Payment disincentives for vulnerable patients
NHS payment mechanisms that inadvertently disincentivise local systems from prioritising or providing adequate care for hard-to-reach patients.
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
PFD report
73match
Clive Rivers
The coroner raised concerns that a vulnerable inpatient was not vaccinated for Covid-19 due to hospital policy and contracted the virus because of discharge delays. The discharge assessment framework did not adequately consider his vulnerability to rapid decline from Covid-19.
Matched on
terms: patient, 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
Alan MacDonald
The coroner noted Addcounsel continued charging a patient for visits from a non-medically qualified director while an inpatient, despite no treatment being provided. Concerns were raised that the patient's financial worries were not addressed nor was NHS care access highlighted.
Matched on
terms: patient
PFD report
65match
Amanda Hesketh
The coroner noted a lack of systematic review and individual care plans for patients on repeat multiple analgesics within general practice, alongside difficulties in accessing specialist pain clinics due to long waiting lists. Concerns were also raised regarding GP practices not universally engaging practice pharmacists for patients with complex analgesia regimes.
Matched on
terms: patient
PFD report
65match
Gregor Lynn
The cost of histological analysis in private treatment may deter patients from crucial diagnostic tests routinely included in NHS care. This disparity poses a risk of future deaths by hindering early cancer detection.
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 complained the Trust failed to inform him that his son's care became chargeable as an overseas patient, leading to a backdated payment request of over £9,000.
Matched on
terms: patient, payment
PFD report
61match
Barbara Ellis
The coroner noted difficulties in cross-border care provision where a patient's GP and social care commissioning are in different counties, leading to an inability to access therapeutic services.
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
Nathaniel Phillips
The coroner noted that brittle asthma is not covered by the medical exemption certificate, unlike other conditions requiring continuous medication. This created a financial barrier to obtaining prescriptions, which meant the GP did not escalate the patient's case or reassess asthma control.
Matched on
terms: patient
PFD report
57match
Elaine Talbot
The coroner noted that GPs lacked direct urgent access to CT scanning, unlike those in neighbouring areas, identifying this as a commissioning issue that could affect patient outcomes.
Matched on
terms: patient
PFD report
57match
William Abrahams
The coroner raises concerns that the Abdominal Aortic Aneurysm (AAA) screening programme's age criteria excluded Mr Abrahams, and notes that the asymptomatic nature of AAAs makes the benefits of opting in unclear to patients.
Matched on
terms: patient
PFD report
57match
Neil Hickman
K&C hospital did not measure ferritin levels in patients receiving frequent platelet transfusions, risking undetected iron overload. The coroner noted that even without funding for chelation therapy, patients could be referred or informed of private treatment options.
Matched on
terms: patient
PFD report
57match
Peter Fanning
The coroner noted delays in replacing feeding tubes due to limited radiology list availability for complex patients, leading to suboptimal nutrition. There is also a need to consider how best to maintain patient nutrition after tube dislodgments.
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
Delays in accessing NHS mental health services led the individual to private therapy, resulting in a lack of joined-up care and information sharing. Concerns were also raised that private therapists have no obligation to obtain information about medication prescribing.
Matched on
classifier match
Committee recommendation
53match
#14 - 3rd Report - Digital exclusion
Most social tariffs are still too expensive for the most financially vulnerable.
Matched on
terms: vulnerable
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
The coroner noted that consultant referrals were routinely handled by middle-grade doctors first, and liver function tests were declined due to demand management without a clear mechanism for staff to override this policy for clinical necessity.
Matched on
classifier match
Committee recommendation
48match
#12 - 13th Report - Regulation of water, energy and broadband
Martin Lewis told us that, as with social tariffs, the system places the burden on people in vulnerable circumstances to declare those circumstances to companies and to ask for support.33 CCW told us that, for those consumers who are aware, they may be deterred from seeking support, for example if they are fearful about bringing their financial situation...
