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NHS Confederation - Changes to emergency admissions rate address NHS worries

Proposed changes to the way urgent and emergency care services are funded have recognised NHS concerns about current implementation of the marginal rate for emergency admissions and responded to calls for a more transparent, clear and effective system.

Limited benefits

Responding to a review of the 30 per cent marginal rate rule for emergency admissions, the NHS Confederation expressed members' view that the rate has realised limited benefits since it was introduced in 2010/11.

Members from across the NHS raised concerns about a lack of transparency in how funds are collected and reinvested and the limited involvement of local commissioners and providers.

'Patchy' impact

They cited examples of the rule's 'patchy' impact on demand, with emergency admissions continuing to grow at a national level.

Members also cautioned that the way the rate is currently applied means it can only deal with a specific part of the system.

Raising members' views

The Confederation relayed members' views in response to Monitor and NHS England's review in June.

The organisation also used feedback gleaned from a number of engagement opportunities over the summer, and a report in September, to call for a payment system that helps to encourage better joint working with more focus on intervention and greater investment in community services.

Updated rule

On 3 October, the review agreed with Confederation members that the rule could be reformed to facilitate joint working and a whole-system approach to urgent and emergency care.

They propose to update it in two respects:

  • require the baseline value above which the 30 per cent marginal rate applies be adjusted where evidence suggests there have been material changes in patient flows.
  • place an additional requirement on commissioners to show how the retained funds are used to ensure plans are evidence-based, transparent and effective.

The proposals have been included in the draft 2014/15 National Tariff document currently under consultation.

Find out more

Find out more the marginal rate, what members said, what has changed and what still needs to be done.


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