Ministers are to review financial incentives to encourage the NHS to rehabilitate older people in the community, rather than acute settings.
Health minister Lord Warner told HSJthat he is working with national clinical directors for older people's services and coronary heart disease to see how the tariff system can be 'unbundled' so PCTs are rewarded for moving older patients out of hospitals.
He said next year's preliminary tariff system would be published in two weeks, enabling the NHS to 'road test it to death' before its introduction next April.
'We were criticised last year, I think fairly, for not road testing the tariff to make sure there were no unexpected glitches,' he said. 'We're not going to change this just because people don't like it, but if they can expose unexpected consequences then we will look at them again.'
He said the new tariff would include optional ways to unbundle the tariff, while the Department of Health would also examine local alternatives which had agreement from both commissioners and providers.
The government this week announced 30 demonstration projects on moving six key areas, including urology and general surgery, out of the acute sector and into community settings. But Lord Warner said the DoH wanted to go further to encourage tariff unbundling and move more rehabilitation of older people out of acute settings, as well as to reward providers offering community diagnostic services.
'We are working on ways to reset the tariff so there is the incentive to provide rehabilitation services for older people in the community,' he said. 'And diagnostics is another area where we could do this.'
'In our announcement on the new tariff we will be saying something about unbundling the tariff. It won't be mandatory, but it will give people some ways to do that which they can use next year.'
He said the DoH would examine any moves by the local NHS to unbundle the tariff to help get services into the community.
'We want to encourage people locally to develop initiatives,' he said. 'If commissioners and providers can agree on this then we will be encouraging that to develop.'
Yesterday Lord Warner launched a progress document on the white paper on healthcare outside hospitals, Our Health, Our Care, Our Say: making it happen.
In it the DoH promises to publish the operating framework for 2007-08 by the end of the year.
There is also a commitment to look at the practice-based commitment framework, to ensure it provides the flexibilities and incentives for GPs to work with social care and others to provide new forms of support.
This week Lord Warner called on the NHS and local councils to offer patients access to GPs, health services and social workers under one roof in new 'super-centres'.