Important – NHS Tariffs

I was on a webinar recently where an eminent commentator described how NHS tariffs incentivised hospital attendance for outpatients, so I thought I’d just remind everyone that the NHS is now transitioning to Blended Payments. NHS guidance published last December runs to a mere 81 pages and is well worth a skim if you are involved in a business model that claims to save the NHS money.

The NHS Providers commentary includes the paragraph:

“The proposed blended model involves a combination of ‘intelligent fixed payments’, alongside financial risk-sharing elements, a variable element reflecting actual activity levels, and outcomes-based payments. Under a blended system, providers are paid a fixed amount for a forecast level of activity, can share risk associated with excess costs with commissioners, and receive rewards where health outcomes improve. After bringing in the first blended payment models for mental health and emergency care in 2019/20 – which we are yet to see an evaluation of – NHS England and NHS Improvement wants to extend the approach to outpatients and maternity services for 2020/21.”

The ultimate intention is for the tariff system to promote joined up care, although “For the moment, there is no clear payment framework leading to more integrated care”. However it’s this extension to outpatients that is particularly relevant to digital health companies because last financial year what the NHS insists on calling “non-face-to-face” consultations were set at 68% of some face-to-face consultations (see Page 25 of the guidance) so hospitals dragged patients into large germ exchange systems, aka waiting rooms, from far and wide so that hospitals could maximise their cash.  Where a face-to-face consultation is not essential this new system allows for payment equality – eg for video calls – so potentially incentivising consultants from working wherever suits them best (eg home or local NHS building) whilst patients remain safe in their homes or places of work.

The flipside is that the new payment systems are more complex and are likely to vary across the country.

Prospecting for digital health gold – part II

The PPP, in partnership with Tunstall has recently published Connecting Services, Transforming Lives, a 62 page booklet which is essentially an encouragement to government to roll out digital services faster. There is no information in the booklet as to who wrote it, from which affiliation, though the mention of Tunstall successes in a good selection of the case studies suggests an answer. This is the latest in a long list of attempted promotions of digital healthcare technology stretching back to 3 million lives in 2012 and before that, in 2008, the Preventive Technology Grant, all of which, broadly speaking have sought to encourage the public sector to get on with rolling it out. There are however two basic issues, neither of which get a mention in the PPP/Tunstall document (or most of the others).

The first is a very basic one that organisations favour investment in services from which they will benefit. Many TECS cut across traditional boundaries so for example a council is going to be less willing to invest in telecare if the principal beneficiary is the NHS than if all the benefits were to accrue to the council. This is equally true of primary care investments that reduce secondary care costs etc. Other than taking an altruistic approach, which thankfully some organisations do, the best answer is to move to integrated care systems as quickly as possible.

The second issue is something that industry can do something about. When Carers UK and DHACA researched the reasons why carers were not using assistive technology to lighten their load, the principal reason was ignorance of the technology – just 5% on average in our focus groups had bought such technology. When explained, interest rose immediately to 69%. Both of us are charities with relatively small pockets so at the time we proposed that industry join together to fund a campaign to “put it on the side of busses”. In those focus groups it emerged that carers were prepared to pay up to £150 for the technology and there were 6.5 million of them then, making a £1 billion market. With Covid-19, there are now estimated to be 9 million carers, so the opportunity for industry is even huger.

There’s your gold mine.

(Recently in a webinar, Tara Donnelly told me that NHSX had commissioned some TEC promotional material on YouTube – if anyone can point me to it I’d be most grateful as I cannot find it).



The AHSN Network has again kindly offered to fund DHACA to lay on a series of #Wednesdaywebinars that we hope to begin on 28th October using the same format as before. Currently invitations have been extended to the NHS to tell us about the successor to the DAQs, progress on the NHS App, how the ICSs are developing and the EMIS App Library.

Watch this space for developments


There is another RSM Digital Health Section webinar in their series coming up on Thursday 1st October evening – Dr Colin Fincham, Senior Director and Chief Medical Officer, EMEA, LATAM and Canada at Cerner, will discuss how electronic health records can release time for clinicians. Dr Fincham will review the use of digital tools to support clinical practice, exploring how digital tools can help to reduce clinician burnout. He will explain how digital tools can help to provide the right data at the right time to support integrated care, as well as support and enhance communications and workflow management between clinical teams. More details and to book here. The 50% discount code for DHACA members is DHACATEN68

And finally…

Many thanks as always to Prof Mike Short for pointing me to items I might otherwise have missed.

Watch out for more news on our webinars!