Payment disincentives for vulnerable patients
34 items
2 sources
NHS payment mechanisms that inadvertently disincentivise local systems from prioritising or providing adequate care for hard-to-reach patients.
Cross-Source Insight
Payment disincentives for vulnerable patients has been flagged across 2 independent accountability sources:
20 inquiry recs
14 PFD reports
This issue has been identified by multiple independent accountability bodies, suggesting it is a recurring systemic concern.
Inquiry Recommendations (20)
BRIS-142 — Prioritise quality and safety for specialist services; fund patient travel and accommodation
Recommendation: Where the interests of securing quality of care and the safety of patients require that there be only a small number of centres offering a specialist service, the requirements of quality and safety should prevail over considerations of ease of …
Unknown
30 — Enhance Professional Standards Unit independence and seniority
Recommendation: The Home Office must: take steps to enhance the independence of the Professional Standards Unit from the Home Office and the perception of this independence; and increase the seniority of the Head of the Professional Standards Unit so that they …
Gov response: The government does not accept this recommendation. The government stated: 'The seniority of the Head of the PSU will not be changed.' The government expressed confidence in existing ACAS Code compliance and PPO escalation routes.
Not Accepted
HIA-4 — Compensation as Lump Sum Payment
Recommendation: We therefore recommend that compensation should take the form of a lump sum payment.
Gov response: No formal government response published.
Accepted
Delivered
IBI-1 — Compensation Scheme
Recommendation: My principal recommendation remains that a compensation scheme should be set up now
Gov response: The Infected Blood Compensation Authority (IBCA) was established through the Victims and Prisoners Act 2024. Scheme regulations came into force August 2024 with first payments made December 2024. As of October 2025, over £1.35 billion …
Accepted
Delivered
IBI-A-3a — HIV Eligibility Start Date
Recommendation: An amendment to the Regulations be made as soon as possible to remove the reference to 1 January 1982 from Regulation 3.
Gov response: In his oral evidence to the Inquiry, the Minister for the Cabinet Office agreed to look again at the Scheme's eligibility criteria for people infected with HIV. The Inquiry went on to recommend that the …
Accepted
In progress
IBI-A-4a — Interferon Treatment Impacts
Recommendation: People infected with Hepatitis B or C who have received a course of treatment with or based on interferon should be recognised as entitled to core awards at Level 3.
Gov response: The impact of interferon treatment on those infected with Hepatitis B or C often resulted in severe side effects, both psychological and physical. The Inquiry recommended that more be done to recognise the impact of …
Accepted in Part
In progress
IBI-A-4b — Special Category Mechanism
Recommendation: The Government reconsider whether to maintain its rejection in February 2025 of the recommendations of Sir Robert Francis KC and advice from the Infected Blood Inquiry Response Expert Group of August 2024, which was expressly accepted at the time by …
Gov response: In his oral evidence to the Inquiry, the Minister for the Cabinet Office agreed to look again at how the Scheme reflects the existing Special Category Mechanism and its equivalents. The England Infected Blood Support …
Accepted in Part
In progress
IBI-A-4c — Effective Treatment - Earnings Floor
Recommendation: For the calculation of Financial Loss awards for Hepatitis B, people born after 1953 should be treated like those born in or before 1953 on provision of evidence that their health did not improve or that it remained difficult to …
Gov response: The Government acknowledges the concerns raised by the Inquiry regarding the calculation of financial loss awards for individuals with Hepatitis B or C. Currently the amount awarded is determined partially by reference to the introduction …
Accepted
In progress
IBI-A-4d — Deeming of Severity Bands
Recommendation: Where the level of severity of a person's infection at Level 3 or more has been established to IBCA's satisfaction in relation to a given year, but it is not known when it reached Level 3 or more, the legislative …
Gov response: The Government acknowledges the concerns that the Inquiry has set out regarding the mechanism for determining the number of years a person with Hepatitis was likely to have spent at particular severity bands when there …
Accepted
In progress
IBI-A-4e — Evidence of Diagnosis Date
Recommendation: Regulation 14(2)(c) be amended to remove the requirement for evidence of the date of diagnosis of Hepatitis B or C. An appropriate redraft to achieve this would be: "where the diagnosis mentioned in sub-paragraph (a) is one of HIV, the …
Gov response: In order to aid processing of claims quicker, the Government has accepted the Inquiry's recommendation to remove the requirement for people with Hepatitis B or C to evidence their date of diagnosis with those infections …
Accepted
In progress
IBI-A-6a — Financial Loss and Care
Recommendation: "x" be removed from the equation set out in Regulation 7.
