3. SYSTEM REFORM
3.1.6 Can the Department detail the current
timetable for the implementation of Payment by Results, explaining
any delays? When does the Department expect to achieve 100% coverage?
(Q25)
Answer
1. In 2009-10, the payment by results (PbR)
mandatory tariff is payable for admitted patient care, outpatient
and A&E services carried out by NHS trusts, NHS foundation
trusts, PCTs as providers and independent sector providers.
2. The Options for the Future of Payment by
Results: 2008-09 to 2010-11[2]
consultation exercise set out the Department plans to expand the
scope of PbR. Although continuing to follow this strategy, the
Department is mindful of the need to review how PbR operates in
the constrained period of public funding that is expected after
2010-11.
3. Options placed an emphasis on strengthening
the building blocks of PbR, to ensure that appropriate and robust
data underpin the transactions that PbR enables. The Department
sees this as an important pre-requisite for further expansion
of the scope of PbR.
4. In 2009-10, the Department introduced a new
designed for purpose tariff currency, Healthcare Resource Groups
Version 4 (HRG4). Although HRG4 includes new HRGs for areas such
as critical care, chemotherapy, radiotherapy and specialist palliative
care, the Department concluded that the underlying data was not
robust enough to introduce national tariffs for these areas in
2009-10. The Department will introduce new services as and when
it is satisfied the data is sufficiently robust and the design
appropriate. This will increase the share of acute trust income
that comes from PbR.
5. In August 2008, the Department commissioned
a report[3]
of the diagnosis, intervention and casemix classification systems
used in the English NHS against comparators in Australia, Canada
and Germany. The report recommends that HRG4 should be retained
because it performs as well as any of the other international
systems. This decision should allow us to focus more on bringing
new services into the scope of PbR.
6. However, it is not necessarily the intention
to set a national tariff for all services. This is because some
services are not sufficiently uniform to be funded in the same
way across the country (eg weight management services).
7. Options raised a number of service
areas as candidates for future development of national currencies.
The Department is therefore working on the potential expansion
of PbR to a number of priority areas including (NHS approximate
spend in brackets):
— mental health (£8 billion);
— community services (£10 billion);
— critical care (£2 billion);
— urgent and emergency care including ambulances
(£3 billion); and
— long-term conditions (69% of total health
and social care spend).
8. The Department has several projects underway
on the payment for non-acute sector healthcare, using 40 local
NHS "development sites" to test out new ideas. The Department
has asked PricewaterhouseCoopers to evaluate and report on these
sites later this year.
9. For mental health, a commitment was made
in Lord Darzi's High Quality Care for All[4]
final report to develop national currencies available for use
from 2010-11. In 2010-11, currencies based on 21 patient clusters
will be available for use in shadow form. In 2011-12, the Department
plans to mandate these clusters as the national currency in contracting
arrangements. The Department will then evaluate a move to a mandatory
national tariff which, due to data flows, will not be before 2013-14.
10. For community services, High Quality
Care for All stated that "we will also increase transparency
by moving away from `block contract' funding." Transforming
Community Services: currency and pricing options for community
services[5]
is helping the NHS to create locally more transparent models of
funding. Possible quick wins include areas such as podiatry. In
addition, the Department is doing national currency development
work on end-of-life care and child health promotion. These are
strategically important but complex areas—work is at present
in the scoping stage.
11. Five ambulance trusts are working as
development sites to develop local currencies, which could lead
to national prices.
12. Finally, the local development sites
are looking at long-term conditions as diverse as cystic fibrosis
and diabetes.
2 A summary of the responses to the consultation was
published in January 2008, and is available via the Department's
website at: http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_082424 Back
3
The Department is negotiating publication of the report with the
Australian government due to their concerns about confidentiality. Back
4
Published on 30 June 2008 at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 Back
5
Published on 20 November 2008 at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093008 Back
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