Internet Explorer is no longer supported by Microsoft. To browse the NIHR site please use a modern, secure browser like Google Chrome, Mozilla Firefox, or Microsoft Edge.

Excess treatment costs: Payment thresholds lowered for NHS trusts

Published: 13 June 2022

NHS trusts delivering non-commercial clinical research will benefit from additional funding to deliver studies across England - following a financial policy change lowering the point at which trusts can claim back research excess treatment costs.

Excess treatment costs (ETC) are the costs incurred by NHS trusts and care providers involved in delivering research, when the treatments given as part of delivering studies are more expensive than the care/treatment that the participants would have normally received.

NHS England and NHS Improvement’s national NHS Clinical Commissioning Group (CCG) ETC payment system, which is managed by the National Institute for Health and Care Research (NIHR), applies a contribution threshold to NHS secondary care sites for claiming back the excess treatment costs they incur while delivering studies. NHS sites are required to surpass this threshold before any ETC payments can be made.

Since 2018, the organisational ETC threshold has been set at 0.01% of the NHS trust’s operating budget. With effect from 1 April 2022, this threshold has now been lowered to 0.001%.

This significant reduction in the payment threshold will provide additional funding of £4m per annum to secondary care providers - with an additional 120 NHS sites set to receive payments. Averaged over the last few years, only 25% of secondary NHS sites which incurred ETCs exceeded the thresholds and received these payments (40 sites out of 160 NHS sites).

The decision to reset thresholds will significantly reduce the average threshold levels for secondary care providers from an average of £40,000, to £4,000 per annum. This will not only create additional funding for NHS sites which incur these excess treatment costs, but will provide the funding earlier in the financial year - creating stability and assurances for sites during the budgeting stages.

Prof Lucy Chappell, Chief Scientific Adviser to the Department of Health and Social Care, and CEO of the NIHR said:

“The decision to lower the threshold for excess treatment costs is fantastic news and will open up research - both for the NHS, and for patients and the public.

“Lower thresholds will simplify the process of delivering studies for NHS trusts, making it easier to reclaim more of the costs involved. It will make research a more attractive, viable prospect for many more NHS trusts across the country, and give even more people the opportunity to take part in potentially life-changing research.”

Ali Austin, NHS England Deputy Director for Research said:

“Research provides us with the evidence of the best ways to improve care, treatment and lives of the whole population, underpinning transformation in the NHS. The majority of studies carried out in the NHS are funded by non-commercial bodies, so public sector and charities, and these studies are eligible for excess treatment costs (ETCs). The reduction in the ETC threshold will mean that more providers will receive ETC, encouraging more hospitals to take part in more non-commercial trials, helping get the best new treatments to UK patients faster”.

The decision to lower ETC thresholds is supported by the Department of Health and Social Care and forms part of the UK’s Clinical Research Recovery, Resilience and Growth programme. The programme aims to deliver the Government’s research vision - and unleash the full potential of clinical research delivery to tackle health inequalities, bolster economic recovery and to improve the lives of people across the UK.

Find out more

Read more about excess treatment costs here.

Latest news