Fair and transparent pricing for NHS services A consultation on proposals for objecting to proposed pricing methodology
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Fair and transparent pricing for NHS services A consultation on proposals for objecting to proposed pricing methodologies You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/ Crown copyright 2012 First published October 2012 Published to DH website, in electronic PDF format only. www.dh.gov.uk/publications 3
Contents Contents... 4 What is this document about?... 5 Section A: Background on pricing... 6 Section B: The consultation... 12 4
What is this document about? This document describes the new arrangements for the National Tariff (covering the prices to be paid for NHS services) provided for in the Health and Social Care Act 2012. It includes consultation questions relating to the circumstances in which objections from providers and/or commissioners to the pricing methodology proposed by Monitor would require either reconsideration by Monitor of the proposal or a referral to the Competition Commission. The consultation is one of a number DH is carrying out in relation to the new arrangements for regulating healthcare services 1. It should be considered alongside current consultations on; a new licensing regime for NHS providers 2 and procurement regulations for NHS commissioners 3. The Department seeks views and comments on the proposals in this document Depending on the outcome of this consultation, the current intention is to lay the relevant regulations in April 2013. How to Respond Please return your responses, no later than 21 December 2012. e-mail pricing.consultation@dh.gsi.gov.uk with the subject Pricing Consultation post Pricing Consultation Department of Health Room 229 Richmond House 79 Whitehall London SWIA 2NS online An online response form is available on the DH website 4. An impact assessment (IA) was produced for the Health and Social Care Bill 2011. This covered the principles for a fair and transparent pricing system. This IA can be found at: http://www.dh.gov.uk/prod_consum_dh/groups/ dhdigitalassets/documents/ digitalasset/dh_129917.pdf. The regulations that DH would be making following this consultation clarify the process set out in the Act for objections to proposed pricing methodologies. We will consider further, following the outcome of this consultation, whether publication of a further IA would be appropriate. 1 Further details are at: http://www.dh.gov.uk/health/2012/07/sector-regulation-update/ 2 http://healthandcare.dh.gov.uk/consultation-licensing/ 3 http://healthandcare.dh.gov.uk/consultation-commissioners/ 4 http://www.dh.gov.uk/health/category/publications/consultations/ 5
Section A: BACKGROUND ON PRICING Introduction 1. The Government wants to ensure the system delivers better health, better care and better value for money. Better value for money will be a key part in delivering enhanced services to patients and in equipping the NHS to improve standards, against the background of rising demand for health services and increasing treatment costs. Monitor will have the specific duty of promoting healthcare services that are value for money and maintain or improve quality. A key way in which Monitor will achieve this is working with the NHS Commissioning Board to regulate prices. 2. Monitor will be responsible for publishing the National Tariff from April 2014. It will develop its proposals for 2014/15 with the NHS Commissioning Board and engage widely on them, including giving providers, commissioners and others an opportunity to raise any concerns and offer suggestions for improvement. 3. Monitor will be required to publish a final draft of the National Tariff and allow 28 days for commissioners and providers to object to the proposed methodology for calculating tariff prices. If sufficient of them object, Monitor will have either to reconsider the proposed methodology and re-consult on revised proposals; or to refer the proposed methodology to the Competition Commission for a decision on whether it is appropriate. These arrangements for a final check and balance will apply to all versions of the tariff from April 2014 onwards. 4. This consultation is about the details of the arrangements for objections at the final consultation stage. It seeks views on DH s proposals for: which providers can formally object to Monitor s proposed methodology; and the extent of objections from Clinical Commissioning Groups (CCGs) and providers that would require Monitor to reconsider the methodology or refer it to the Competition Commission for a determination about whether it is appropriate. The rationale for the new pricing system 5. Value for money in the provision of healthcare services means getting the maximum benefit from the NHS budget. This will ensure that we make the best use of our resources, that inefficiencies in the system are addressed, that best practice models of care are implemented and the right behaviours are incentivised. Thus, achieving the right balance between quality, outcomes and costs will ensure that patients get the best services possible and commissioners will have more funds to extend and improve services to patients overall. 6. An effective pricing system is key to achieving value for money. The National Tariff will include prices for specified services or bundles of services, delivered to prescribed standards. It is not about the cheapest price. It is about paying a fair price for the services patients want, delivered to high standards. Such a system means competition on quality, not price, which will drive improvements in standards. By paying fair prices, an effective pricing system will encourage a sustainable and vibrant sector supplying healthcare 6
