HSJ’s daily digest of Monday’s significant developments for healthcare leaders:

The controversy surrounding the 2015-16 tariff proposals continues to be felt.

We broke the news on Monday that that Monitor is readying to refer the rejected proposals to the Competition and Markets Authority as soon as next month, should the regulator’s board decide to do so.

The tariff was blocked in January when providers responsible for three quarters of all services formally objected to the offer.

While Monitor and NHS England have secured agreement from the majority of providers to a tweaked “voluntary” offer, the arm’s length bodies are required by law to set a national tariff for the current year, meaning they either have to refer it to the CMA or revise their proposals and consult again. The decision is likely to be run past a new government after the election – will it want a battle fought in public over hospital funding?

The outcome will be significant for the 30 trusts who did not sign up to the voluntary tariff – once a tariff has been set for 2015-16 these trusts will automatically be moved onto it.

Will they have made the right gamble in not signing up to NHS England and Monitor’s offer?

The tariff row also has implications for the health service’s struggle to crack down on delayed discharge, HSJ has uncovered.

We have reported that schemes to reduce the number of patients experiencing delays – which are a major difficulty for increasingly clogged up hospitals – have been scaled back because commissioners can no longer afford to fund them under current tariff arrangements.

The voluntary tariff offer, to which most trusts have now signed up, has raised the amount providers are reimbursed for emergency admissions above 2009-09 levels from 30 per cent to 70 per cent.

But this has shifted the cost burden to clinical commissioning groups, which had no say in their providers’ tariff decision. Some have had in turn to withdraw funding for schemes intended to ease delays pressures – something you would expect to be a cornerstone of stepping up efforts to ensure patients are not in hospital when they don’t need to be.

Some trusts are now having to pay for it themselves, or even stop it.

The tariff issue is certain to loom large over NHS finance and related discussions for the rest of the year.

As we entered the final full week of the election campaign, HSJ’s editor asked Twitter what the race and the last five years have taught us about political stewardship of the NHS.

The replies were pretty interesting:


Finally, on that theme, look out on Tuesday for the results of the final instalment of HSJ/FTI Consulting’s series of surveys running up to the election, and for @HSJeditor’s own take on what the health service can learn from the election campaign.