Comment / Communication, communication, communication …

It’s been a challenging start to 2023 for everybody involved in costing, both practitioners and the central team at NHS England. But just as we start to see signs of new life in our gardens over the past few weeks, we have also started to see the early seeds of change.

In the March edition of Healthcare Finance, Steve Brown reports on the announcement, made during a recent NHS England webinar, that the national cost collection (NCC) will go ahead in 2023 and will be undertaken at the patient level. This is despite a series of updates in January from the national costing team that initially threw the format and timing of this year’s collection into doubt.

The uncertainty has not been helpful for costing practitioners trying to plan workload output and, equally importantly, summer holidays. But, during the webinar, senior staff from the NHS England costing team were open and honest in explaining the reasons behind it. The team also explained how the delays will affect this year’s collection and steps being taken to minimise further disruption.

There is no doubt that the team is in an extremely difficult position. It is working hard to maintain business as usual against a backdrop of high vacancy rates in both the costing and data science teams, brought about by organisational restructure and reduction, a recruitment freeze and voluntary redundancy.

In 2021/22, the Approved costing guidance included reference to the fact that the 2022/23 NCC would mark completion of the five-year costing transformation programme (CTP), meaning withdrawal of NCC workbooks and a move to patient-level costing for most remaining services. But this was also thrown into doubt by the announcements in early 2023, which confirmed a delay in publication of the 2022/23 Approved costing guidance, but indicated minimal change.

Some practitioners read this to mean that the final step of CTP would be delayed for a further 12 months. Instead, NHS England’s intention was that the ‘minimal change’ referenced deviation from the previously published transition path. Again, the recent webinar provided clarity. Even though the costing guidance will not be published until May 2023, the central team confirmed that trusts can plan work based on previously published guidance, including that for the recent early implementer pilot for the final step of CTP.

Therefore, practitioners now have confirmation that cost collection will not take place before mid-September, that it will be at patient level and will be in line with previously communicated plans to complete the five-year CTP. The central team has now provided sufficient information to enable practitioners to start planning, and to book that all important time off with family!

There is an important lesson for us all to take away from this, whether involved in costing or any other part of NHS finance. Communication is absolutely key to a successful relationship. My experience is that timely information, even if it is incomplete, but with a clear explanation, will always be better than complete information that is too late to be useful.

Given that last statement, it would be remiss of me not to mention the delays in publishing results from the 2021/22 NCC exercise, which have also been delayed for the same NHS England resource reasons. It is vitally important that practitioners, and other stakeholders, do have access to the most up-to-date national data. On one level, practitioners need to see the results of their hard work in producing the information, but it is also a vital tool in national benchmarking at a much wider level, informing the outputs from the Getting It Right First Time programme and model health system improvement tool among others.

Again, we need to recognise that the central NHS England teams are currently juggling more priorities than their limited resources allow and publishing full national data may be too resource intensive at this time. Despite the delays in this data, across the NHS there are plenty of examples of internal cost data being used to facilitate conversations about value, efficiency and productivity and providing evidence of benefit of continual quality improvement. This leads me to think that there may be a compromise – what level of data could be published that would be useful, but not as onerous? Again, the key to understanding this is open and honest discussion involving a range of key stakeholders.

As CTP reaches completion, it may be seen by some as a time to pause and embed the changes to date. But both practitioners and NHS England recognise that the costing methodology and detailed collection requirements have introduced significant complexity and additional burden into cost production for national requirements. At the HFMA, we welcome the ongoing work by NHS England to understand the difference between local and national patient level costing and ambitions to reduce complexity of the costing methodology.

Continuing in the spirit of communication, a specific webinar to update practitioners on the work already undertaken will be well received and should give them the opportunity to comment on the planning for the next stages of streamlining and automating the costing and collection process.

Returning to my initial analogy, it takes time and effort to get from the early signs of spring to reaping the rewards of full blooms. Handled correctly there is scope for this work to solve many of challenges facing both the central team and practitioners this year. But it will take time and it is unlikely that NHS England and its external stakeholders would agree to a pause in NCC in the meantime.

But by maintaining regular, open communication between the central team and practitioners it should be possible to ensure that all stakeholders understand the impact of decisions and can act accordingly.