services, as well as minimising any perverse incentives for providers to cherry pick the services they deliver or the patients they treat. 7. The new National Tariff will be consistent with a set of six shared principles for pricing that Monitor (the independent sector regulator for healthcare services) and the NHS Commissioning Board have agreed ie: i. Enable and promote improvements in care for patients and taxpayers ii. Enable an efficient provider to earn appropriate reimbursement for their services iii. Have regard to sustaining the NHS offer in the long run (a taxpayer funded health service that is universal and comprehensive based on clinical need, not ability to pay) iv. Not preclude the delivery of the Secretary of State s Mandate for the NHS Commissioning Board v. Have regard to the principles of better regulation vi. Support movement towards a fairer playing field for providers 8. Under the Government s reforms, Monitor, the sector regulator for healthcare services, working alongside the NHS Commissioning Board, will manage the National pricing Tariff for NHS-funded services. This will place that responsibility with the bodies best placed in the new system to undertake it. Commissioners are most suited - due to their clinical expertise and understanding of patient needs - to say what currencies they will need in contracting for health services and to ensure these are aligned with their priorities for service improvement. 9. Monitor will be able to access necessary cost and activity information and to review this information over time. Their independence and objectivity will ensure that prices reflect provider costs and structures appropriately. Hence, Monitor will be responsible for developing the pricing methodology and for calculating prices, using that methodology. It will also have the overall responsibility for publishing the National Tariff and related guidance and carry out any necessary enforcement. 10. These arrangements will replace the current ones whereby the Department of Health manages the national pricing tariff. The Department will continue to do this until March 2014 including collecting data to inform Monitor s setting of the prices that will apply from April 2014 onwards. 11. In future, Monitor will be responsible for: developing the methodology for setting prices; setting out the prices in the National Tariff setting the methodology for agreeing local modifications to prices setting the rules for local price setting, where services are not included in the National Tariff consulting on the methodology publishing the National Tariff; and agreeing local modifications to prices. 7
The NHS Commissioning Board will be responsible for: Defining the scope of the tariff (ie what services for patients will be included) Determining currencies (ie the unit of reimbursement for services) Setting rules for variations to the National Tariff How the new pricing tariff will work 12. The new national pricing tariff will include: Currencies of individual or groups of services for which prices are included in the tariff; and the national prices payable for those services. 13. It may also include: Local variations to national prices, to take account of the circumstances in which the service is provided (eg in urban or rural areas); Different national prices or different local variations for different types of provider (eg to take account of unavoidable cost differences such as case complexity or pension provision), but with variation based on the provider s ownership (eg public or private) disallowed; and Rules governing the prices to be paid for specified services for which the tariff does not include national prices. 14. Commissioners and providers will be able to agree modifications to prices calculated in accordance with the tariff, where it would be uneconomic for the provider to provide a service at the tariff price. An agreement to modify a price in the tariff could go ahead only if Monitor agreed it. If a provider sought a modification to a tariff price and failed to reach agreement with the commissioner, the provider could ask Monitor for a modification. In any such case, it would be for Monitor to decide whether a modification should be made, what the modification should be and the circumstances in which it would apply. Monitor must include in the National Tariff the method it proposes to use for assessing applications for modifications. What the changes will mean for patients, commissioners and providers 15. Increasingly accurate pricing information. Monitor has stated that improving the quality of cost data is a key priority, thus collecting good quality information will be a focus of its medium-term strategy 5 and is already conducting analyses on how to achieve better accuracy. 16. Greater confidence in future prices should help commissioners and providers plan and budget and so help ensure the right services are in the right place at the right time to meet patients needs. Providers should also have more confidence to invest in developing their services. 5 Evaluation of the reimbursement system for NHS-funded care http://www.monitor-nhsft.gov.uk/sites/default/files/evaluation%20report%20- %20Full%20Report%20FINAL.pdf 8
