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Last Updated: Monday, 30 October 2006, 16:18 GMT
The hospital waiting game
Paramedics take a patient into an Accident and Emergency department
More or Less
Monday, 30 October, 2006
BBC Radio 4, 1630 GMT
More or Less this week looked at new evidence in the NHS of what is known as "gaming".

It is not as harmless as it sounds.

Presenter Andrew Dilnot asked if hospitals are finding new ways around targets, and now with an added twist: that doing so also pays off financially.

Under recent government reforms introducing payment by results, could there be a double incentive to play the system?

We looked at one area of hospital activity around the four hour target for Accident and Emergency (A and E).

The statistics are stark.

While the number of people arriving at A and E between 1999-2000 and 2004-5 has gone up 20%, the number being admitted has gone up 40%.

The proportion being admitted, but discharged without staying overnight, has gone up more than 100%, and in some hospitals by 200% or 300%.

So do these numbers suggest that some hospitals are achieving the four hour target by admitting many more people - people who are often out again very shortly afterwards?

What is more, with additional payments of 500 for each admission, are they also earning money from it? We examined the evidence.

Immigration

Also this week, we tried to get to the bottom line of the immigration debate.

Are people coming to this country, to use a hostile phrase, "nicking our jobs", or are they rather adding to output?

And we looked at more unintended consequences.

Presenter: Andrew Dilnot
Producer: Michael Blastland

BBC Radio 4's More or Less was broadcast on Monday, 30 October, 2006 at 1630 GMT.


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