Request
To whom it may concern,
This is a request under the Freedom of Information Act.
The 2011-12 guidance to the NHS Payment By Results system introduced a new “flexibility”, whereby “in exceptional circumstances, where providers and commissioners agree, they can seek approval to operate a variation to price which is lower, but not higher, than the published tariff, provided that there is no adverse impact on quality, patient choice or competition”.
The guidance goes on to say that: “This does not mean replacing the national price with a local price, but it does mean agreeing a variation within the tariff rules. Such a reduction could be in the form of a simple unit price reduction or a marginal rate above an agreed threshold but any variation must be operated within the overall framework of the tariff.”
It adds: “Where a commissioner and provider agree on a variation to the published tariff price, the commissioner must seek SHA approval before it can be implemented. Approval for any variation can only be given where a commissioner is able to demonstrate how they will measure quality of service. SHAs must monitor the impact of any agreed variations to tariff.”
I would like to see copies of all information held by NHS East Midlands about any such requests for approval it has received.
1. At a minimum, for each such request this should include:
· The name of the commissioner(s) requesting the variation
· The name of the provider(s) that agreed to the variation
· The name(s) and tariff code(s) of the service(s) to which they sought to apply the variation
· The unit value of the service, at tariff price, to the provider(s) in question (having applied market forces factor, etc)
· The applicants’ forecast of the volume (total number of spells) of that service that would be provided to the commissioner(s) by the provider(s) in 2011-12
· Any estimates (by the SHA, PCT, provider, etc) of what the £ value of the service contract would be to the provider(s) in 2011-12 if it were reimbursed at the full tariff price
· Any estimates (by the SHA, PCT, provider, etc) of what the £ value of the service contract would be to the provider(s) in 2011-12 if it were reimbursed using the proposed variation
· Any descriptions (by the SHA, PCT, provider, etc) of the mechanism by which the variation would – or does – work (i.e. was – or is – it a simple variation in the unit price, a marginal rate above a certain level, if it was the latter what triggered the marginal rate, etc)
· The full rationale given by the applicant(s) for requesting the variation, including the commissioner’s account of how they would measure quality of service.
· The SHA’s decision on whether or not to approve the variation, and the reasons given
· If the variation was approved, all information subsequently collected by the SHA in order to monitor the impact of the agreed variation, and any analyses/reports produced within the SHA about how the service was operating
This information should be available, and should not be hard to obtain. The guidance also states, as a principle for agreeing any flexibilities to the operation of the tariff, that the flexibility must be “clearly established and documented – an audit trail for the agreed flexibility is necessary and it should be documented as part of contract negotiations”.
2. If it is possible, within the statutorily defined limit for the amount of time organisations are required to spend responding to Freedom of Information Act Requests, I would also like to see all information held by the SHA relating to any requested or granted reductions to tariff price, as described above. Please bear in mind that in calculating the time it would take you to answer this request you are not legally entitled to include any time spent deciding whether information should be disclosed, or redacting information which is exempt from disclosure.
If you are able to respond to part 2 of my request in such a way that it provides all the information requested in part 1, but are not able to respond to both within the statutorily defined time limit, please provide the information requested in part 1 as part of your response to part 2, rather than spending time extracting information that would anyway be included in a complete response to part 2 in order to respond to part 1. If you are able to respond to fully respond to both parts of the request within the time limit, please do so.
Where any of the above requested information is held as data, I would like it provided in an Excel spreadsheet format, or, if that is technically impossible, as a text file that can be imported into a spreadsheet or database.
Lest there be any concern that the release of the requested information might raise issues of commercial confidentiality, I should point out that there are very strong, and acknowledged, arguments for the public interest in transparency in this case. As the 2012 PbR guidance states: “The finance and business rules are in place to help ensure that there is consistency and transparency across NHS organisations in the way the financial framework is applied.” The newly published 2012 Operating Framework states: “The PbR guidance and accompanying Code of Conduct will describe one system and one set of rules for England that are mandatory. Where commissioners and providers find the rules prevent them doing the best for patients, then local variation is permitted. However, variations which in effect enable the continuation of poor-quality, inefficient models of care or restrict patient choice are not valid.” To withhold information about variations to tariff price would undermine the intended transparency in the system, and the public’s ability to evaluate whether any such variations are in the interests of patients and taxpayers. It would also, potentially, be anti-competitive, giving other would be competitors an unfair disadvantage in a system where prices are generally expected to be uniform and publicly available.
For your convenience, here is a link to the 2011-12 PbR guidance: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_126157.pdf
Thanks in advance for your help on this request. If there are any ambiguities in this request that you would like to discuss, or any other issues which might prevent you responding to it within the statutory deadline, please contact me as soon as possible on the number below.
I look forward to receiving your response as soon as possible, and in any case within the statutory 20 day deadline. Please confirm receipt of this request.
Our Response
I refer to your email requesting information in respect of Tariff Variations.
I can confirm in accordance with S.1 (1) of the Freedom of Information Act 2000 (FOIA) that we do not hold the information that you have requested.
I hope that this information is of use. If you are dissatisfied with the way in which we have dealt with your request you can ask us to review our decision by writing to:-
Mr Moosa Patel
Director of Corporate Affairs
NHS East Midlands
Octavia House
Interchange Business Park
Bostock's Lane
Sandiacre
Nottingham
NG10 5QG
If at the conclusion of any review you remain dissatisfied you may complain to the Information Commissioner who can be contacted at:-
The Office of the Information Commissioner
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Follow up Query
I don’t want to request a review, but could I ask you to clarify your answer. Do you mean that you don’t hold the information requested because no commissioners have requested variations as described, or because the SHA has not documented any such requests?
Thanks in advance,
Our Response
NHS East Midlands has not received any requests from Commissioners and/or Providers under this section of the PbR Guidance. Therefore we hold no information related to this request.