17. Better reflecting clinical complexity. Monitor and the NHS Commissioning Board will be under a statutory duty to have regard to the different costs involved in providing services to patients with differing needs. The National Tariff should ensure that payment better reflects the specific costs that individual providers incur in treating their particular patients. Extending the extent to which the National Tariff allows for clinical complexity should reduce further the potential perverse effects of cherry picking. 18. Enabling integrated care. In carrying out all its functions, including developing the National Tariff, Monitor will be under a duty to do so with a view to enabling greater integration of services where this would improve the quality of services, increase efficiency or reduce inequalities of access or outcomes for patients. The NHS Commissioning Board will be under a duty to exercise its functions with a view to securing that services are provided in an integrated way where this would improve quality or reduce inequalities. These duties mean that Monitor and the Commissioning Board should use the tariff where appropriate to play a greater role in future in taking forward the development of integrated care, where that is beneficial for outcomes for patients. 19. Encompassing a broader range of services. Monitor and the NHS Commissioning Board will work together to develop a plan for encompassing a wider range of services within the scope of the National Tariff. In doing this, Monitor and the Commissioning Board will be required to take account of any potential adverse impacts on the provision of NHS services. This plan will mean that, over time, the benefits from the changes to the tariff extend to more services and patients. 20. A phased process of change. The Department of Health is currently in the process of handing over the responsibility of the National Tariff to Monitor and the NHS Commissioning board. This intention is that will be completed by 2014/15, when Monitor publishes its first National Tariff. The 2013/14 tariff will remain the responsibility of the Department and the current process will remain the same. 21. For the 2014/15 tariff onwards, Monitor and the NHSCB are currently undertaking work that will inform future developments. This work builds on work done to date, such as the Evaluation and Strategic Options for Costing 6. Monitor and the Board are currently working closely to develop further the proposals for 2014/15 and will provide further details in due course. Influencing the National Tariff 22. As now, stakeholders will have a key role in developing the National Tariff. Monitor and the NHS Commissioning Board are already seeking to involve patients, providers and commissioners in their work 3 - Monitor has already published three pricing documents for comment. Engagement throughout the development of the tariff will ensure that any issues and potential problems are identified and addressed early on in the process. 6 Strategic options for costing http://www.monitornhsft.gov.uk/sites/default/files/strategic%20options%20for%20costing%20(full%20report)%20-%20190612_0.pdf A methodology for approving local modifications to the National Tariff http://www.monitor-nhsft.gov.uk/sites/default/files/frontier%20- %20Local%20modifications%20methodology%20report%20-%20Monitor%20foreword%20and%20Exec%20report%20-%20Final(2)_0.pdf Evaluation of the reimbursement system for NHS-funded care http://www.monitor-nhsft.gov.uk/sites/default/files/evaluation%20report%20- %20Full%20Report%20FINAL.pdf 9
23. Figure 1 shows planned stakeholder engagement in the development of the National Tariff. Once the development and engagement work has been completed, taking account of the views of stakeholders, Monitor will conduct a statutory consultation for 28 days on a final draft of the National Tariff, before the tariff is published and implemented. This final draft will include: the services Monitor and the Commissioning Board intend be covered by the National Tariff; the intended national prices for those services; the intended methodology used to determine prices; and the methods Monitor intends to use to decide whether to approve local modification of a price, whether agreed by both the commissioner and provider, or proposed by the provider but not agreed by the commissioner. Fig 1: Stakeholder engagement in development of the tariff. 1a. Potential referral to the Competition Commission A final check and balance 1. National Tariff development and consultation Early development of currencies, methodology rules and guidance. Stakeholder engagement throughout development STATUTORY CONSULTATION on final draft of the national tariff 2. Publication of the final National tariff The National Tariff document 24. The consultation on the final draft of the National Tariff will give commissioners and providers a final opportunity to object to the pricing methodology. If sufficient of them object, Monitor will be able to go ahead with the proposals in the final draft of the National Tariff only if the Competition Commission determines that the methodology proposed in the final draft is appropriate. Figure 2 illustrates the possible outcomes following Monitor s consultation on the final draft of the National Tariff. 10
