Providers will have to wait to see if controversial tariff plans for 2015-16 will be enforced as Monitor wades through hundreds of responses to establish if it received enough formal objections to trigger a new consultation.
The regulator said this morning that a decision would be made on the 2015-16 payment rules at a board meeting “in due course”. This is expected to be this month’s meeting on 28 January.
The law on tariff setting says 51 per cent of the provider sector - defined by turnover - must object in order to trigger a reconsultation on revised proposals or a referral to the Competition and Markets Authority.
A one month consultation on the proposed tariff, which is set jointly by NHS England and Monitor, closed on Christmas Eve. Monitor said it had received 310 “formal” responses “together with about 109 emails, 38 letters and 6,765 signatories on an e-petition organised by a mental health charity”. The regulator must decide how much of this correspondence should be considered as formal objections from an organisation rather than an individual employee.
The proposals have already outraged providers. These include a 3.8 per cent efficiency target and a new marginal rate rule that restricts payments for specialised services to 50 per cent of normal rates for all activity above an agreed baseline.
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Senior figures in the £50bn English hospital sector told HSJ the plans amounted to “the biggest smash and grab in the NHS for 25 years” and would “destroy” specialised services.
A number of sources in the provider sector said problems with the process could see them launch a judicial review of the process.
The Association of UK University Hospitals wrote to Monitor on behalf of its 43 English members to object to several aspects of the tariff proposals.
In a letter, obtained by HSJ, the chair of the association’s committee of finance directors, Adrian Roberts, said the required level of efficiency savings was “not sustainable” and that the 50 per cent cap “would create unacceptable levels of further exposure to the acknowledged excess treatment costs of more complex patients”.
Mr Roberts, who is also finance director of Central Manchester University Hospitals Foundation Trust, added: “There is insufficient independence in the process by which the national tariff and the rules that surround it are set, specifically that NHS England appears to have a dual role of setting the rules of the game and as a commissioner of specialist services.”
Another hospital finance director told HSJ the efficiency target was too high. He said: “Trusts have been cutting the fat for years and there is now very little left. Monitor, as a regulator, should have understood this.”
A Monitor spokesman told HSJ the consultation responses “convey[ed] a range of views on all aspects of the national tariff”.
He continued: “We are therefore analysing the responses in order to identify formal objections to the methodology and assess the other responses that we have received.
“The outcome of this analysis, together with feedback from the consultation generally, will be presented to the Monitor board in due course for a final decision on the way forward.”
Specialised services are commissioned by NHS England rather than local clinical commissioning groups and cost roughly £14bn each year.
According to NHS England’s most recently reported figures, the specialised commissioning budget is forecast to be £150m overspent in 2014-15, despite being bolstered by a one-off £400m drawdown of previously accumulated surpluses.