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The four weddings and a funeral guide to the updated palliative care currency

13 Apr, 17 | by jbanning

by Dr Ollie Minton, Macmillan consultant and honorary senior lecturer in palliative medicine.

I can’t quote the line for obvious reasons but as I trawled through the extensive analysis of the proposed currency I channelled Hugh Grant as Charles looking at his alarm clock at the start of the film. The opening iconic scene of Four Weddings and a Funeral and subsequent panic with Scarlett took me back immediately to 1994. Coincidentally this was around the time palliative medicine finally became a recognised specialty by the Royal College of Physicians. Read the RCP’s article titled ‘Specialty spotlight – palliative medicine’ or the End of Life Studies Group’s post on ‘Palliative medicine as a specialty’.

At the time the politics of medicine all passed me by, Four Weddings less so, but it illustrates that over 20 years have passed and we are still working on a way to properly fund what we do.

In the maelstrom of the NHS acronym production line of STPs (sustainability and transformation plans) ACOs (accountable care organisations) MCPs (multispecialty community providers) you could be forgiven for missing the announcement of the publication of the updated currency.

For those not aware an updated currency template was released at the end of March. For those still bemused by the terminology: “A currency is a consistently identified unit used as the basis for payment between provider and commissioners. A currency is a balance of case mix and the resources required to deliver it.” It’s not quite “show me the money” but a stepping stone to it.

The accompanying silence from NHS England probably tells you all you need to know. The suggestion is based on a proposed case mix spells and phases which can be taken to commissioners to establish equity of funding. If I were back in 1994 playing Dungeons and Dragons then maybe I could muster some excitement as fantasy fighting was enjoyable. However this harsh reality is on a background of a reduction in real terms funding to hospices and relevant NHS organisations.

The technical details make interpretation difficult even as specialist and sadly the lack of transparency in learning I feel makes implementation all but impossible. I’d encourage others to read and judge for themselves. I feel I can make an informed judgement as we were a pilot site with the promise of fortune and glory or at least some IT support. We stopped recording the data the moment it became clear we were not going to be able to link it to monies. We now have a locally negotiated per diem tariff working well in its place.

The actual currency report is a snappy 26 pages. The technical appendices and Dungeon Master guide is 53 pages.

My very brief reading of the report is as follows:
The data is subjective around the case mix interpretation and therefore open to gamification  if money or targets were ever attached. The national average 30% NHS funding of hospices doesn’t however leave much margin of error regardless of the algorithmic output. Commissioners do not understand the narrative generated and the ability to tell a story is paramount for business cases and the wider population alike.

If this is ever to be routine data for palliative care wherever it is provided the Information Technology must be seamless and link to broader health and social care usage. The money pot is finite even with the next iteration of the five year forward view and NHS mandate.

I was left at the end of the report feeling like Charles at the third wedding surrounded by all his ex-girlfriends wondering when it would all be over.

I am happy to be proved wrong but I think the focus on routine health usage statistics will pay more dividends in this fiercely competitive market.

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