- Teaching hospital included walk in data for A&E target from centre it does not run
- The trust would not have met target without doing so, board papers said
- The trust insisted its data was being ‘correctly reported’
- News follows widespread concerns over NHS fiddling it’s A&E data
Regulators withheld funding from a teaching hospital after it admitted only meeting its accident and emergency target “through the inclusion of the walk in centre performance [data]” from a facility it does not run, HSJ has learned.
The news follows NHS Improvement launching a review last month of the rules for how A&E data is collected and counted, amid confusion in the sector and concern data was being deliberately massaged.
NHSI’s review was prompted by the UK Statistics Authority announcing a probe of the data. It said it had concerns that the data may be “misleading”. Specific issues were raised around minor injuries and walk in attendances, coded as “Type 3” data.
This followed a letter from NHS Improvement to trusts in November about emergency performance reporting, which sought to improve consistency but appears to have added to confusion.
Norfolk and Norwich University Hospitals Foundation Trust’s November performance report to the board stated: ”The A&E target for Q1 was met and for Q2 was only met through the inclusion of the walk in centre performance.”
It said that NHSI had “disputed this inclusion [of walk in data] and also the assumed target and thus the achievement of Q2 [sustainability and transformation funding] for A&E [worth £800,000]”.
The board paper added: “We are actively engaging with them and have not adjusted our reported position for the associated risk of £798,000. We have accrued for the STF income in month which assumes that Q3 financial and A&E plan will be achieved. This is a significant risk – £1.3m.”
The trust confirmed to HSJ that NHS Improvement had withheld the funding – but it denied any wrong doing and insisted its data was being “correctly reported”. It also confirmed the Type 3 data had been taken from Norwich Walk-in Centre, which is run by Norwich Practices Ltd, a separate company owned by local GPs.
The rules on what type of data trusts are allowed to include in their overall A&E data were set out by NHS England in November 2015.
Type 3 performance against the 95 per cent target is significantly higher nationally against the Type 1 performance, the measure for serious hospital admissions, which are more complex. The guidelines state walk in centre data can only be included if the trust has clinical responsibility for it, or if it is co-located, neither of which are true for the Norfolk and Norwich University Hospitals Trust.
However, NHS Improvement’s November letter indicated the regulator may allow minor injury unit and walk in centre activity to be counted in a different way, stating: “If you can demonstrate agreement with all relevant local parties, including your local delivery boards, we will allocate Type 3 activity on co-located / non-co-located sites in line with these local agreements, for performance reporting purposes.”
A trust spokeswoman said: “STF funding was withheld because we did not achieve the Q2 A&E target. It is not connected with data issue which have been fully resolved and we have received confirmation that our data is being correctly reported.”
Asked who operates the Norwich Walk-in Centre, they added: “The provider is Norwich Practices Ltd.”
NHSI declined to comment when asked if any other trusts had seen STF funding withheld after including Type 3 data from a facility they did not run.
A NHSI spokeswoman said: “Payment of the STF is subject to trusts meeting the measures agreed by the trust and NHS Improvement at the start of each financial year. Payments are made quarterly based on published information which is then reviewed by NHS Improvement as per the STF guidelines.”
Information supplied to HSJ
- East of England
- HSJ LOCAL
- JAMES PAGET UNIVERSITY HOSPITALS NHS FT
- NHS Improvement
- NHS North Norfolk CCG
- NHS Norwich CCG
- NHS South Norfolk CCG
- NHS West Norfolk CCG
- NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST
- NORFOLK AND SUFFOLK NHS FOUNDATION TRUST
- THE QUEEN ELIZABETH HOSPITAL KING'S LYNN NHS FOUNDATION TRUST
- West Midlands