New Future Forum guidance calls for tariff 'flexibilities'

They come in a letter addressed to health secretary Andrew Lansley, which covers three of the Future Forum’s four workstreams, with recommendations on information, integration, and public health. However, there is nothing on education and training, subjects that the Operating Framework will not address.

Future Forum chair Steve Field said: “The purpose of writing to you now is to present some interim findings and advice on information, integrated care and the NHS’s role in improving the public’s health, to feed into documents which we understand the department will shortly publish.”

On integration, the letter says there are incentives in the current system, such as the tariff and “other financial flows”, which make it more difficult to introduce new models of integrated care.

“We would therefore encourage the Department of Health, through the publication of the 2012-13 Operating Framework, to ensure that these incentives can be better aligned to promote integrated care.”

One possibility, the forum suggests, would be allowing local partners to agree to use “flexibilities” in the tariff. These could include “varying the tariff for a certain period of time if there are concerns that it may act as a barrier to implementing new models of care which are better for patients, quality and efficiency”.

Professor Field said NHS bodies are keen to develop new integrated models during the period of transition to the newly restructured NHS. “We would therefore urge the DH to set the scene in the 2012-13 Operating Framework in championing and allowing for better ways of delivering seamless, integrated care for individuals, through the transition.”

He told HSJ that recommendations in the forum’s final report, due next month, would be more radical, and that the purpose of the letter was to send a message to the DH ahead of the release of the NHS Operating Framework, due to be published on November 24.

The forum had heard that the tariff was “rigid” and “out of date”, professor Field said. “What’s been hugely impressive is that people are doing things despite the existing rules and despite the tariff. Where people are working together, things are moving. We’re saying the future involves collaboration and integration around the needs of the patient.

The letter also encourages the DH to ensure the framework emphasises the importance of information.

“The default position should be that information about the performance of health and social care services is put in the public domain transparently and in a useable and understandable form,” it says.

“Data collection should be embraced as being integral to care, rather than a bureaucratic burden. Patients must have better online access to services and to their health and care records, including making use of the Summary Care Record. We would hope to see significant progress on this over the next year.”

Professor Field notes that a “very significant proportion” of information systems currently used by GPs can already deliver that goal.

Using the NHS number, patient data should also be shared between all organisations involved in caring for an individual, subject to patient consent and the right safeguards.

The Future Forum called on the DH to clarify the relationship between the NHS Commissioning Board and Public Health England, and to set up what each body will be responsible for, how they will work together and how they will be held to account.

The department should also make it clear how, following the restructure, NHS commissioners will be able to access information about population health.