Fig 2:The pricing methodology consultation, objections and reference process Monitor publishes the final draft of the National Tariff document for consultation. [28 days] Do provider and/ or CCG objections meet a threshold? NO YES Monitor re-drafts the methodology in the National Tariff in light of the consultation feedback Monitor disagrees with the objections and refers them, and the reasons why it considers them invalid to the Competition Commission [The Commission makes a determination within 30, or if there are good reasons, up to 50, working days.] Monitor re-drafts the methodology in the National Tariff in light of the consultation feedback The Competition Commission determines that the methodology is NOT appropriate and sets out reasons why it requires reconsideration The Competition Commission determines that the methodology IS appropriate Monitor makes changes to the methodology, having regard to the Competition Commission s reasons. The Commission has a power of veto over the proposed changes Publication of the final National Tariff document 11
Section B: THE CONSULTATION The objections process 25. This system will ensure that Monitor take due account of its objectives when delivering the National Tariff. It will ensure engagement with providers, commissions and other stakeholders as well as placing a backstop provision within the system. 26. Commissioners and providers will be able to object to method for determining the national prices of services proposed in the final draft of the National Tariff. All objections will count towards the total number of objections received. 27. A commissioner or a provider objecting to adoption of the proposed methodology may object on the basis of one or more aspect of the methodology (eg what costs are taken into account and/or the specific figures used for the costs that are included), but will count as having made one objection. Monitor will then calculate: the percentage of commissioners objecting; the percentage of providers objecting; the percentage share of supply held by the objecting providers, which allows the objections of providers to be weighted proportionate to the services they deliver. 28. If any of these percentages reach the level set by the Government in regulations following this consultation - ie one or more of the objection percentage thresholds is met - Monitor must choose either to: reconsider the proposed methodology itself and then publish a revised final draft of the National Tariff for further consultation; or refer the methodology, and all objections received, to the Competition Commission ie make a reference. How the reference process works 29. In making a reference to the Competition Commission, Monitor must set out its reasons behind the proposed methodology and why it considers the methodology to be appropriate. Monitor s submission will address the grounds on which the Competition Commission can determine that the methodology is not appropriate ie that: i. the proposed methodology was based wholly or partly on an error of fact, which could include that the methodology was not based on the best available data; and/or ii. that in determining the methodology, Monitor failed to have regard to the matters it must have regard to in exercising its functions, including its duty to protect and promote the interests of people who use health care services by promoting provision of economic, efficient and effective healthcare services that improve or maintain quality and its duty to enable integrated services; and/or iii. that in determining the methodology, Monitor had made a decision that was wrong in law. 12
30. If the Competition Commission determined that the methodology was appropriate, Monitor could publish the National Tariff and in due course, that tariff would apply. If the Commission decided, for one of the reasons set out above, that the methodology was not appropriate, it would state its reasons and remit the matter to Monitor. Monitor would then reconsider the methodology and make changes, having regard to the Competition Commission s reasons. The Commission would have a power of veto over the proposed changes. 31. If the Competition Commission determined that the methodology was not appropriate, Monitor would pay the Commission s costs in connection with the reference. If the Commission determined that the methodology was appropriate, it would specify which objector(s) must pay those costs. If the Commission specified more than one objector, it could state the proportion of the costs that each must pay. 32. If the Commission determined that the methodology was not appropriate, it could also instruct Monitor to pay the costs that some of all of the objectors incurred in connection with the reference. Similarly, if the Commission determined that the methodology was appropriate, it could require some or all of the objectors to pay Monitor s costs. 