Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 12 April 2019 to Questions 242132 and 242133 on Ophthalmic Services, what assessment he has made of the merits of having a tariff for combined trabecular bypass and cataract procedure that does not cover the cost of a combined procedure; and if his Department will publish the reference cost for the 2017-2019 national tariff for BZ91.

In the development of each national tariff, NHS England and NHS Improvement undertakes an overall assessment of the impact of proposals. While this provides an overall assessment of impact, detailed feedback on proposed prices for individual HRGs (units of healthcare) is sought from clinical Expert Working Groups (EWGs). This is to ensure that the published tariff supports clinical practice.

For the 2017/19 tariff (set for two years), the prices for BZ91 were increased following EWG feedback. However, for the 2019/20 tariff the EWG advised that increasing the prices was no longer appropriate. The EWG felt that there had been a significant change in clinical practice since the 2017/19 prices were set, with a shift to performing minimally invasive glaucoma surgery (MIGS), which are significantly cheaper, rather than open/tube glaucoma procedures. Based on diagnosis and procedure codes entered into patient records, MIGS activity is assigned to the HRG BZ91. However, the current codes do not allow differentiation between MIGS and non-MIGS activity. This means that BZ91 covers procedures of different levels of resource use.

Reference costs are collected and published annually and the latest published data is for the financial year 2017-18. The reference cost data and links to previous years data can be found at the following link:

https://improvement.nhs.uk/resources/reference-costs/#rc1718