Published: 10/03/2005, Volume II5, No. 5946 Page 9
A successful introduction of payment by results would offer the best chance of avoiding the kind of controversy which hit North Cheshire Hospitals trust last week, according to chief executive Ian Dalton.
Mr Dalton was speaking after pensioner Margaret Dixon's wait for a shoulder operation at the trust's Warrington Hospital hit the headlines last week. Conservative leader Michael Howard claimed in the Commons the operation had been cancelled seven times - although the hospital claimed it was three.
Mr Dalton admitted it was crucial there was a fair tariff for procedures like Mrs Dixon's, which could require a high-dependency unit bed, to ensure hospitals did not evade the most complicated cases.
But he told HSJ the ability of the trust to make big gains under the system because of the range of its specialist work meant it could create the extra capacity needed to minimise the risk of cancelled operations like that of Ms Dixon.
Mr Dalton said: 'We are still trying to understand the position of critical care under payment by results. There is not a separate tariff for an HDU so it will be vital the income we get for the more complex surgical procedures is enough to fully fund complex parts of the care pathway such as critical care.' Mr Dalton said he believed the trust is 'a potential big gainer under payment by results', enabling it to build up its clinical infrastructure and minimise cases such as Mrs Dixon's.
'We do more specialist work than most district general hospitals. Processes such as spinal surgery and complex vascular work do get an enhanced healthcare resource group tariff and we are hoping we will bring revenue into the organisation to enable us to build more HDU beds on the Warrington site.' Mr Dalton said he was 'very, very sad' about Mrs Dixon's situation but was satisfied that it had been the correct clinical decision, with more urgent cases such as spinal fractures and road traffic accident head injuries taking precedence.
He explained that Warrington had 'outgrown' the four HDU beds it had had since 2001.
'We have had significant developments at Warrington, particularly a further development of vascular surgery where we are increasingly becoming a significant regional hub, and also further developments in orthopaedics. Both those areas are big HDU users.' He added: 'The issue always is how we allocate beds and that is done on the basis of looking first at preserving life.'