Payment disincentives for vulnerable patients
NHS payment mechanisms that inadvertently disincentivise local systems from prioritising or providing adequate care for hard-to-reach patients.
363 items
8 sources
4 inquiries
Strongest theme matches
Mixed across source types and ranked by classifier confidence plus text match strength.
Committee recommendation
100match
#4 - Review NHSE payment systems and processes to incentivise local systems supporting hard-to-reach patients.
In some cases, NHSE’s payment mechanisms can mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients. GP surgeries receive a payment for every child vaccination. This vaccination funding mechanism favours areas where parents are more willing to inoculate their children, while areas with higher levels of vaccine hesitancy, which may be more deprived...
Matched on
terms: patient, payment
Committee recommendation
76match
#6 - Implement planned changes to control framework to prevent further ineligible payments by summer 2024.
NHS England again made payments to suspended GPs who were not eligible to receive them and has failed to adequately recover these overpayments. NHS England has made overpayments worth £1.3 million to suspended medical practitioners since 2017–18, just £33,000 of which it has recovered. For the second consecutive year the C&AG qualified his regularity opinion on NHS England’s...
Matched on
terms: patient, payment
Committee recommendation
74match
#119 - Cash remains essential for vulnerable groups, as digital solutions may not ensure full financial inclusion.
Cash is an enduring payment method that many people prefer to use and on which people who do not have equal access to non-cash payment methods rely. Although technology may progress further and reduce the number of people who rely on cash, demand for physical cash will always exist. The Government’s focus on reducing digital exclusion as part...
Matched on
terms: payment, vulnerable
Committee recommendation
68match
#5 - Twenty-Fifth Report - Regulation of energy suppliers
It is unacceptable that many vulnerable customers, on top of having to pay higher energy prices, face extra challenges working with energy suppliers and accessing benefits designed to help people with their energy bills. Vulnerable customers are most exposed to the rise in energy prices and some also face additional costs. Many vulnerable customers rely on prepayment meters,...
Matched on
terms: payment, vulnerable
Committee recommendation
66match
#20 - Provide free over-the-counter medication for low-income patients through Pharmacy First scheme.
To avoid patients continuing to use GPs for support that could be offered in a community pharmacy setting because of concerns about the affordability of over-the- counter medication, we recommend that such medication is free for people on low incomes, as part of the Pharmacy First scheme.
Matched on
terms: patient
PFD report
65match
Gregor Lynn
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.
Matched on
terms: patient
Committee recommendation
64match
#20 - Twenty-Fifth Report - Regulation of energy suppliers
We were concerned that some energy customers have been disproportionately affected by the energy crisis. For example, we noted that some vulnerable customers rely on prepayment meters but it costs more to administer the cost of energy paid by prepayment than by direct debit, which is reflected in the prices these customers pay. Some vulnerable 40 C&AG’s Report,...
Matched on
terms: payment, vulnerable
PHSO casework decision
64match
P-003292 - University Hospitals Plymouth NHS Trust
Dr Y complains that the Trust failed to tell him that when his son turned three months old, his care became chargeable as an overseas patient. He says the Trust did not tell him until his son was about two years old and it has now asked for a backdated payment of almost £10,000.00.
Matched on
terms: patient, payment
PFD report
61match
Nathaniel Phillips
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.
Matched on
terms: patient
PFD report
61match
Barbara Ellis
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.
Matched on
terms: patient
PFD report
61match
Alan MacDonald
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.
Matched on
terms: patient
PFD report
61match
Amanda Hesketh
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.
Matched on
terms: patient
Committee recommendation
60match
#21 - Twenty-Fifth Report - Regulation of energy suppliers
We asked Ofgem what it was doing to support vulnerable customers. Some stakeholders criticised Ofgem’s decision to add the SOLR cost levy to the electricity standing charge when customers cannot influence this cost by reducing their energy usage. Ofgem told us that it was examining the impact on different groups of vulnerable customers of spreading the cost of...
Matched on
terms: payment, vulnerable
Committee recommendation
60match
#30 - NHS England establishing a national team to enhance controls over suspension payments.
We asked NHS England why it did not have adequate controls in place to prevent ineligible payments of this nature and what controls it was putting in place to ensure that this does not happen again. NHS England confirmed that following two cases that were identified in late 2022 as part of the audit of its 2021–22 accounts,...
Matched on
terms: payment
PFD report
57match
Kristian Jaworski
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.
Matched on
terms: patient
PFD report
57match
Elaine Talbot
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.
Matched on
terms: patient
PFD report
57match
Clive Rivers
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.
Matched on
terms: patient
PFD report
57match
Neil Hickman
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.
Matched on
terms: patient
PFD report
57match
Peter Fanning
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.
