Specialist children’s hospitals could see a significant drop in their income under changes to the national tariff.

Department of Health guidance, sent to trusts last week, says the specialist children’s services top-up - an additional payment above the standard tariff to selected providers - will be cut from 78 per cent to 25 per cent of the standard rate.

Trusts which specialise in these services are expecting a significant drop in income because of the change, HSJ understands.

The change follows a “fundamental review of the methodology which underpins” top-ups, according to a letter sent to trusts from NHS deputy chief executive David Flory.

The review has concluded that in addition to the children’s services top-up an existing orthopaedic top-up should also be reduced, from 30 per cent to 25 per cent.

But it also recommended introducing top-ups to the tariff price of up to 30 per cent for cancer, spinal, neurosciences and cardiac and cardiology services.

The guidance said the DH would work with specialised commissioning groups to review which trusts are eligible for spinal, neurosciences and cardiac and cardiology top-ups.

Separately, it also confirms that trusts will often not be paid when patients are readmitted within 30 days of discharge - a policy announced by health secretary Andrew Lansley shortly after he took office.

Mr Lansley argued this would prevent patients being discharged too early, and incentivise good post-discharge care. The NHS Confederation said the policy could mean a significant 2.5 per cent loss of income for the average trust.

Mr Flory’s guidance confirms providers will “become responsible for some aspects of care for patients in the 30 days after their discharge”. However, he says “a number of services [will] be excluded” and still attract payment for readmissions.

For some other emergency admissions, payments will be increased, “to reflect the fact that readmissions in these areas may well be appropriate”.

The guidance also confirms that “best practice” tariffs, which pay trusts less to encourage them to become more efficient, will be used for the first time in 2011-12 for several high volume services, including hip and knee replacements, adult renal dialysis and transient ischaemic attacks. This could mean a further income hit for trusts.

The guidance says the changes will be tested and a final 2011-12 tariff package published in February.