Top-up payments for specialised services 1. Existing policy 2. Proposed changes Specialised services are accessed by comparatively few We propose to: patients from a small number of providers with the right Move to top-ups based on the Prescribed Specialised expertise. They are relatively expensive and account for Services (PSS) definition of specialised services (). around 14% of the total NHS budget. Move to top-up payments for 2017/18 that adopt the Top-up payments for specialised services were recommendations from the . introduced in 2005 to reflect the additional costs of Mitigate the impact by transitioning to the new rates complexity. 8 shows the current top-ups. over four years for services that would lose income Our proposal to move to HRG4+ phase 3, combined with from the new rates. Other rates will be scaled new , changes the need for top-up payments. to maintain a total payment amount of around £415 million. 3. Rationale 4. What does this mean? We have reviewed specialised top-ups to reflect the new If we moved straight to the PSS flags the total top-ups specialised service definitions and the HRG4+ currency would increase from about £320 million to about £415 design. million. Given the other changes proposed within the system, we consider it appropriate to transition areas This change would use the latest reference costs and that see significant reductions under the new approach HES data, and a methodology developed by the (paediatrics and orthopaedics) over a period of four University of York with input from the service and the years. Specialist and Complex Care Advisory Group. We remain committed to exploring the reasons for cost Moving straight to the new top-up rates could destabilise variation in specialised and complex care with the providers. We are also analysing how complexity is service, and to develop policies that address your captured by the national tariff. As we will not conclude this concerns. analysis in time for proposals to be included for the 2017 to 2019 national tariff, we believe that is appropriate to We would move to the second year of the transition path transition to the new top-up levels. for 2018/19.
Top-up payments for specialised services 1. Existing policy Specialised services are accessed by comparatively few patients from a small number of providers with the right expertise. They are relatively expensive and account for around 14% of the total NHS budget. Top-up payments for specialised services were introduced in 2005 to reflect the additional costs of complexity. 8 shows the current top-ups. Our proposal to move to HRG4+ phase 3, combined with new , changes the need for top-up payments. 2. Proposed changes We propose to: Move to top-ups based on the Prescribed Specialised Services (PSS) definition of specialised services (). Move to top-up payments for 2017/18 that adopt the recommendations from the . Mitigate the impact by transitioning to the new rates over four years for services that would lose income from the new rates. Other rates will be scaled to maintain a total payment amount of around £415 million. 3. Rationale We have reviewed specialised top-ups to reflect the new specialised service definitions and the HRG4+ currency design. This change would use the latest reference costs and HES data, and a methodology developed by the University of York with input from the service and the Specialist and Complex Care Advisory Group. Moving straight to the new top-up rates could destabilise providers. We are also analysing how complexity is captured by the national tariff. As we will not conclude this analysis in time for proposals to be included for the 2017 to 2019 national tariff, we believe that is appropriate to transition to the new top-up levels. 4. What does this mean? If we moved straight to the PSS flags the total top-ups would increase from about £320 million to about £415 million. Given the other changes proposed within the system, we consider it appropriate to transition areas that see significant reductions under the new approach (paediatrics and orthopaedics) over a period of four years. We remain committed to exploring the reasons for cost variation in specialised and complex care with the service, and to develop policies that address your concerns. We would move to the second year of the transition path for 2018/19.
Final_tariff_engagement_document_with_cover_word_version_3.docx