Cuts to A&E per capita payments mean A&E departments can’t meet costs

The Foundation Trust Network Chief Executive, Chris Hopson, recently blogged that cuts to the A&E tariff for patient admissions above the 2008/9 baseline have made it impossible for A&E departments to treat “skyrocketing admissions.”

Calderdale A&E must be running at a loss, because admissions have gone up since 2008/9, but under NHS payment rules drawn up by Monitor and NHS England, Calderdale Clinical Commissioning Group is only allowed to pay Calderdale and Huddersfield NHS Foundation Trust 30% of the tariff for any A&E admissions over 2008/9 baseline.

Matt Walsh, Chief Officer of Calderdale Clinical Commissioning Group (CCCG), told a CCG Governing Body meeting last year that this restriction lay behind CCCG’s request to Calderdale and Huddersfield Foundation Trust (CHFT) to commission the National Clinical Advisory Team (NCAT) to review urgent care and to report on recommendations for the CHFT to consider.

Nine months after NCAT gave CHFT its report on Calderdale and Huddersfield A&E, CHFT finally released it to local politicians and the public last week.

On the Foundation Trust Network website, the Chief Executive Chris Hopson recently blogged,

“We can’t go on pretending that… A&E departments can treat skyrocketing admissions while only being paid 30% of the cost of treating many of those patients.”

Monitor, the regulator of NHS Foundation Trusts, has told Foundation Trusts only to deliver services that make a surplus, and to cut down or close down services that make a loss. Monitor sees the role of Foundation Trusts as being to act like commercial businesses.

Monitor, which was created by the 2012 Health & Social Care Act in order to regulate the new NHS “market” that the Act aimed to stimulate, is run by an executive team drawn almost entirely from private sector management consultancies – KPMG and McKinsey in particular.

But A&E is protected in Monitor’s licenses to Foundation Trusts – in other words, Foundation Trusts have to provide A&E even if it runs at a loss. So they can only cut down A&E services, not close them down completely.

Calderdale and Huddersfield NHS Foundation Trust has to solve its share of a predicted NHS £30bn funding shortfall by 2020

Chris Hopson’s blog says that NHS England’s Call to Action, which identifies an NHS funding shortfall of £30bn by 2020, creates a massive “financial challenge” for Foundation Trusts and other NHS “providers” – eg GPs’primary care, community and mental health services.

GP funding has been cut a lot recently, and community and mental health services have just had their tariffs cut – ie they will be paid less for providing their services.

Shortage of money and staff – Calderdale CCG’s Strategic 5 year plan

NHS England’s Call To Action, released in Summer 2013, tells CCGs to come up with new 3-5 year commissioning plans that will find ‘local solutions’ to cutting their share of the £30bn NHS funding shortfall.

Calderdale CCG will present its 5 year plan at its 13 March meeting, which is open to the public. The documents are on their website and are linked to at the bottom of this article. The 5 Year Strategic Plan, which

“build[s] on the work of the Strategic Review

and envisions

“Large Scale Transformational Change”


“There is a gap in resources (both financial and workforce) available to the health and social care system”

Proposals in CHFT NCAT Report and Strategic Review pose “risks to service delivery and quality”

According to the Chief Executive of the Foundation Trust Network:

“We can’t go on pretending that:

  • all providers can realise 4% recurrent efficiency savings year on year till 2021 without rapid, radical change;
  • community and mental health providers can continue to absorb increased volumes on declining block contracts without an impact on service delivery;
  • A&E departments can treat skyrocketing admissions while only being paid 30% of the cost of treating many of those patients;
  • providers can improve patient / staff ratios, move to seven-day services, and deliver the new integrated care pathways without finding significant extra investment; and
  • providers can carry ever increasing risk, for example, taking £2.1 billion from NHS budgets in 2015/16 and expecting 6-7% efficiency savings from the acute sector, if that is what happens with the new Integrated Transformation Fund.

So each plan needs to be realistic about what can be achieved within the available financial envelope, and the risks to service delivery and quality need to be clearly
identified and managed. If that means the pace of transition to the new models of care envisaged in the ITF is a little slower than ideal, so be it.”

Here is a demolition of the myth created by Andrew Landsley when he was Secretary of State for Health, that the NHS is “unsustainable”.


Here’s the Foundation Trust Network Chief Executive’s blog post.
Here is information about how Monitor and NHS England set tariffs for NHS services.
Documents for Calderdale CCG Meeting on 13th march are here.
You can download Calderdale CCG’s 5 Year Strategic Plan here

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