News / PAC probes marginal tariff and agency staff issues

Mr Hardy, chief executive of University Hospitals Coventry and Warwickshire NHS Trust, was giving evidence on behalf of the association as part of the committee’s inquiry into the financial sustainability of NHS trusts. Held ahead of the launch of the national tariff for 2015/16, the committee asked what would make the biggest difference to address the worsening financial positions reported by acute providers.

‘The figures suggest that all acutes are starting to struggle to different degrees. One of the main drivers behind that is undoubtedly the differential tariff, because if you look at the increase in activity it has been predominantly on the emergency side,’ Mr Hardy said. The 30% marginal tariff had not succeeded in stopping this increase.

However, he said that local organisations had to tackle the rise as a ‘system issue’. ‘We have worked with our commissioners to re-base, so we are not seeing the financial challenges that some other organisations are having with that 30%,’ he said.

NHS England chief executive Simon Stevens later told the committee that local health economies wanting to take a different approach on emergency admission payment could bring their ideas to NHS England and Monitor. Over the longer term the payment system would be redesigned to support redesign of urgent care and he hinted at changes to the marginal rate in 2015/16, subsequently confirmed by the national tariff publication (see page 28).

The committee also highlighted rising temporary staff costs and recruitment concerns in emergency staffing.  ‘There is clearly a national challenge in terms of recruitment of staff, within both the emergency department and acute medical jobs, Mr Hardy said. ‘They are incredibly stressful jobs – it is relentless. There are different ways you can address that. For example, we are looking at joint posts between sub-specialties and acute medicine, to make those posts attractive.’

However he admitted that, with high agency pay rates, some doctors and nurses were choosing to become permanent temporary staff.