Health minister Lord Howe this week admitted the controversial 30 per cent marginal rate for emergency care “hasn’t worked very well” to help commissioners and providers ease pressure on emergency departments.
He told the Commons health committee the 30 per cent tariff was there “in theory to “enable commissioners and providers to look at ways of reducing demand”. But he added: “That hasn’t worked very well, we need to mobilise that 70 per cent of the tariff which commissioners have to get those conversations going.”
Under the policy, hospitals are paid just 30 per cent of normal “tariff rates” for all non-elective admissions above 2008-09 levels. The remaining 70 per cent is supposed to go into a fund for investment in local schemes to manage emergency demand. The approach has been deeply unpopular with acute providers, and is currently under review by NHS England and Monitor.
Earl Howe and NHS England officials were called to the health committee on Tuesday to be quizzed on their response to the decline in accident and emergency performance over the past winter.
He told MPs that urgent care boards, which have been set up across the country since April on the instruction of NHS England, had been tasked with securing more effective use of money released by the marginal rate.
“The short-term priority has to be to make sure the system is configured so that we don’t get similar unacceptable pressures next winter, hence the looking at how we can mobilise that 70 per cent of the tariff much more effectively,” he said.
“Urgent care boards have been formed in part to do that, but that is not their sole function. Their function is a broader one; it is to get the engagement of all the local players including social care to see how people can work better together.”
He added the Government would seek to ensure “more money” was provided in this context, although clarified this meant from existing funds rather than new investment.
NHS England interim deputy chief executive Dame Barbara Hakin told the committee “solutions would be local” and the 150 urgent care boards were not part of “the formal governance structure that we would keep records of.”
She said she could see no reason why they would not become permanent adding: “They are there to look at day to day operational issues and how people can work better together rather than reconfiguration.”