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New tariff objection threshold makes it harder to be heard, say providers

NHS Providers have said that proposals to raise the objection threshold when setting the national tariff could make it “more difficult” to make their voice heard. 

The Health and Social Care Act 2012 makes provision about when certain percentage levels of objection are received from commissioners or providers, when certain actions are required, and the relevant threshold levels for objections are prescribed by regulations. 

However, the Department of Health’s consultation, which is open until 11 September, is looking to ‘revise’ the thresholds that were prescribed by regulations made in 2013. 

Back in January, providers rejected the controversial 2015-16 national tariff proposals with around 13% of CCGs, 37% of relevant providers by number, and 75% of relevant providers by share of supply, objecting to the proposed method. 

Since then, approximately 88% of all NHS providers elected to move to a new voluntary tariff option for 2015-16 (Enhanced Tariff Option), but this has been labelled a temporary solution to a difficult problem that is “threatening the structural integrity” of the health service.  

The consultation is now proposing that the objection threshold based on the provider’s ‘share of supply’ be removed. The document says: “Evidence indicates that exercising the power to prescribe a threshold for providers by share of supply has resulted in giving a disproportionate weight to views of a small group of providers with a large share of supply. As set out previously, the 2015-16 process was only triggered by 134 of 361 relevant providers by ‘share of supply’. A number of the largest hospitals were included in the 134 and would have accounted for most of the share of supply.” 

Additionally, the DH is ‘minded’ to increase the objection thresholds for commissioners and providers to between 66% and 75% rather than remain on the current threshold at 51%. 

“We think it is fair for the levels for both providers and commissioners to be the same,” the document reads. “While both represent an increase over the current threshold level, we believe these are proportionate and reasonable at a time of financial constraint.” 

But Chris Hopson, CEO at NHS Providers, said the lessons from last year’s use of the objection mechanism is that the dialogue around the tariff needs to be “better, richer and deeper”. 

“We are concerned that these proposals, by themselves, point in the opposite direction. Raising the objection threshold and abolishing the “by share of supply” trigger make it more difficult for providers – those who actually deliver care at the frontline – to make their voice heard. There are no compensating proposals to enable the richer and deeper dialogue that is needed,” he said. 

“We will obviously reflect our members’ views in our response to the consultation, but we are concerned that these proposals make it easier for the NHS to end up with an undeliverable tariff, at the cost of high quality patient care.”