08.11.16
NHSI to press ahead with two-year tariff despite concerns
NHS Improvement (NHSI) has announced that it intends to press on with introducing two-year tariffs, despite a consultation into the proposals identifying some concerns about how they would be delivered.
The organisation has now opened a final consultation the tariffs for 2017-18 and 2018-19, which are intended to make it easier for NHS providers to plan ahead in a challenging financial situation. The consultation closes on 6 December, in time for the tariffs to be introduced next year.
But the document said that some respondents to the initial consultation warned that it “may not be the best time” to introduce a two-year tariff in light of other changes, particularly including the move to the HRG4+ currency.
Respondents also pointed out that any errors in the reference cost data underpinning national prices would be carried over for two years, and the data would be out of date for 2018-19.
Commissioners and providers also argued that material changes outside their control could take place, such as the impact of Brexit, future NICE recommendations on drugs and devices, and inflation.
Responding to these concerns, NHSI said: “We have based our assumptions on the best available evidence. There will always be challenges in setting forward-looking prices but these challenges are faced by other regulated industries and we feel that the advantages of greater planning certainty outweigh the risks.”
It added that now was “an opportune time” to introduce the tariff because wider planning is being undertaken to support STPs, and there will be no planned revisions to CCG allocations until 2019.
As part of the changes, mental health providers and commissioners will be required to link prices to locally-agreed quality and outcome measures and the delivery of access and waits standards, instead of paying through block contracts. This is intended to support parity of esteem between mental and physical health services.
NHSI said public response was positive when it initially opened a consultation on the proposals in October 2015, but in response to this year’s consultation, some commissioners argued that data submitted by providers were not sufficiently robust to support payment.
They were also concerned that they did not have sufficient time or resources to fully implement the proposals because of pressure related to the acute sector.
But NHSI said that it would not make “any adjustments to the existing proposals” and would press ahead with locally-agreed pricing from 2017-18.
However, it said it will publish further guidance to help local health economies develop local payment approaches, and will work with NHS Digital to ensure data reporting supports this.
It will then introduce a mandatory outcomes-based payment model for Improving Access to Psychological Therapy (IAPT) from 2018-19.
Local health authorities will be allowed flexibility in developing their own payment model, but this will need to take into account the severity and complexity of a service user’s presenting problem and use 10 national outcome measures.
Commissioners and providers are encouraged to shadow-test their chosen payment models in 2017-18.
Have you got a story to tell? Would you like to become an NHE columnist? If so, click here.