Matched on
terms: vulnerable
Committee recommendation
48match
#2 - 13th Report - Regulation of water, energy and broadband
The current system relies too heavily on customers in vulnerable circumstances being willing and able to repeat personal information to multiple companies. In energy and water, companies maintain the 3 Priority Services Register (PSR) to provide support to customers with additional communication, safety and access needs. Take-up of the PSR has increased in energy and water, though (at...
Matched on
terms: vulnerable
Committee recommendation
48match
#35 - 3rd Report – Access to Justice: Legal Aid
Remote advice can help extend provision, but it cannot be treated as a complete substitute for local face-to-face services, particularly for digitally excluded or vulnerable clients and for cases involving court proceedings. (Conclusion, Paragraph 108)
Matched on
terms: vulnerable
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
Kristian Jaworski
The coroner noted a presumption in favour of vaginal delivery, influenced by cost considerations, which required re-evaluation.
Matched on
classifier match
PFD report
45match
Michael Spencer
The coroner raised concerns regarding the non-availability of Andexanet alfa, a reversal agent for Factor Xa inhibitor anticoagulants, in the UK, given the increasing clinical use of these drugs.
Matched on
classifier match
Committee recommendation
45match
#17 - 3rd Report - Digital exclusion
We recommend Ofcom consults on requiring Openreach to offer a wholesale social tariff.
Matched on
classifier match
Committee recommendation
44match
#22 - 13th Report - Regulation of water, energy and broadband
The National Audit Office (NAO) report found that consumers in otherwise similar vulnerable circumstances can experience very different outcomes depending on who their provider is. While the average social tariff discount amounted to 55% of average household water bills in 2024–25, there is considerable variation around that average. The extent to which water customers on social tariffs saw...
Matched on
terms: vulnerable
Committee recommendation
44match
#21 - 13th Report - Regulation of water, energy and broadband
There are inconsistencies in the eligibility criteria for supporting consumers in vulnerable circumstances. In water, the Department for Environment, Food & Rural Affairs (Defra) issues guidance setting the framework within which all water companies offer social tariffs to low-income households.59 Water and broadband companies have discretion over the eligibility 54 C&AG’s Report, para 3 55 Q 21 56...
Matched on
terms: vulnerable
Committee recommendation
44match
#19 - 13th Report - Regulation of water, energy and broadband
Defining vulnerable circumstances is complex, but essential to ensuring that people needing support are identified and that support is tailored to their specific needs. People can move in and out of vulnerabilities on a temporary basis, for example becoming financially at risk or if they have been bereaved.54 Even when people are identified as eligible for inclusion on...
Matched on
terms: vulnerable
Committee recommendation
44match
#14 - 13th Report - Regulation of water, energy and broadband
There are no PSR arrangements in telecoms. Instead, Ofcom requires companies to give consideration to services for people in vulnerable circumstances, and to register customers based on needs.39 In 2024, the overall satisfaction for customers with a limiting condition was five percentage points lower than consumer satisfaction overall.40 When asked whether it supported the former Department for Business...
Matched on
terms: vulnerable
Committee recommendation
44match
#10 - 13th Report - Regulation of water, energy and broadband
Martin Lewis told us that differing social tariff levels also make it difficult for consumers in financially vulnerable circumstances to compare companies’ offers and identify the best deals for themselves.25 Social tariffs are not always visible on Ofcom-accredited price comparison websites, making it difficult for customers to understand the benefits of social tariffs when making a decision to...
Matched on
terms: vulnerable
PHSO casework decision
44match
P-003226 - NHS England - South - South East (Local office)
Ms R complained NHS England's review panel wrongly decided her late mother was ineligible for NHS continuing healthcare, alleging insufficient consideration of her needs and procedural errors.
Matched on
classifier match
PHSO casework decision
43match
P-001769 - Royal Berkshire NHS Foundation Trust
Dr R complained the Trust failed to confirm NHS funding for his wife's fertility treatment, retrospectively billing her and then using intimidating tactics for payment.
Matched on
terms: payment
PHSO casework decision
43match
P-002821 - Hertfordshire and West Essex Integrated Care Board
Ms O complained the ICB agreed to refund nursing fees for her mother but then refused payment, impacting her mother's estate.
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