Gov response: The Inquiry has raised concerns regarding the calculation of past care and financial loss awards for those who choose to continue receiving support scheme payments. The Inquiry has recommended that a formula in the regulations …
Accepted in Part
In progress
IBI-A-6b — Exceptional Loss Evidence
Recommendation: The Cabinet Office consult on whether the evidential requirements for exceptional reduced earnings are likely to prove a barrier to people who have sufficient evidence that their eligibility for such an award could with confidence be established on a balance …
Gov response: The exceptional loss award which is part of the supplementary route provides additional compensation for those infected people who would have received higher pay if it were not for their infection. The Government commits to …
Accepted in Part
In progress
IBI-A-7a — Unethical Research Award
Recommendation: Where there is evidence that an individual was the victim of unethical research practices IBCA should be authorised to make an unethical research practices award to that individual.
Gov response: The issue of unethical research is one of the most shocking areas of this scandal. In his oral evidence to the Inquiry, the Minister for the Cabinet Office agreed to look again at how the …
Accepted in Part
In progress
IBI-A-8b — Affected Estates
Recommendation: The Regulations be amended such that where someone who would be an eligible affected person dies between 21 May 2024 and 31 December 2029, their claim does not die with them but becomes part of their estate.
Gov response: In his oral evidence to the Inquiry, the Minister for the Cabinet Office agreed to look again at how the Scheme compensates the estates of affected people. The Inquiry originally recommended that it was beyond …
Accepted
In progress
IBI-A-9a — Bereaved Partner Support Scheme
Recommendation: The IBSS cut-off date of 31 March 2025 be reviewed, that the scheme should as soon as possible reinstate support payments to partners bereaved after 31 March 2025 until such time as they receive compensation and that they should have …
Gov response: In his oral evidence to the Inquiry, the Minister for the Cabinet Office agreed to look again at the 31 March 2025 'cut-off' date for bereaved partners to join an Infected Blood Support Scheme. The …
Accepted
In progress
IR2-3 — Standard of Proof and Automatic Eligibility
Recommendation: As above, save that (a) the last bullet point should read: "eligibility is accepted if the information available points towards eligibility and the opposite cannot be shown to be more likely" and (b) eligibility should be automatic for individuals already …
Gov response: The Government acknowledges the further distress and trauma that can be caused to those applying for compensation, and so the Scheme has been designed to minimise the burden on applicants whilst protecting against fraud. People …
Accepted
Delivered
IR2-4 — Affected Persons Categories
Recommendation: I recommend that the following relevant affected persons should be admitted to the scheme: a) spouses, civil partners and long term cohabitees (for at least one year in the case of the latter) of living or deceased eligible infected persons; …
Gov response: With respect to recommendation 4 of the Second Interim Report, for those who have been affected by this scandal, affected persons will be eligible where their case is linked to that of an eligible infected …
Accepted
Delivered
IR2-6 — Categories of Loss and Award Heads
Recommendation: I recommend that the appropriate award in any case should be composed under the following categories of loss, applicable to both eligible infected and affected persons: a) an Injury Impact Award for past and future physical and mental injury, emotional …
Gov response: With respect to recommendation 6 of the Second Interim Report, the Government has accepted the Inquiry's recommended categories of award, and has therefore designed the Scheme to award compensation to include the following: Injury Impact …
Accepted
Delivered
IR2-8 — Tariff-Based Compensation Framework
Recommendation: I recommend that the Government should approve a scheme setting out a framework of tariff based compensation for eligible infected and affected persons, at rates which broadly take account of but are not limited by current practice in courts and …