33. These arrangements are set out in chapter 4 of Part 3 of and schedule 12 to the Health and Social Care Act 2012. Consultation questions on the objections process Definition of relevant providers 34. In order to determine the proportion of providers that must object in order to require Monitor to re-consider the methodology or refer it to the Competition Commission, it is first necessary to define which providers should be counted. 35. DH proposes that all providers of services covered by the National Tariff in operation at the point at which the consultation on the future tariff takes place will, if they object, count towards the objection percentage. This would be irrespective of whether providers were licence holders or exempt 7 from the requirement to hold a licence. 36. Under this proposal, Monitor will derive the total number of providers delivering tariff services (ie the denominator), and of this the total number of objectors (ie the numerator), in order to calculate whether a threshold has been met. The Department proposes that data used to calculate the number of providers, the thresholds and to apply a weighting is drawn from figures in a provider s previous year s financial accounts. Total tariff income is reported in both Foundation Trust and NHS Trust accounts and therefore should be easy to obtain. However, independent and voluntary sector providers would need to collect this information 7 The Health and Social Care Act 2012 set out provisions for providers of healthcare to hold a licence. Licensing establishes a legal framework for Monitor to set and enforce rules on providers of NHS services, for the purposes of protecting and promoting patients interests. The Department of Health s August 2012 consultation document Protecting and promoting patients interests licensing providers of NHS services https://www.wp.dh.gov.uk/publications/files/2012/08/licensing-consultation.pdf sets out the criteria that would qualify some providers for an exemption from the requirement to hold a licence. 13
and report it to Monitor. This approach will offer a stable base in which to determine the denominator of all calculations and to proportion an appropriate weighting for the share of supply calculation, which is discussed in more detail later. 37. We recognise that under this approach providers of new services included on the tariff and potential new entrants to tariff services will not have the opportunity to raise a formal objection in the first year. We cannot see how this can be achieved in a fairer and more transparent manner without imposing an excessive administrative burden on both providers and Monitor. We would welcome views on this as part of the consultation. 38. The Health and Social Care Act 2012 makes no provision for defining which commissioners should count towards the relevant objection percentage. The calculation will be the proportion of all commissioners of NHS-funded services who object. Question 1: Do you agree that providers of services in the tariff in operation at the time at which Monitor consults on the next tariff should count towards the thresholds? If not, can you suggest an alternative method to base this on? Question 2: If yes, do you agree that this should include any such providers who are exempt from the requirement to hold a licence? Questions 3: Do you agree that the data used to calculate an objection threshold should be based on total tariff income, as reported in financial accounts? If no, please suggest an alternative source. Question 4: Are there any other providers who should count towards the threshold? If yes, please give details and reasons. The objection percentage thresholds for commissioners and providers 39. In developing proposals for the calculation of the objection percentage and the related thresholds for commissioners and providers, DH has considered the following issues: The new arrangements for the National Tariff are intended to achieve better value for money in the provision of NHS services by creating the right incentives. A successful pricing system can reinforce these incentives and establish safeguards to protect patients interests, particularly where market forces alone would fail to do so. For example, the incentives on monopoly providers of hospital care to increase efficiency will be relatively weak due to the absence of competition. However, as well as creating incentives to increase efficiency, prices should take account of unavoidable cost differences, such as those arising from geographical location and clinical case complexity. Thresholds therefore need to be set at levels that will capture widespread concerns from a range of providers and/ or commissioners, minimising the risk of triggering re-consideration simply because some providers were finding it difficult to make improvements. Reference to the Competition Commission is a final check and balance in the system, not the first line stakeholder engagement process. 14
