Unbundling the stroke tariff

Quality marker 10 of the National Stroke Strategy, High-quality specialist rehabilitation, includes the recommendation that services 'implement Payment by Results guidance on unbundling the national tariff for acute stroke to direct funding into specialist rehabilitation (whether to a rehabilitation unit, ESD or community team, or elsewhere).'  The Unbundling the stroke tariff resource includes information that may assist organisations working towards this.

Payment by Results (PbR) is the hospital payment system in England in which commissioners pay providers (NHS trusts, NHS foundation trusts (FTs) and the independent sector) a national tariff or price for the number and complexity of patients treated or seen. There are national tariffs for admitted patient care, outpatients and A&E.

Payment by Results Guidance for 2011-12 includes a commitment to produce additional support for commissioners and providers on further unbundling the tariff to support development of stroke care pathways that best meet the needs of each patient.

Following a Consensus Workshop held in February 2011, this resource has been developed to provide a framework to support local health economies who are seeking to undertake unbundling stroke tariff, providing a structured approach, access to the learning from other organisations, links to presentations and wider resources that will inform and enable discussions locally between commissioners and providers.

The NHS White Paper, Equity and Excellence: Liberating the NHS, was published in July 2010 and set out the new Government’s plans to reform PbR which will have implications for ongoing delivery. In the future, the NHS Commissioning Board will be responsible for the structure of the tariff and Monitor will set prices.

Key principles
When approaching unbundling the stroke tariff, it is understood that the tariff:

• should not act as a barrier to local planning to provide high quality stroke care to all patients at the right time and in the right place
• should not cause erosion of existing integrated, specialist pathways
• should foster local reviews and where appropriate, reconsideration of existing pathways, from both a clinical and financial perspective
• acknowledges that rehabilitation begins as soon as possible after stroke
• should foster increased access to evidence-based care in settings along the whole care pathway, including stroke unit care, specialist community stroke care and early supported discharge

Framework for unbundling the stroke tariff
Following the Consensus Workshop in February 2011, the following five steps were identified to inform and structure local discussion across health and social care communities:

1. Clarify existing local patient pathways and associated financial flows
2. Focus on what is best for patients when redesigning services and a new local tariff structure
3. Agree the principles of new local stroke service model and tariff structure
4. Create and implement the new local stroke service model and tariff structure
5. Ensure data systems are in place to monitor patient and financial flows after changes are made

The briefing paper circulated before the consensus workshop is available.


Visit the Tariff page of the Community Stroke Resource for more information on delivering high-quality specialist rehabilitation, addressing quality marker 10 of the National Stroke Strategy.


If you have information you would like to share on the Unbundling the stroke tariff resource, please contact Sue Hall.