What does the future hold for the national tariff?
Following the first ever two-year tariff for 2017/18 and 2018/19, NHS England and NHS Improvement had been expected to release their proposals for the next two years. The transition to a two-year tariff appears to have been a success, giving both commissioners and providers greater stability when making medium-term plans and investment decisions. There were suggestions that a longer period would be useful to provide further stability.
However, it recently emerged that the two system leaders will not be publishing a 2019-21 national tariff engagement document in the short-term. Instead, they have decided to reflect on the July funding settlement and align the development of tariff and pricing proposals with the development of the longer-term plan for the NHS, before engaging with the sector.
In a health and social care system moving itself towards a more integrated service, and with some areas already moving away from using the national tariff, it is expected that this approach will be welcomed. Provided any delay does not significantly impact organisational planning for 2019/20 and beyond.
Given that the current tariff system breaks down patient care into individual episodes, within individual organisations, it does not lend itself well to recognising the need for continuity and co-ordination of care across existing organisational boundaries.
It is unlikely that a one-size fits all solution is achievable, or indeed suitable or sustainable. Some areas are already taking different approaches and a ‘pick and choose’ style system can be seen as a pragmatic solution. This involves using different contracting arrangements for different services, different pathways and indeed different stages along the integration journey.
Any changes to the payment mechanism are unlikely to mean the end of national tariffs altogether. The basis of what it costs to treat a patient – or rather a nation of them – will continue to provide essential information at both a local and national level.
So, what does the future hold for the national payment system? During the transitional phase of integration, the national tariff offers a stable platform. Equally, those areas further down the integration journey are likely to prefer to adapt the system according to their local needs rather than starting from scratch in the early years of increased collaboration.
To read further into this topic, read the full article on the HFMA website.