With annual efficiency gains of at least 4 per cent stretching far into the future, a little more certainty about future plans for the tariff would be useful – for, in reality, we know remarkably little about how the tariff will look, even in 2013.
One hears the “mood music”: the tariff is here to stay. The practice of creaming savings off the top – at least 1.5 per cent in 2012-13 – will continue. There will be more “best practice” tariffs, and the scope of payment by results will continue to expand.
Yet searching for detail on any of these apparent trends is in vain. What are the next priorities for “best practice” pricing? How far into non-acute care will the tariff extend? Trusts are taking strategic decisions on investment and mergers without any secure knowledge of pricing intentions. Price transparency was one of the original reasons for introducing payment by results, and underpins competition – but it’s been replaced by guesswork and surmise.
This partly reflects uncertainty caused by the Health Bill. Its broad thrust is that the structure of the tariff becomes the responsibility of the NHS Commissioning Board, while Monitor takes on price-setting.
Section 114 (1) of the Health Bill requires them, jointly, to publish a tariff specifying national prices for services and the methods used for determining those prices. How will this work in practice? So far the answer is no clearer than that other difficult question: who will succeed the Audit Commission in its crucial lead role in controlling and improving data quality and monitoring the reimbursement process?
In its 2011 annual report, the commission proposed that “the NHS Commissioning Board and Monitor should develop a long term, joined up approach to payment by results data recording”. It highlighted a key dynamic: “As the NHS moves care into more efficient settings that are more convenient for the patient, so data definitions and payment structures need to adapt to reflect these changes.”
Practical steps towards making joint working a reality would be reassuring, and would hardly pre-empt the House of Lords’ deliberations.
An outline plan for the tariff, covering the remaining years of the current fiscal cycle, would be even better.