A significant number of providers are still yet to decide whether to accept NHS England and Monitor’s offer of a ‘voluntary’ tariff for 2015-16, with just a day to go until the offer expires, HSJ has been told.

Representative body NHS Providers said quite a few trusts were holding special board meetings today or tomorrow to decide their response to the latest pricing offer.

The pricing authorities made the offer two weeks ago, after official tariff proposals for next year were scuppered by objections from providers accounting for three quarters of tariff funded services.

Chris Hopson

Many providers feel ‘this is really not a choice at all’, Chris Hopson said

Trusts were given a deadline of 4 March to decide whether to accept the deal.

It is estimated that the “voluntary” tariff would cost commissioners up to £500m more than the rejected proposals.

The main differences include an increase in the proposed “marginal rate” for specialised services from 50 to 70 per cent; a corresponding increase in the marginal rate for emergency admissions; and a reduction in the headline savings target from 3.8 to 3.5 per cent.

Those that reject the offer have been told they will automatically remain on 2014-15 prices. However, they will not have access to commissioning for quality and innovation payments worth up to 2.5 per cent of contract income.

NHS Providers chief executive Chris Hopson told HSJ that initial indications suggested a majority would opt for the voluntary tariff, but there were a significant number that felt strongly that they should not be accepting something they feel will be impossible to deliver.

“Whilst there is a degree of welcome for the fact that movement has been made – people recognise that an extra £500m has been put in – the reality is this still means that for the majority the task of trying to deliver financial balance and the NHS constitution performance targets is going to be extremely difficult/impossible,” he said. 

“There’s a sense in quite a few places that this is really not a choice at all. I think there’s still very strong opposition to the idea of introducing a marginal rate in specialised commissioning, and the potential impact that’s going to have on patients from the most vulnerable groups.”

He added: “We’ve been talking to trusts – particularly people who have been affected by the specialised commissioning marginal rate – who’ve got [projected cost improvement programme] savings of 7-8 per cent next year, and people are saying it’s just impossible for us to deliver that.”

Even up to a few hours ago, talks were underway about possibly requesting an extension to the 4 March deadline. However, HSJ understands that a decision has been taken that this would not be viable, on the grounds that it would disadvantage providers that have already submitted their choices.

Jane Tomkinson, chief executive of cardiac specialist the Liverpool Heart and Chest Hospital Foundation Trust, told HSJ her trust was still working through the numbers, but would probably opt to remain on 2014-15 prices.

She said: “The marginal rate [for specialised services], even at 70 per cent, leaves us with financial risk that isn’t tenable. We would move into a position where we’re not financially viable.”

Ms Tomkinson told HSJ that National Institute for Health and Care Excellence guidance issued last year had brought “a whole new patient population” into operative scope for her trust that would not be reflected in baseline activity levels and would require very expensive devices.

She added: “You cannot manage the financial risk associated with any sort of marginal rate. It comes together as a perfect storm of changes which will tip organisations that have just about been holding their own financially into being non-viable.”

Asked how other specialists were responding to the offer, she told HSJ: “I’m conscious some organisations feel they’re stuck between a rock and a hard place, and therefore don’t want to commit to either. I know that’s not an option, but either is so unpalatable they would potentially want to sit on the fence.”