New NHSE incentive scheme ‘doesn’t make sense’, experts warn

The warnings follow NHSE writing to trusts to outline how trusts and integrated care systems can get a share of the new capital fund, which is based on UEC performance in 2024-25.

The guidance says around £100m of the funding will be made available to trusts which are either in the top 10 performers or the most improved against the four-hour accident and emergency standard and 12-hour waits. Meanwhile, up to £50m will be given to integrated care boards for improved ambulance performance (see full list of criteria below).

But the scheme has been criticised because the rewards for four-hours performance and 12-hour waits will only be given to acute trusts with a major type one emergency department, while urgent care is widely recognised as being a priority for wider system partners.

Community providers made similar criticisms about last year’s scheme.

Nuffield Trust chief executive Thea Stein, who previously ran community provider Leeds Community Healthcare Trust, said: “How long the average patient spends in A&E reflects decisions and capacity across many parts of the NHS and public services - from out-of-hours GPs to social care.

“The hospital trust is also crucial and can make many improvements, but giving out rewards to just one organisation doesn’t make much sense, and it’s hard to see how this will drive real lasting change.”

Royal College of Emergency Medicine president Adrian Boyle welcomed the incentive scheme and its focus on 12-hour stays.

But he added: “We remain unconvinced that these ‘incentives’ will lead to long-term, sustained improvement. They can result in target chasing and gaming, neither of which truly benefit our patients.

“There are no easy wins or quick fixes to addressing the scale and prevalence of the issues facing our EDs. And while this scheme will benefit a small number of departments, many others, who could greatly benefit from support, will not see any reward.”

However, NHSE said it was “helping provide capital funding to those who are implementing what we know works and demonstrating improvement in services for their patients”.

Sarah-Jane Marsh, NHSE national director for urgent and emergency care, added: “We have listened to our system and provider colleagues’ feedback and adapted this year’s incentive scheme to add an additional focus on 12-hour A&E waits, alongside the four hour standard and Category 2 response time.”

The recipients of the UEC capital incentives will be confirmed in May, following a “validation process” by NHSE. It told HSJ it was measuring and incentivising performance across the whole year.