News / Specialised top-ups to be phased in

The regulator opened a consultation following the proposal to switch to HRG4+ in 2016/17 and changes in the way specialised services are defined. It proposed changing the set of specialised services eligible for top-up in 2016/17. It also recommended the amount paid for top-ups should be based on a new model developed by the University of York.

Specialised services top-ups currently amount to £250m-£300m a year, which is top-sliced from total tariff payments, reducing payments for non-specialised activity. Funding is in four areas – neurosciences, orthopaedics, paediatrics and spinal surgery. But with the introduction of prescribed specialised services (PSS) and the new model for calculating top-ups, the consultation proposes 36 top-ups.

These are spread across specialties covered by existing top-ups, plus new areas – cancer, cardiac, respiratory and other (largely vascular and colorectal surgery).

Some services previously eligible for top-ups would no longer receive them under the PSS 2015/16 monitoring tool. But for services not subject to top-ups, new HRG4+-based prices should better reflect the costs of delivering more complex activity under the core tariff.

York University analysis also identified additional services eligible for top-ups. As a result, the total value of top-ups would rise to £400m in 2016/17.

However, rather than implementing the changes in full immediately, Monitor proposed a transition to minimise the impact. It has invited comments and expects to make a final proposal in the statutory consultation on the 2016/17 national tariff early in 2016.