Matched on
terms: patient
Committee recommendation
56match
#29 - NHS England made £1.3 million ineligible payments to suspended practitioners, with minimal recovery.
NHS England can make payments to medical practitioners who have been suspended, in accordance with the relevant statutory regulations and conditions. The C&AG qualified his opinion on NHS England’s accounts for the second time, as a result of it making ineligible suspension payments to medical practitioners. NHS England made payments to 12 medical practitioners who did not meet...
Matched on
terms: payment
NAO recommendation
56match
NHS financial management and sustainability
The Department and NHSE&I should develop a better understanding of how much of the deficits in trusts in severe financial difficulties are down to structural issues that cannot be addressed by local health systems and develop a plan to address these structural issues and include this in any changes to payment systems.
Matched on
terms: payment
Committee recommendation
55match
#3 - Fifth Report - The treatment of autistic people and people with learning disabilities
We also recommend that the Department then needs to redesign the financial incentives in the healthcare system so that local authorities do not seek to ‘offload’ autistic people and people with learning disabilities onto the NHS or place these individuals in inpatient facilities. The Department must instead offer a credible alternative and provide additional support so that autistic...
Matched on
terms: patient
PFD report
53match
Danyon Chesters
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.
Matched on
classifier match
LGO / SPSO decision
52match
23-012-780 - Kent County Council
Summary: Ms F complained that her mother was wrongly charged a contribution to her residential care fees from 2002 to 2021 when she was entitled to free mental health aftercare. She also complained that the Council had not explained how it had calculated the refund or whether it had included interest. The Council has accepted fault, sent its...
Matched on
terms: payment
Inquiry recommendation
52match
BRIS-142 - Prioritise quality and safety for specialist services; fund patient travel and accommodation
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 access. It is and should be the responsibility of the NHS to assist patients, and their families or...
Matched on
terms: patient
Committee recommendation
52match
#31 - NHS England faces challenges in fully recovering identified overpayments from 2022-23.
We asked NHS England whether it was pursuing recovery of the overpaid amounts identified in 2022–23. NHS England told us that it was still seeking to recover more of the overpayments, but that it did not think that it would recover all the money paid. It reported that it needed to ensure it has sound legal grounds to...
Matched on
terms: payment
PFD report
49match
Cerith Pugh
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.
Matched on
classifier match
Committee recommendation
47match
#23 - Free' specialised devices create perverse financial incentives, conflicting with clinical judgement.
NHSE described how it has established an evidence base for which specialised products are best to use (formerly known as high cost tariff excluded devices and now known as the Specialised Services Devices Programme). NHSE explained in written evidence that products purchased through this route are effectively free to trusts, with any consequent savings being available for spending...
Matched on
terms: patient
LGO / SPSO decision
47match
24-000-844 - Staffordshire County Council
Summary: We will not investigate this complaint about the Council’s decision to not reimburse the complainant for alleged overpayments his family made in meeting his late mother’s care needs. This is because the complaint concerns historical events since 2010 and is therefore late. The passage of time means there is no realistic prospect of us reaching a sound,...
Matched on
terms: payment
LGO / SPSO decision
47match
24-002-360 - Birmingham City Council
Summary: Ms X said the Council was not providing the property protection service Mr Z was paying for and its failure to do so might affect Mr Z’s ability to meet his care costs. We found fault in the Council’s service delivery but it did not cause Mr Z significant personal injustice. We also found fault in the...
Matched on
terms: payment
PFD report
45match
Michael Spencer
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.
Matched on
classifier match
PFD report
45match
William Abrahams
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.
Matched on
classifier match
PHSO casework decision
43match
P-001769 - Royal Berkshire NHS Foundation Trust
Dr R complains about the Trust’s decision to charge for fertility treatment. He says the Trust did not find out if the treatment would be funded by the NHS first and later billed them for treatment they had so far. He complains the Trust was intimidating when chasing payment and that when he made a complaint, it failed...
Matched on
terms: payment
PHSO casework decision
43match
P-002821 - Hertfordshire and West Essex Integrated Care Board
Ms O complains the ICB agreed to refund nursing fees for her mother but then refused to issue payment.
Matched on
terms: payment
LGO / SPSO decision
43match
21-005-322 - Dorset Council
Summary: Mrs X complained about the Council’s handling of her father’s financial assessment in December 2020. There was fault in the way the Council decided that gifts to great grandchildren amounted to a deprivation of assets and it will reconsider that decision. There was also an initial failure to explain its reasons for deciding a payment for renovations...
Matched on
terms: payment
LGO / SPSO decision
43match
20-013-004 - Hampshire County Council
stop payments, and that it has not reviewed Mr B’s needs. The Council is at fault because it did not try to contact Mr B’s representatives as it should have done, it stopped payments without ensuring Mr B’s care needs were still met and has delayed reviewing Mr B’s needs. Mr B and his family have had to...
