News / HFMA 2014: No definite timetable for HRG4+

The recent national tariff guidance for 2015/16 - issued for consultation - said that Monitor and NHS England were 'reviewing the development of HRG4+ for inclusion in future tariff years'. But asked directly when the service would switch on the more granular admitted care currency, Monitor finance and reporting director Jason Dorsett said that he could not confirm a date.

Taking part in a panel question and answer session, Mr Dorsett said that the tariff had been introduced 'in a different decade and for different purposes' and that there were lots of aspects of the system that needed changing.

But he said that not all parts of the system could be targeted upfront. 'HRG4+ is a high priority area,' he said, acknowledging that its more granular structure and the way it takes account of different levels of complexity would aid some providers.

'It will help with some of the issues of providers of higher cost more complex care,' he said. 'But the fundamental issue facing the health system is not how we pay for specialist healthcare, but how we pay for the non-elective care for the frail elderly in particular - so that's the priority in fixing prices.'

Charlotte Moar, finance director of Cardiff and Vale University Health Board, said that NHS bodies should not look to the tariff to solve all their problems. She said national prices had played a role in driving waiting lists down and driving coding quality up, but had a downside in the amount of time and energy expended 'arguing about tariff'.

A former strategic health authority finance director, Ms Moar now works in Wales, which operates an integrated system with no tariff. She suggested that on balance working without a tariff was 'probably overall better'. 'I think our coding could be better but you don't need to address this through the tariff,' she said.