trusts didn’t hold the information on where the marginal tariff funding had gone, and 46 trusts didn’t hold the information on where the money withheld as a result of the readmissions policy was spent. The substantial variation across trusts suggests that there might be a problem in terms of the interpretation of these rules and implementation. The work undertaken in collaboration with the Centre was aired on Dispatches, in February 2014, on ITV 4.

Publications

Associated media
Channel 4 Dispatches – £1 billion NHS funds withheld