2014/15 Marginal Rate Emergency Tariff (MRET) investment in Specialised Services

Demand for prescribed specialised services has grown at a faster rate than other healthcare services. Although improvements in efficiency contribute to managing this situation, stretching our limited finances ever more thinly over a rising number of patients puts unsustainable pressure on service quality. Achieving more in terms of prevention, early intervention and demand management is a key priority for NHS England.

In 2014/15, in line with national guidance from Monitor, NHSE in the East Midlands made available over £4 million for investment in demand management, preventative, community rehabilitation and reablement services with the aim of reducing emergency admissions to specialised services pathways.

The Area Team developed and implemented an inclusive and collaborative process whereby providers of health and social care services were invited to submit bids for MRET funding. The bids were assessed by a multidisciplinary panel against set criteria including:

  • Clear impact on demand for specialised services
  • Clinical evidence base in support of the proposed intervention
  • Demonstration of value for money

The process resulted in over £3 million being invested in both acute and community providers across the East Midlands. The successful bids covered a broad range of initiatives including:

  • smoking cessation services in acute care settings targeting cardiac, stroke and respiratory patients,
  • additional support to the coordination of admissions to paediatric critical care facilities,
  • critical care outreach services to ensure best use of critical care facilities and improve coordination with other hospital departments,
  • extension of a cardio pulmonary rehabilitation service to include patients who have had an implantable cardiac defibrillator,
  • paediatric long term ventilation support services in the community,
  • muscular dystrophy community nursing support services,
  • integrated paediatric neurology rehabilitation,
  • specialist palliative care support in the community,
  • enhanced support and training for patients with long term conditions at the point of discharge,
  • An outreach service to provide rehabilitation in the community for patients at greatest risk of repeat admission to specialised services pathways.

The most common reason for bids being unsuccessful was the lack of a clear impact on specialised services pathways.

The process concluded in July 2014 and the schemes are now being implemented and those providers who received funding are required to submit performance monitoring data returns that will enable us to assess the impact of these initiatives.

It is our intention to run a similar process to decide how we invest our 2015/16 MRET funding.