1. Sarah Butler/Martin Campbell Deputy Directors of NHS Finance HRG4 Roadshows PbR in 2009-10 and beyond

2. HRG4 Roadshows March 2009 Key messages –HRG4 is a challenge – but it is the right thing to do –Introduction of HRG4 for payment will be phased in –Data quality is an issue

3. HRG4 Roadshows March 2009 PbR Governance – we get a lot of advice PbR Programme Board External Advisory Group (EAG) Clinical Advisory Panel (CAP) DH PbR Division Technical Working Group (TWG)

4. HRG4 Roadshows March 2009 PbR development process Analysis of costs Scope and structure of tariff Sense check Road test Final tariff TWG, EAG TWG, EAG, CAP CAP, EAG, West Midlands SHA CAP, EAG. NHS SHA Directors of Finance

5. HRG4 Roadshows March 2009 We changed the sense check process for 2009- 10…….  Final design was not agreed by July  Impact analysis revealed large and unexplainable changes so……  Needed to re-run with 07/08 data  Poor coding:  large number of U codes  procedures in outpatients  A&E

6. HRG4 Roadshows March 2009 Therefore, to mitigate the impact of the introduction of HRG4 in 2009-10..…..  Outpatient procedures payable via a non- mandatory tariff  A&E - no move to HRG4  Capping of new MFF

7. HRG4 Roadshows March 2009 Following Sense Check Phase 2 and road-testing we……  Normatively adjusted prices, mainly by combining  Following consultation with Expert Working Groups (EWGs) we normatively adjusted prices in the orthopaedic and cardiac chapters  Adjustments were cost neutral within chapters

8. HRG4 Roadshows March 2009 Following Sense Check Phase 2 and road-testing we……  Increased the number of HRGs eligible for receiving specialist top-ups for children’s or orthopaedic services  Excluded some HRGs and outpatient TFCs  Clarified elements within the supporting guidance Final PbR package launched on 5 February 2009

9. HRG4 Roadshows March 2009 Looking forward to the tariff for 2010/11….  Will be based on 07/08 reference costs  Propose to revert to normal process and timetable for producing tariff  Share underlying data much earlier with clinicians for comment – CAP and Expert Working Groups

10. HRG4 Roadshows March 2009 Looking forward to the tariff for 2010/11….  Review of 2009-10 tariff  Roll forward of current pricing adjustments  Introduce best practice tariffs for  stroke  fractured neck of femur  cholecystectomy and  cataract  New currency for mental health services