• Top-up payments for specialised services to increase by 36pc under new proposals
  • Some current recipients would lose out, with top-ups for paediatrics cut by more than 50pc
  • Any cuts to existing top-ups would be phased in over a period of up to four years
  • Treatments newly eligible for top-up payments in cancer, cardiac and respiratory specialties

Top-up payments for specialised services would increase by more than a third under new tariff proposals, but would be slashed by more than half in paediatrics.

Under the proposals from Monitor and NHS England, new top-up payments would be introduced in specialised cancer, cardiac and respiratory services.

The extra payments are currently grouped into four areas: spinal surgery; neurosciences; orthopaedics; and paediatrics. They currently total about £290m per year nationally and are designed to reflect the additional costs of providing specialised services.

However, the proposed changes would make a range of additional treatments eligible for top-ups, increasing the overall bill to about £400m. 

Some current recipients of top-ups would lose out under the changes, but the pricing authorities are proposing to phase in these funding reductions over a “transitional period” to soften the impact on affected services.

Of the “potential new areas for top-ups”, cardiac services would receive £92m, cancer services £20m, and respiratory services £42m.

But paediatrics, which currently receives about £215m per year, about 70 per cent of the total, would see top-ups eventually reduced to around £97m under the plans.

Spinal surgery would receive £8m, down from £18m, and orthopaedics would receive £2m, down from £7m.

Top-ups for neurosciences would more than double, from £51m to £112m.

The consultation document says the changes, which are subject to a consultation and follow an analysis by the University of York, are designed to provide a “better reflection of complexity within national prices”.

The regulator proposes two options to phase in the changes, which would ease the initial impact on services losing money. Under one option the cuts would be phased over four years, while the other option two proposes a “faster rate” of change.

However, treatments which are newly eligible for payments would receive the full value straight away under both options. This means the overall costs could rise to £500m during the transitional period.

The consultation document adds: “We understand that there are considerable proposed changes in both the currency and the definitions of specialised care.

“We believe that these changes are based on firm, clinically informed foundations and, together with the analysis done by the University of York, provide a more rigorous and evidence-based approach to top-ups for specialised services.”

The document stresses the figures are provisional and subject to revision. A final proposal on top-ups for specialised services will be published along with the consultation notice on the 2016-17 national tariff in the new year.

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