Addressing the costing staff deficit

by Catherine Mitchell

27 June 2018

Robust, patient-level costing data is fundamental to delivering value in the NHS but we need to ensure costing teams are properly resourced.

The increased NHS funding unveiled by prime minister Theresa May earlier this month will be accompanied by a renewed focus on efficiency to ensure that ‘every penny is well spent’. She added that the 10-year plan that will be agreed with the NHS later this year will need to ‘tackle waste, reduce bureaucracy and eliminate unacceptable variation’.

Robust and detailed cost data is vital for supporting this aim, allowing the NHS to understand service costs, reduce unwarranted variation and develop new models of care. But does the NHS have enough finance staff with the right skills to generate this data?

NHS Improvement’s Costing Transformation Programme (CTP) aims to deliver significant improvements to the quality of costing information in the NHS, with patient-level costing (PLICS) in place across all NHS providers by 2020. These enhancements to the quality of costing information will support providers to understand how they use their resources and drive improvements in the efficiency and effectiveness of patient care.

The NHS has made a good start with this programme but there is some distance to go and significant challenges ahead – perhaps particularly outside the acute sector where costing has not traditionally been so well resourced. Beyond the ‘technical’ challenge of collating robust patient-level cost data there needs to be a parallel focus on engaging clinicians and operational managers to ensure costing and activity data is actively used to drive improvements in patient care.

This all places new and challenging demands on NHS finance teams, where costing has traditionally been a ‘back room’ function and for many the focus has been on the completion of national reference cost collections using average specialty costs.

The Healthcare Costing for Value Institute surveyed members to gauge whether there is the capability and capacity within the NHS to deliver the requirements of the CTP, as well as promote the use of cost data. These survey results have provided a useful insight into the ability of the NHS finance profession to deliver the changes needed for this costing revolution.

Most trusts anticipate additional workload pressures on costing teams with the implementation of the new costing standards, and the increased use of costing data across the organisation.

More than half of trusts surveyed have two staff or fewer in their central costing teams. And two-thirds reported that they did not have enough staff with the right skills to deliver the increased workload. If the surveyed trusts were representative of all NHS trusts, this would equate to over an additional 200 new costing posts being required nationally.

Nearly a quarter of trusts had vacancies in their costing teams. The lack of promotion opportunities within the costing profession, with no formal career path, is seen as a barrier to the recruitment and retention of staff.

These results highlight the scale of the challenge facing the NHS, both in terms of implementing the new costing standards, and maximising the use of PLICS data to support improvements in patient care. But costing data is fundamental to delivering value going forward. And if we are serious about ensuring every penny is spent well, we need to address this staffing and skills deficit.

Costing skills in the NHS

HFMA have developed a new masters level costing module O6 Supporting quality care with patient-level costing. This module can be studied as part of the HFMA master level qualifications programme. Find out more.


The Healthcare Costing for Value Institute supports the NHS to improve costing, turn data into powerful patient-level information, champion multi-disciplinary collaboration, and ultimately drive value across patient pathways. For more information on becoming a member please contact Richard Sawyer on 01179388989 or via