HFMA response / The HFMA’s response to the consultation on the 2021/22 national tariff payment system
The HFMA has responded to the consultation on the 2021/22 national tariff payment system and is broadly supportive of the proposed changes and the introduction of the aligned payment and incentive approach.
The tariff documentation sets out that it is a transition year and further refinement will be necessary. However, at a time of significant structural change for commissioners and a period of recovery for providers, implementation of the approach may be affected. Our members are also concerned that introduction mid-year would lead to two contracting rounds within a few months of each other, diverting resources away from supporting services to address waiting lists and establishing ICSs.
For members working in specialist or tertiary providers, there are expressions of concern that the proposed payment system will destabilise their income. These trusts work with patients from multiple ICSs, but it is not feasible to agree aligned payment and incentive contracts with multiple commissioners. There is also a concern that devolving funding decisions for specialist services to local systems may mean that focus is lost on national priorities and the innovation and technical developments required, will not be sufficiently funded.
It is essential that the NHS as a whole, ICSs and constituent organisations retain a focus on data collection and quality. Understanding activity and costs underpins service development and transformation. It can support the identification and reduction of health inequalities and demonstrates whether taxpayer funding is being used well, or not. There is a danger that the move away from activity-based payments will reduce the incentives to collect good quality data. The HFMA supports the proposed payment approach and welcomes the move away from activity-based payment as it will support collaborative working. However, activity and costing data must remain at the core of the approach.
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The tariff documentation sets out that it is a transition year and further refinement will be necessary. However, at a time of significant structural change for commissioners and a period of recovery for providers, implementation of the approach may be affected. Our members are also concerned that introduction mid-year would lead to two contracting rounds within a few months of each other, diverting resources away from supporting services to address waiting lists and establishing ICSs.
For members working in specialist or tertiary providers, there are expressions of concern that the proposed payment system will destabilise their income. These trusts work with patients from multiple ICSs, but it is not feasible to agree aligned payment and incentive contracts with multiple commissioners. There is also a concern that devolving funding decisions for specialist services to local systems may mean that focus is lost on national priorities and the innovation and technical developments required, will not be sufficiently funded.
It is essential that the NHS as a whole, ICSs and constituent organisations retain a focus on data collection and quality. Understanding activity and costs underpins service development and transformation. It can support the identification and reduction of health inequalities and demonstrates whether taxpayer funding is being used well, or not. There is a danger that the move away from activity-based payments will reduce the incentives to collect good quality data. The HFMA supports the proposed payment approach and welcomes the move away from activity-based payment as it will support collaborative working. However, activity and costing data must remain at the core of the approach.
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