Reference to the Competition Commission may cause delay to the publication of the National Tariff. There is therefore a balance to be struck between the benefits of getting the methodology in the National Tariff as appropriate as possible and the costs of delaying the implementation of the Tariff. This suggests that there should be a significant number of objections to require re-consideration of the final draft of the National Tariff. The thresholds must be set at levels that would provide an opportunity to rectify any serious errors in the methodology in the final draft of the National Tariff, where the majority of providers and/ or commissioners objected. 40. DH therefore proposes that the objection percentage thresholds be set at 51% of the total number of commissioners and 51% of the total number of providers. If either proportion was 51% or more, Monitor would have either to re-consider the proposals for the methodology included in the final draft of the National Tariff or refer it to the Competition Commission. Question 5: Do you agree that the objection percentage threshold should be set at 51% for commissioners? If not, what figure would you propose, and why? Question 6: Do you agree that the objection percentage threshold should be set at 51% for providers? If not, what figure would you propose, and why? Share of Supply and weighting 41. There will be a third objection percentage threshold that would, if met or exceeded, require Monitor either to re-consider the proposals for the methodology in the final draft of the National Tariff or refer it to the Competition Commission. This share of supply threshold will take account of the providers who are most affected by tariff pricing and therefore offer them a proportionate weight to the NHS services that they deliver. 42. For calculating share of supply, DH proposes defining supply as the entirety of tariff services provided at a national level in the first instance. Hence, providers would be weighted according to their share of this supply ie the total income they received from all tariff services, minus any local area adjustments 8. With regard to the calculation, the denominator would be the total number of relevant providers, weighted by their total tariff income as reported in the previous year s financial accounts. Thus, the numerator would be the total number of weighted objectors. 43. DH has considered the alternative of a range of share of supply calculations. Under this option, services would be grouped (eg acute services) and there would be separate threshold for each group of services. This option would mean that if an issue around the appropriateness of Monitor s proposed methodology was especially salient for providers of one particular type of service, those providers would have more chance of triggering reconsideration of the proposed methodology than under DH s proposal for a single share of supply measure. However, this option would be significantly more complex and create 8 Please note that we propose that tariff income should be exclusive of local area payments - such as the MFF - and any approved local modifications to tariff payments received. 15
greater administrative burdens 9, both for Monitor which would have to do the necessary calculations and for providers, who would have to supply information about the type of tariff services, not just their total value. Hence, DH is proposing that initially at least, there should be a single definition of supply. This position will be reviewed in the light of experience. Question 7: Do you agree that a provider s share of supply should be calculated across all tariff services covered by the tariff in force at the time at which the consultation takes place? If not, how should their share of supply be calculated? Question 8: Do you agree that providers should be weighted based on income received from tariff services, as stated in the previous year s financial accounts, minus local area adjustments? If not, on what basis should they be weighted? 44. The same issues that led DH to propose that the objection percentage thresholds for commissioners and providers be set at 51% have led it to propose that the share of supply percentage threshold should also be 51%. Under DH s proposals, this third threshold would be met if objections were received from organisations providing 51% or more of the services on the tariff in operation when the consultation took place, measured by the income generated from such services, as stated in the previous years financial accounts. 45. If any of the objection percentage thresholds - unweighted proportion of commissioners, unweighted proportion of providers, or weighted proportion of providers calculated as above - were met, Monitor would have to reconsider its proposals or make a reference to the Competition Commission. Question 9: Do you agree that the share of supply percentage threshold should be set at the same figure as for the objection percentage thresholds, ie 51% of the total supply? If not, what percentage should be set, and why? Future review of thresholds 46. DH will consider the initial arrangements for the thresholds and how they are calculated in the light of experience. Equalities 47. We do not anticipate any adverse impact on equalities as a result of the proposals in this consultation. This is consistent with the Government s overall assessment of the equalities impact of its wider proposals for regulating providers 10 and reflects the nature of the function, in that regulators do not provide or commission services directly. However, Monitor has general 11 and specific 12 duties under Equalities legislation. Equality Duties cover the following protected characteristics: 9 Other share of supply options are explored in the corresponding impact assessment see XX. However, these have been disregarded in the first instance, until a time where there is more clarity regarding the changes Monitor intends to make to defining service groups. 