Initial ‘reform proposals’ for the NHS national tariff payment system in England have been published for consultation by NHS England and NHS Improvement. The implementation of a blended payment approach for emergency care is the headline act. It provides a signal of intent towards reforming the payment system to facilitate more collaborative and constructive contracting between providers and commissioners. Anything that can move the system away from confrontational contractual impasse and misalignment of contracted activity volumes (and there are many of them at the moment) is a step in the right direction. Some of these issues are however deep rooted. We know from our work in providing independent assurance of contracting positions and challenges that a tweaking (not a ‘reform’) of the payment system won’t address the historical, inaccurate activity and funding baselines and the resulting breakdown of trust within healthcare systems.
Other proposals, such as changes to outpatient non face-to-face, maternity pathways and a well overdue update of the market forces factor, are welcomed and a step in the right direction to address some known issues with the current system. But with the proposals and tariffs being applied for only 1 year it does feel like a holding position before the real reform post publication of the NHS long term plan later this year.
Whether it’s for these changes or for more radical payment reforms, having an accurate activity baseline to start from is key. As para 12 of the consultation states:
‘Good quality activity and cost data would will continue to be essential for making optimal decisions on service design and improving efficiency and improving patient outcomes’ (this is a direct quote and not my English I hasten to add!)
We couldn’t agree more – in fact we said as much in our briefing ‘Getting the date right first time’. Our work has shown only too often that historical, current and potentially future contract levels and funding are based on inaccurate data. So let’s make sure we get the data right so these payment changes do genuinely support the much needed reforms and provide an accurate, planning basis for the new STP/ICS operational plans which are muted to fall out of the imminent NHS long term plan.
2019/20 Payment Reform Proposals We are proposing a number of changes to the payment system in 2019/20 and are looking for feedback on our proposals.