The Department of Health has abandoned plans to prevent the “cherry picking” of straightforward patients and cases by independent sector providers by making further changes to the payment by results tariff, it has emerged.
The commitment to do so was made in June last year, in response to concerns in the service, and a political row, about the potential for “cherry picking” of cases.
In response to its NHS Future Forum review of its controversial NHS reform plans, the government said it was “introducing a suite of additional safeguards” to “minimise the risk of cherrypicking”. It said the DH would be “undertaking a piece of work with the royal colleges to identify the procedures most at risk of cherry picking and prioritising work on payment by results to ensure that fair prices are set for these procedures from 2013-14 onwards”.
However, a letter sent to NHS managers on plans on 20 September, about the payment by results system for 2013-14, makes clear there will not be further changes to the tariff to address the issue.
An annex to the letter, from NHS deputy chief executive David Flory, contains a section called “cherry picking”. It says: “The government’s response to the NHS Future Forum report included a commitment to tackle the ‘cherry picking’ of patients.
“Having consulted with our [payment by results] advisory groups, we do not plan to tackle this issue through changes to tariff structure.
“We will instead look to strengthen guidance, with the possibility of including a list of procedures that appear to be most prone to ‘cherry picking’.”
The DH introduced a rule in the NHS Operating Framework for 2012-13 – published in November – which dictated that providers should be paid less than the national “tariff” price for the treatment of patients with more straightforward conditions.
The operating framework said: “In response to concerns about the ‘cherry picking’ of patients, commissioners will now be required to adjust the tariff price if the type of patients that a provider treats results in it incurring lower costs than the average of the tariff category.”
It is unclear how far this rule has been implemented over the past six months, and whether it will be retained for 2013-14.
It also said there would be “a specific duty on Monitor in setting the national tariff [its role from April 2013], to ensure that efficient providers are paid fairly, taking into account the clinical complexity of the cases that they treat”.
The operating framework rule - and the government’s commitments in June last year - were prompted by fears that increased competition would destabilise NHS hospitals by allowing private providers to treat the most profitable patient cases.
At the time the NHS Operating Framework 2012-13 was introduced, experts highlighted the rule was likely to be difficult to implement, and also introduced potential for providers to compete on price.
Responding to the change for 2013-14, NHS Partners Network director David Worskett told the Financial Times, which highlighted the issue, that the planned rules had been “unworkable”.
A DH spokesman said: “We are committed to preventing ‘cherry picking’ of patients but there is more than one way to tackle this. After extensive consultation and advice by the experts we believe that strengthening guidance around payment by results is a more effective way of preventing cherry picking than changing the tariff structure.”