Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what his Department’s policy is on NHS trusts delivering elective care under block contract arrangements.

Integrated care boards (ICBs) are responsible for the commissioning of elective care services, based on the needs of their population.

The NHS Payment Scheme is the set of rules, prices, and guidance that determine how providers of National Health Service-funded healthcare are paid for the services they provide. It is designed to ensure that funding flows fairly and efficiently across the healthcare system. Under the NHS Payment Scheme 2025/26, NHS trusts should not be paid under a block contract basis for elective care. NHS trusts should be paid on the basis of the elective care they deliver.

The only exception is where the value of patient activity between a commissioner and an NHS trust is less than £1.5 million, and in these circumstances the trust is paid a fixed amount for all the activity that they deliver for that commissioner, including both elective and non-elective, to minimise the number of low value transactions between NHS organisations.

NHS England expects each ICB and provider to meet the requirements of the 2025/26 Planning Guidance, including delivering the necessary elective recovery targets. Where systems and providers are failing to meet their plans, NHS England will work with them to ensure appropriate mitigations are in place. This can include escalation into the national tiering programme, and the provision of improvement support. The National Oversight Framework describes how NHS England assesses ICBs and NHS providers, ensuring public accountability for performance. These processes are the same for all providers and systems, regardless of the commissioning arrangements in place.

Details of the 2025/26 NHS Payment Scheme are published at the following link:

https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/