Emails reveal elite hospitals' high level lobbying for extra cash

The Shelford Group of England’s 10 leading teaching hospitals have pushed for an “infrastructure payment” on top of their existing contract income, the correspondence between the organisations shows.

The group has called for between £15m and £25m in extra funding a year per trust, arguing it will take many years for tariff systems to accurately reflect cost.

The group says the higher costs its members face as providers of specialist tertiary care puts it at particularly high financial risk because of falling tariff prices and training budgets. Tariff prices are calculated by taking the average cost of a procedure across all providers. The Shelford Group argues that its members treat patients of above average complexity.

One of the emails, obtained under the Freedom of Information Act (see attached files, right), refers to the need for the group to make “political arguments” in order to “push the National Commissioning Board [now NHS England] towards implementation”.

The message, sent in March to directors at the 10 trusts, said these arguments would be a “combination of [asking] ‘where the system needs our help’ backed up by ‘what are the adverse consequences of doing nothing?’”.

The group also planned to, “define a tight ring of eligible recipients [of additional funding] … to obviate the fear that this would ‘open the floodgates’ [for other trusts to receive it]”.

When HSJ revealed in August that the Shelford Group was pushing for a 10 per cent top up to its members’ tariff income, many smaller trusts said this would be unfair.

One of the emails seen by HSJ was sent between the finance directors in the group, by a director whose name was redacted. It said that, in a meeting involving NHS England, a senior policymaker had admitted the “core issue around the complexity… attached to bed days which are averaged across providers with quite differing case mix… was probably not ‘fixable’ any time soon”.

The email said that, because of this, there was “a clear argument for ongoing infrastructure payments for our hospitals”.

The group’s efforts to demonstrate the need for additional payments have also included commissioning a report on the differing cost and complexity of patients across hospitals from consultancy Ernst and Young.

The Department of Health’s response, sent to HSJ under the Freedom of Information Act, concluded the consultants had not proven how much of the difference in costs between specialists and other hospitals was due to variation in efficiency. It also said it estimated £200m was already due to be paid to specialist trusts in 2013-14 under “specialist top up” rules.