Matched on
terms: payment
LGO / SPSO decision
43match
21-017-426 - Blackpool Borough Council
Summary: Ms B complained on behalf of her mother, Mrs X, that the Council failed to send deferred payment agreement forms after she moved into residential care and failed to advise her that she could claim Attendance Allowance. We found the Council delayed in sending the deferred payment agreement form to Mrs X and failed to arrange an...
Matched on
terms: payment
LGO / SPSO decision
43match
23-019-120 - Warrington Council
Summary: We will not investigate Ms X’s complaint about the Council’s decision that the setting up of a family trust amounted to a deprivation of assets. The Council has agreed to make a payment to recognise the uncertainty caused by its delay in making the decision. There is insufficient evidence of fault to justify us investigating the decision-making...
Matched on
terms: payment
LGO / SPSO decision
43match
22-011-518-report - Coulson & Collins Care Home Ltd
The Local Government and Social Care Ombudsman investigated a complaint about Coulson & Collins Care Home Ltd. We found the care provider did not correctly record and refund an overpayment for the complainant’s late father’s care, incorrectly charged an administration fee, and delayed responding to her. It means her father’s estate is at a financial loss and she...
Matched on
terms: payment
LGO / SPSO decision
43match
24-001-518 - Cornwall Council
Summary: Mrs X said the Council’s handling of Mr X’s added care costs after he left hospital was unnecessarily time consuming, caused distress and significantly affected her finances. We found there was avoidable delay by the Council and a failure to properly process Mrs X’s complaint about the costs. To put matters right, the Council agreed to apologise...
Matched on
terms: payment
LGO / SPSO decision
43match
23-019-512 - Manchester City Council
Summary: Mr X’s representative complained the Council wrongly charged him for a contribution to his residential care fees when he was entitled to free mental health aftercare. His representative also complained about how the Council calculated an interest refund payment on the amount Mr X paid. The Council has accepted fault. It has agreed to make Mr X...
Matched on
terms: payment
LGO / SPSO decision
43match
24-000-859 - Somerset Council
Summary: Mrs Z complained the Council has wrongly withdrawn Mrs Y’s care package, without properly considering how her needs will be met until her land can be sold. We found the Council’s decision to immediately end Mrs Y’s care package and seek to recover all costs incurred since April 2023 is fault. This has caused an injustice as...
Matched on
terms: payment
LGO / SPSO decision
43match
24-020-403 - Redwood Tower UK Opco 2 Limited
Summary: Mrs X complained Avery Healthcare (the care provider) failed to promptly tell her of the fees payable and invoices for Mrs Y’s care when she became self-funding. She also complained the care home charged for care not needed or provided. Mrs X said the care home caused distress and frustration, and impacted Mrs Y financially. Mrs X...
Matched on
terms: payment
PHSO casework decision
40match
P-004778 - The Dudley Group NHS Foundation Trust
Mrs E complains that the Trust stopped her routine podiatry treatment without prior notice and offered no alternative options or referrals. She says she was advised to seek private care, which she cannot afford as she receives Universal Credit.
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classifier match
PHSO casework decision
40match
P-001579 - NHS Surrey Heartlands
Mr N complains that his wife did not receive the continuing healthcare funding she was entitled to between 1 October 2019 and 22 April 2020.
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classifier match
PHSO casework decision
40match
P-003246 - NHS England
Mr A complains NHS England’s independent review panel (IRP) upheld the ICB’s decision that his late mother was not eligible for NHS funded continuing healthcare (CHC) when it assessed her care needs on 7 October 2022.
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classifier match
PHSO casework decision
40match
P-003226 - NHS England - South - South East (Local office)
Ms R complains about the IRP’s consideration of the ICB’s decision to not uphold her appeal for retrospective CHC funding for her mother.
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classifier match
PHSO casework decision
40match
P-004412 - Royal Devon University Healthcare NHS Foundation Trust
Mrs A complains about a Trust in the Devon area (the Trust). She says the Trust incorrectly charged her mother for Acute Healthcare At Home (AHAH) care without consent in January 2024.
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classifier match
NAO recommendation
39match
The Restart scheme for long‑term unemployed people
f) continuously improve its use of Payment by Results using its open book accounting provisions. It should review the incentives in its payment by result contracts and seek to refine these for future programmes, to reduce the extent to which contractors? profit depends on things outside their control;
Matched on
terms: payment
PHSO casework decision
39match
P-003055 - Department for Work and Pensions
Mr A complains that since August 2021 the DWP failed to pay him the correct amount of rent through an Alternative Payment Arrangement (APA).
Matched on
terms: payment