Payment by results not panacea for problems of NHS

As I've indicated previously (see post), I find it difficult to understand why NHS Foundation Trusts (FTs) are in favour of payment by results (PbR). After all, the motivation for such a system is to encourage other providers into the NHS market. If an NHS FT has an almost monopoly, what does it gain by having competitors come into the market?

A report from the Kings Fund reviews the experience of PbR. It concludes that the current system as applied is not fit for purpose. PbR does not transmit much, if any, pressure to be more efficient. For example, it does not provide an incentive to reduce admission to hospital.

As, again, I've mentioned in a previous post, as far as mental health services are concerned, there has been a delay in implementing PbR. The motivation to introduce PbR in mental health is often said to be because mental health is losing out compared to the rest of medicine by not having PbR. The Kings Fund report puts such a claim in perspective. Any implementation of PbR in mental health should be postponed further until the issues raised by the Kings Fund report are taken on board.