In reply to johncoxmysteriously:
> Thanks. So if I understand you, there is some body called the Commissioners, and if a target is missed they extract some money from the relevant budget and use it to try and see that the target isn't missed again. Presumably these Commissioners are specialists in running hospitals who can do it better than the local managers, right?
> >Independent sector hospitals are not exempt.
> Really? Private hospitals get intervened in in the same way?
> jcm
Sorry, didn't cover all of this. Was marginally incensed by the seemingly bonkers ICU penalty!
Commissioners are, in our brave new world, GPs... so they aren't hospital managers, but they are clinicians. Supported by managers who have generally had a range of experience working within providers as well as in commissioning / corporate. Each local area has a "CCG" Clinical Commissioning Group, this is a group of GPs and professionals who manage the whole budget for that particular area (For Mental Health, Cancer, Drugs, Community nursing, School nursing, as well as hospitals).
They pay for services delivered, and where necessary reduce payment according to any applicable fines. HOWEVER, from today they do now have discretion for applying financial penalties - so one would hope that they and their providers can be sensible about it (last year was the only year where the application of financial penalties was legally binding and there was a LOT of complaint in the system about it, so it's been amended this year).