Draft National Health Service (NHS Payment Scheme - Consultation) (No. 2) Regulations 2022

Will Quince Excerpts

Monday 9th January 2023 General Committees

[The Minister of State, Department of Health and Social Care (Will Quince)]

I beg to move,

That the Committee has considered the draft National Health Service (NHS Payment Scheme—Consultation) (No. 2) Regulations.

It is a great pleasure to serve under your chairmanship this afternoon, Sir Graham. Last year, the Government set out their ambitious health and care agenda through the Health and Care Act 2022, which established systems and structures to reform how health and adult social care work together. By introducing integrated care systems on a legislative basis, there was an opportunity to review and therefore tailor an integrated approach to how the financial frameworks in the NHS worked.

The Act replaces the NHS national tariff payment system with the NHS payment scheme by inserting new sections 114A to 114F into the Health and Social Care Act 2012. As with the tariff, the NHS payment scheme will set rules around how commissioners establish the amounts to pay providers for healthcare services for the NHS, but it will allow NHS England to have a more flexible approach in setting the rules. It does not set the amount of money available, but it intends to ensure that the resources available are used effectively and efficiently.

Before a new payment scheme can be published, NHS England has a duty under the 2012 Act to consult on the proposals for the new scheme. The consultation was as much a requirement with the tariff as it is with the new scheme. NHS England is required to consult each integrated care board, each relevant provider and other such persons it considers appropriate. It opened the consultation on the proposals for the 2023 to 2025 payment scheme on 23 December last year, and the consultation is scheduled to close on Friday 27 January. That brings me on to the purpose of these regulations, which is relevant to how those consulted respond and what it means for NHS England.

The regulations will set the required objection percentage thresholds for responses to the consultation at 66%, which will be reached if the requisite percentage of ICBs or providers object to the proposals. Laying these regulations is a relatively administrative process. The objection percentages are not changing compared with the previous consultations on the tariffs, so we are maintaining the status quo at 66%, which is a proportionate level to ensure that a qualified majority can require NHS England to reconsider its proposals, while minor objections will not stop it. I commend the regulations to the Committee.

--- Later in debate ---

[Will Quince]

I thank the hon. Member for Enfield North for her constructive comments and broad support. Several of the issues raised did not actually relate specifically to this debate. We are of course here to discuss the objection percentages. I am conscious that she would like to push further on items including payment by results, but I will just say—not wanting to test your patience, Sir Graham, given the strict parameters of this statutory instrument—that I would be very happy to write to her. Alternatively, there are health oral questions coming up. I stress that if there are proposals that relevant commissioners disagree with, I encourage them to make representations as part of the consultation, which is open until 27 January.

Let me turn specifically to why I believe the 66% is proportionate—I covered that in my opening speech. The 66% is made up of either integrated care boards or providers, and I will happily write to the hon. Member for Bristol South on that. I think the point that she was making was whether there is weighting towards an ICB versus a provider. Is that right?

[Karin Smyth]

To be clear, the two or three trusts in my patch could all object, but the ICB could support this. Do the trusts have to come within the totality, or will the trusts be counted separately, without getting too mathematical about it? Every trust in the country could oppose this, but the 44 ICBs could support it, for example, in extremis.

[Will Quince]

I thank the hon. Lady for clearing that up. I think the answer to the question is that if an integrated care board or a provider hits the 66%, that threshold is triggered.

Perhaps it would be helpful if I set out what would happen if the threshold is triggered. Unlike the previous scheme, where the Competition and Markets Authority would be involved, under the new proposals, if the objection threshold is reached, NHS England must discuss the objections with representatives of all organisations that objected. It is in the interests of both them and NHS England to reach a conclusion that is workable for both.

Following the discussion, NHS England must decide whether to amend the proposed payment scheme and reconsult on the amended payment scheme, or to proceed with the scheme, as published, that was consulted on. If it decides to proceed with publication, it must also publish a notice explaining its reasons for doing so and send a copy explaining with the notice to all organisations that objected and therefore met the threshold.

I thank Committee members for their contributions to today’s debate, and I would be very happy to write to or meet any hon. Member who has further questions. I genuinely believe that the objection percentages that we have discussed strike the right balance in allowing real collaboration between NHS England and those that it is consulting on. I commend the regulations to the Committee.

Question put and agreed to.