News / Commission backs payment change for specialised care

Former health minister Lord Warner convened the commission to mark the 10th anniversary of the Carter review of specialised commissioning.

Lord Warner’s report called for the services, including spinal injury, cancer and rare diseases treatments, to be delivered by networks of providers, including accountable care organisations and lead provider models. These would provide end-to-end services for patients’ entire care, enabling them to minimise use of expensive and overstretched hospital resources, the Specialised Services Commission said.

New models of remuneration would be needed to underpin the networks. The national tariff covers about a third of specialised services payments. While it worked well for acute activity, the tariff did not align well with the future evolution of specialised providers – offering no incentive to share the care of an individual between appropriate providers.

The commission recommended moving to capitated payments, closely linked to outcomes, on a multi-year basis. It insisted that a clear understanding of costs and outcomes was essential to assess the value of specialised services and to improve prioritisation and decision-making.

Costs and outcomes would also be fundamental to inform the debate on which services the NHS should fund. According to the commission, specialised services must improve their efficiency, but without further funding it was unlikely that this alone would be sufficient to avoid hard choices on rationing care.

Lord Warner said: ‘The commission favours more efficient joint working through networks, making patients rather than hospitals the hub of care. The current danger is that chronic deficits will progressively impede the range and quality of what the NHS can afford to do.’

Chris Hopson (above), NHS Providers’ chief executive and commission member, said: ‘We strongly welcome this new report’s recommendations on working towards a deeper understanding on the costs of delivery services. It tackles the broken payment model for specialised services that has seen financial risk passed from commissioners to providers and developing a national strategy that takes better account of which services should be designed and commissioned nationally, regionally and locally.’