BOA Response to National Tariff Payment Scheme for 2015/16

As the professional body for Trauma and Orthopaedics the BOA is a key stakeholder in deliberations about and decisions on the National Tariff. While we understand that we have no statutory right to object (as set out in Annex A to the Statutory Consultation), we nevertheless wish to register a general and significant objection to the proposed National Tariff for 2015/16.

Our grounds for doing so are as follows:

• The tariff setting process this year has involved an enormous amount of detailed work by trauma and orthopaedic subject matter experts to ensure that patient care is not compromised by arbitrary funding cuts and illinformed tariff deflation.
• It was therefore a matter of considerable concern for the BOA that Monitor's first iteration of the National Tariff for 2015/16 took no account of the detailed and carefully constructed inputs from the T&O Expert Working Group or the Specialist Orthopaedic Alliance. Together their contribution covers the full spectrum of orthopaedic trauma and planned care.
• Following protracted discussions with Monitor and a delay (at the request of NHS England) in the statutory process to address a number of concerns with the approach adopted in 2014 and the resultant outcome, we understood there would be some scope to narrow the margin of our concern due to the impact on patient safety.
• Unfortunately the end result as articulated in the Statutory Consultation is still of significant concern in that T&O can expect an overall 3.5% reduction in funding for the provision of life changing procedures.
• This makes no sense when orthopaedic waiting lists are growing, our capacity to deal with them is shrinking, and when Trusts rely on income from planned care to cross subsidise under-funded trauma provision. In this regard the drop in quantum could destabilise the provision of trauma and orthopaedic services and potentially lead to patient harm.
• In particular, the risk to providers of specialised care is especially significant, as are the dangers of the marginal pricing approach for services in those Trusts who already fighting a losing battle with waiting times.
• From the BOA's perspective Monitor's approach has lacked the necessary insight to appreciate the scale of the planned care and trauma problem created by the 2015/16 National Tariff, nor has Monitor understood the concomitant impact on orthopaedic patient safety.

We therefore call on Monitor to address these concerns through a reappraisal of the orthopaedic National Tariff for 2015/16.