10 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_129978.pdf 11 http://www.homeoffice.gov.uk/publications/equalities/equality-act-publications/equality-act-guidance/equalityduty?view=binary 16
age disability gender reassignment pregnancy and maternity race this includes ethnic or national origins, colour or nationality religion or belief this includes lack of belief sex sexual orientation. We would be grateful for any evidence as to the direct impact of the proposals in this document on the protected characteristics. Question 10: Do you have any evidence that the proposals in this document will impact adversely or unfairly on any protected groups? 12 http://www.homeoffice.gov.uk/publications/equalities/equality-act-publications/equality-act-guidance/specificduties?view=binary 17
Summary of consultation questions and how to respond Question 1: Do you agree that providers of services in the tariff in operation at the time at which Monitor consults on the next tariff should count towards the thresholds? Question 2: If yes, do you agree that this should include any such providers who are exempt from the requirement to hold a licence? Questions 3: Do you agree that the data used to calculate an objection threshold should be based on total tariff income, as reported in financial accounts? If no, please suggest an alternative source. Question 4: Are there any other providers who should count towards the threshold? If yes, please give details and reasons. Question 5: Do you agree that the objection percentage threshold should be set at 51% for commissioners? If not, what figure would you propose, and why? Question 6: Do you agree that the objection percentage threshold should be set at 51% for providers? If not, what figure would you propose, and why? Question 7: Do you agree that a provider s share of supply should be calculated across all tariff services covered by the tariff in force at the time at which the consultation takes place? If not, how should their share of supply be calculated? Question 8: Do you agree that providers should be weighted based on income received from tariff services, as stated in the previous years financial years accounts, minus local area adjustments? If not, on what basis should they be weighted? Question 9: Do you agree that the share of supply percentage threshold should be set at the same figure as for the objection percentage thresholds, ie 51% of the total supply? If not, what percentage should be set, and why? Question 10: Do you have any evidence that the proposals in this document will impact adversely or unfairly on any protected groups? 18
Comments on the consultation process itself If you have concerns or comments which you would like to make relating specifically to the consultation process itself please contact e-mail Consultations Coordinator Department of Health 3E48, Quarry House Leeds LS2 7UE consultations.co-ordinator@dh.gsi.gov.uk Please do not send consultation responses to this address. Confidentiality of information We manage the information you provide in response to this consultation in accordance with the Department of Health's Information Charter. Information we receive, including personal information, may be published or disclosed in accordance with the access to information regimes (primarily the Freedom of Information Act 2000 (FOIA), the Data Protection Act 1998 (DPA) and the Environmental Information Regulations 2004). If you want the information that you provide to be treated as confidential, please be aware that, under the FOIA, there is a statutory Code of Practice with which public authorities must comply and which deals, amongst other things, with obligations of confidence. In view of this, it would be helpful if you could explain to us why you regard the information you have provided as confidential. If we receive a request for disclosure of the information we will take full account of your explanation, but we cannot give an assurance that confidentiality can be maintained in all circumstances. An automatic confidentiality disclaimer generated by your IT system will not, of itself, be regarded as binding on the Department. The Department will process your personal data in accordance with the DPA and, in most circumstances, this will mean that your personal data will not be disclosed to third parties. Summary of the consultation A summary of the response to this consultation will be made available before or alongside any further action, such as laying legislation before Parliament, and will be placed on the consultations website at http://www.dh.gov.uk/en/consultations/responsestoconsultations/index.htm 19