Institute themes and frameworks

Supporting improvements in costing

Costing remains high on the NHS agenda and with the move to system working understanding the cost of delivering care is essential in order to allocate resources as effectively as possible.

The Institute provides a support network where partners have the opportunity to discuss costing challenges with their peers, as well as share learning. Our wide range of Confident costing events and publications ensure we support both those new to costing as well as more experienced costing staff.

Confident costing is the first step, developed to help improve your costing processes, enhance your costing data and support you in the delivery of reliable and accurate patient-level costing data, paving the way for you to translate your data into vital business intelligence.

"Our data and processes aren't where they need to be just yet."

Costing is high on the NHS agenda with NHS Improvement’s mandation of new costing standards. The Institute provides a support network where partners have the opportunity to discuss costing challenges with their peers, as well as share learning. Our wide range of Confident costing events and publications ensure we support both those new to costing as well as more experienced costing staff.

“The role of costing within the NHS is an expanding area and our roles are becoming more pivotal to the successful performance of our trusts and the NHS as a whole.”

“Institute events give me confidence in my understanding of the national priorities and direction of travel and allow me to network and help gain understanding of issues affecting costing practitioners.”

Making the most of patient-level cost data

Good-quality data is fundamental to providing the right care to the right patient in the right place. Patient-level costing information plays an integral part in the decisions that need to be made across pathways, organisations and systems. The challenge is how to make the most of patient-level cost data to support improvements in the delivery of care and to support system leaders as they look to improve the health of their local populations in a financially sustainable way.

Translating data has been developed to help you better understand, communicate and use patient-level costing information in financial and clinical decision making, leading to the delivery of value-based healthcare. Providers of NHS services have increasingly large amounts of data about their patients, with the roll-out of patient-level costing (PLICS) across the NHS.

“We have loads of data but aren’t sure what to do with it.”

The Institute has a series of toolkits to help partners turn the cost and activity data generated into powerful intelligence, while its support network allows partners to share examples of how they have embedded patient-level costing within their organisations and systems and how they have worked with clinicians and others to use data to support service redesign.

“PLICS data allows discussions between clinical teams and finance professionals to focus on individual patients. This is a powerful way to start conversations about how resources are used within a trust.”

“Health systems are starting to explore how they can measure costs across patient pathways which often go across more than one organisation. By linking data from different services whole care pathways can be mapped and measured.’’

Improving patient outcomes at the lowest possible cost

As we move to a more collaborative, integrated approach to designing and delivering health services, the question of how we allocate finite resources in a way to maximise outcomes becomes increasingly important. The concept of ‘value’ in healthcare is seen as a key lever to support this. Whether you are deciding what investments will have the greatest impact on your population’s health, seeking to optimise a care pathway or wanting to obtain excellent outcomes for patients, driving value is essential. The challenge is how to do this in practice. What is clear is that clinicians and finance staff need to work more closely together to support improvements in value.

“Now that we understand our data, how do we drive value?”

The Institute has a growing reputation for bringing together senior finance leaders, data analysts and clinicians to explore what value means for the NHS. Institute partners have the opportunity to hear from those at the cutting edge – both nationally and internationally – and take back practical ideas for their own organisations and systems. Our value challenge projects work with partners to put the theory of value into practice.

Driving value provides examples and practical tips on how to match costs to outcomes, giving you the opportunity to deliver the outcomes that matter most to your patients sustainably.

“This event was one of the most informative I have attended in a long time. The quality of the speakers and the enthusiasm in the room was excellent.”

“There’s a real opportunity here; value is clearly the key to understanding how we can deliver better healthcare.”

Pushing costing and value boundaries

The Institute continues to push forward and promote costing and value-based healthcare. This is supported by Institute-led projects which aim to challenge current practices and the existing culture.

There are the value challenge projects, the first of which supported three acute trusts to compare cost and outcome data for cohorts of patients in diabetes and fractured neck of femur pathways. Here is the report on the value challenge pilot.

The Institute works with its partners, associates and commercial partners to learn from and share good practice in the UK and internationally. We are always looking for new ideas and opportunities to ensure that we are at the cutting edge of costing and value.

“We really have to look at what we are doing and see how we can get the best out of our systems to deliver value for the patient in terms of outcomes and in the most cost-effective way.”

The Institute worked with the One NHS Finance (ONF) Future Focused Finance workstream to deliver the Best Possible Value Decision Framework. The framework is a set of tools which help NHS organisations to work through a decision or project using value (measured as outcomes over costs) as the main driver.

What is the challenge?

The NHS is moving to a system led approach with Integrated Care Systems and Integrated Care Boards starting to make changes in how they deliver health and social care to their population. The impact and scale of these changes is much more significant than ever before because the number of people that will be affected by each decision has grown exponentially.

It is therefore fundamental that each decision not only involves a mixed team of providers, commissioners and local authority representatives but also a multidisciplinary team of finance and non-finance personnel who are able to consider every possible outcome of their intended decision before it is made.

The key challenges systems tend to face when making a decision are ensuring that all disciplines are involved and engaged in the process throughout, establishing a consensus on the key decision from the outset and prioritising enough time and resource to complete on time.

What does BPV do?

The BPV Decision Framework helps NHS systems follow a clear, structured decision-making process that demonstrates good governance and models different options based on value. The ‘value equation’, measured as outcomes over resources/costs, is used throughout to assess the impact of strategic and operational decisions within organisations and local health economies.

There are further details about the framework here and supporting documents here.

The Institute worked with the One NHS Finance (ONF) Future Focused Finance workstream to develop and deliver EVO.

EVO facilitates the engagement of a multidisciplinary team in the understanding and use of patient-level information and costs, and its relationship to value in healthcare. The ultimate purpose being to achieve the best outcome for the patient within the resources available.

The roll-out of patient-level costing across the NHS means that services have an increasingly rich source of information to help them understand their patients and services, however awareness of this data outside the costing team is not widespread.

The HFMA’s Healthcare Costing for Value Institute and Future Focused Finance have worked together to develop the Engagement Value Outcome (EVO) framework. EVO promotes collaborative working between clinical and finance teams and their collective understanding of patient-level data, providing the NHS with a framework to ensure resources are used in the most effective way possible to provide high-quality care to patients.

During the second half of 2019 we piloted the EVO framework with four trusts, covering acute, mental health and community services.

Click here to view the EVO pilot summary which provides an overview of EVO and initial findings from the pilot sites. See below for the individual case studies.