Gov response: In line with recommendation 8 of the Second Interim Report, the Scheme will use a tariff-based framework to calculate the amount of compensation payable to those eligible. In practice, this means that compensation will be …
Accepted
Delivered
IR2-9 — Status of Awards and Legal Rights
Recommendation: I recommend that, with reference to the status of awards: a) eligible infected and affected persons should not be required to accept the offer of an award in full and final settlement of any right to pursue legal actions related …
Gov response: In line with recommendations 9 and 10 of the Second Interim Report, acceptance of an award does not require applicants to waive their right to pursue litigation. In defined circumstances, if an infected person's condition …
Accepted
Delivered
PFD Reports (14)
Peter Fanning
Concerns: Insufficient radiology slots for feeding tube replacements caused week-long delays and suboptimal nutrition for complex patients. There was also a lack of clear procedures for maintaining nutrition during these delays.
Responded
Gregor Lynn
Concerns: A cost barrier in private healthcare discourages patients from crucial histological analysis of lesions, unlike NHS treatment where it's included, risking delayed cancer detection for those not meeting NHS referral criteria.
Responded
Amanda Hesketh
Concerns: The practice failed to systematically review patients on multiple repeat analgesics or create individual plans, relying on repeat prescriptions without specialist input. There were also concerns about limited access to specialist pain clinics and underutilization of practice pharmacists for complex pain management.
Responded
Neil Hickman
Concerns: Ferritin levels were not routinely measured in patients receiving frequent platelet transfusions, risking undetected iron overload, largely due to a lack of funding for chelation therapy.
Responded
Clive Rivers
Concerns: Hospital policy prevented inpatient COVID-19 vaccination, and discharge delays led to infection. The discharge assessment failed to consider the patient's rapid COVID-19 decline vulnerability, resulting in an unsafe return to isolated accommodation.
Responded
Danyon Chesters
Concerns: Significant delays in accessing NHS mental health services led to fragmented private care, lack of information sharing between professionals, and private therapists not reviewing medication, impacting the deceased's treatment.
Responded
William Abrahams
Concerns: The current AAA screening program excludes individuals over 65 at its introduction, and the "opt-in" nature for asymptomatic conditions may hinder participation, risking undetected aneurysms.
Responded
Alan MacDonald
Concerns: A non-medically qualified counsellor charged an inpatient for non-treatment visits and failed to advise them on financial alternatives, revealing a systemic omission in Addcounsel's practices.
Responded
Michael Spencer
Concerns: A specific drug (Andexanet alfa) to reverse potentially fatal bleeding caused by Factor Xa inhibitor anticoagulants is not available in the UK, even for compassionate use.
Overdue
Barbara Ellis
Concerns: A patient with cross-border care arrangements was unable to access therapeutic services because her healthcare was commissioned by one county and social care by another.
Overdue
Elaine Talbot
Concerns: General practitioners lacked direct urgent access to CT scanning, unlike those in neighboring areas. This commissioning issue risks delaying diagnoses and potentially impacting patient outcomes.
Overdue
Cerith Pugh
Concerns: Referrals to consultants were inappropriately handled by middle-grade doctors, and essential liver function tests were declined due to a rigid demand management policy, lacking a mechanism for clinical override.
Responded
Kristian Jaworski
Concerns: A presumption in favour of vaginal delivery, partly driven by cost, needs to be re-evaluated to ensure patient safety and appropriate medical decision-making.
Responded
Nathaniel Phillips
Concerns: Brittle asthma, a life-threatening condition, is not covered by medical exemption certificates, causing patients to miss medication due to cost and preventing GPs from escalating care.
Responded