With the window for comments on the Payment system reform proposals for 2019/20 published by NHS England and NHS Improvement about to close, I’ve had a numerous discussions with clients on the ongoing challenges that short-stay emergency care presents to joined-up contracting between commissioners and providers.

For a number of years now the delivery of emergency care has been evolving in the NHS. New care pathways in ambulatory care and assessment units have been implemented at many trusts to stop patients being admitted to a hospital bed unnecessarily, ensuring the most efficient use of hospital resources and a better patient experience for the patients and their families.

However, the ability to measure performance and monitor the quality of care is limited as this activity is not easily identifiable in national datasets, leading to a lack of clarity between commissioners and providers of the purpose and outcomes of new pathways and units. Moreover, how this activity is recorded and funded has been contentious in many heath economies, leading to arbitration, formal disputes and contracts left unsigned. These same issues also distort national figures on admissions from A&E.

The payment system reform proposals include a blended payment approach for emergency care. At its centre is a desire from the national organisations to address complaints about the much maligned MRET and 30 day-readmissions rules without destabilising health economies. However, the blended approach also provides an opportunity for providers and commissioners to address issues with the classification and funding of admissions avoidance activity. This would lead to increased transparency between providers and commissioners on the care delivered, removing the ongoing tension around contracting and funding emergency care, instead facilitating more innovative and effective ways of managing patients as financial and capacity pressures continue to increase.

We've supported a number of healthcare systems in understanding and resolving issues around short stay emergency admission pathways and will be sharing more detail on our insights shortly. For more information on our work in this area visit the Healthcare Assurance page on our web site.