Specialised Healthcare Alliance

The Specialised Healthcare Alliance (SHCA) is a broad coalition of patient groups (1) which has been set up to promote the interests of people with conditions requiring specialised medical care. Examples are numerous but include certain cancers, cystic fibrosis, haemophilia, HIV and neurological conditions.

The aim of national tariffs is to provide a transparent, rules-based system for paying hospital trusts for the operations and treatment they provide and to provide incentives for efficiency. The system will operate by taking groups of cases that are clinically similar and need comparable levels of resource for treatment and care, known as Healthcare Resource Groups (HRGs); an example would be bilateral hip replacements. The groups will then be adjusted for the mix of different types of work, the volume of work commissioned and local variations in costs. This will be used to calculate a nationally determined “tariff” price which will be the sum paid to hospital trusts.

The new system, known as “payment by results” means that hospital trusts will have a financial incentive to perform operations for less than the standard national tariff price. This will save them money to invest elsewhere. Conversely, operations costing more than the tariff will lose the hospital trust money.

Concerns have been raised about how specialised services (2 ) will operate within this new system. These conditions tend to be rarer and are both complex and expensive to treat. They are correspondingly more difficult to cost and price. The SHCA is keen to ensure that national tariffs work effectively on behalf of the many tens of thousands of people requiring specialised medical care.

There is currently a programme underway within the Department of Health (DH) to develop tools suitable for calculating the sums that should be paid for commissioning specialist services. These will be “incorporated when appropriate” with the aim of completing the roll-out of payment by results by 2008.

The Department accepts that accommodating specialist services will be difficult. The SHCA will be seeking discussions to ensure that the interests of patients are protected. Issues include:

Specialist services will be difficult to classify into clinically similar groups or HRGs. Will the groups be sophisticated enough to reflect the range of conditions and complications enhibited by specialist services?
If certain specialised services already fall within a group of clinical conditions, will they be at risk because their cost is so much greater than the majority of cases?
Will national tariffs have an impact on specialised services before they are formally brought within the scheme eg where foundations hospital trusts are concerned?

1) - Membership comprises 25 patient groups with funding from five companies.
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2) - defined in the Specialised Services National Definitions Set.
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National Tariffs and Specialised Services The Specialised Healthcare Alliance (SHCA) is a broad coalition of patient groups (1) which has been set up to promote the interests of people with conditions requiring specialised medical care. Examples are numerous but include certain cancers, cystic fibrosis, haemophilia, HIV and neurological conditions. The aim of national tariffs is to provide a transparent, rules-based system for paying hospital trusts for the operations and treatment they provide and to provide incentives for efficiency. The system will operate by taking groups of cases that are clinically similar and need comparable levels of resource for treatment and care, known as Healthcare Resource Groups (HRGs); an example would be bilateral hip replacements. The groups will then be adjusted for the mix of different types of work, the volume of work commissioned and local variations in costs. This will be used to calculate a nationally determined “tariff” price which will be the sum paid to hospital trusts. The new system, known as “payment by results” means that hospital trusts will have a financial incentive to perform operations for less than the standard national tariff price. This will save them money to invest elsewhere. Conversely, operations costing more than the tariff will lose the hospital trust money. Concerns have been raised about how specialised services (2 ) will operate within this new system. These conditions tend to be rarer and are both complex and expensive to treat. They are correspondingly more difficult to cost and price. The SHCA is keen to ensure that national tariffs work effectively on behalf of the many tens of thousands of people requiring specialised medical care. There is currently a programme underway within the Department of Health (DH) to develop tools suitable for calculating the sums that should be paid for commissioning specialist services. These will be “incorporated when appropriate” with the aim of completing the roll-out of payment by results by 2008. The Department accepts that accommodating specialist services will be difficult. The SHCA will be seeking discussions to ensure that the interests of patients are protected. Issues include: Specialist services will be difficult to classify into clinically similar groups or HRGs. Will the groups be sophisticated enough to reflect the range of conditions and complications enhibited by specialist services? If certain specialised services already fall within a group of clinical conditions, will they be at risk because their cost is so much greater than the majority of cases? Will national tariffs have an impact on specialised services before they are formally brought within the scheme eg where foundations hospital trusts are concerned? For more information contact: Amy Poole on 020 7812 9019 or enquiries@shca.info February 10 2004 notes 1) - Membership comprises 25 patient groups with funding from five companies. return to text 2) - defined in the Specialised Services National Definitions Set. return to text


for further information, please mail: info@shca.info

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National Tariffs and Specialised Services