Comment / Shared knowledge key to better costs

The NHS needs the clinical costing standards and the clinical costing standards need you.

You will, I’m sure, have heard me or one of my colleagues waxing lyrical about the importance of costing – and patient-level costing in particular – in supporting and enabling the transformation of healthcare services. I make no apology for repetition.

We need to identify and understand current variation in service provision and how costs arise. We also need to understand in detail both the costs and benefits of current models of service delivery and those of revised pathways and new service models.

We simply won’t be able to do this with any confidence without a forensic understanding of costs at the most detailed level. We also need clinical decision-makers to understand and support these changes and we can only do this by being transparent and clear about the costs and benefits of options.

Patient-level costs offer us this opportunity and also give us the best chance of engaging the clinical community in the search for better value. Clinicians need to lead service transformation and they need good-quality robust data that reflects the care they know they’ve delivered to individual patients.

Okay, that’s enough of the general patient-level costing marketing pitch. The HFMA clinical costing standards have a major supporting role to play in the drive to adopt patient-level costing across the NHS. They aim to reflect best practice and update this as appropriate on a year-by-year basis.

This evolution can be seen clearly in the work over the past year in improving the allocation of nursing, theatre and medical staff costs to acute hospital patients. This evolution will continue into next year’s standards, with additional guidance to support the costing of out-of-hours care and the work of the emergency department. There is parallel work on mental health services and we are just starting to look at how we can also support community services.

The standards are vital in ensuring a consistent approach across different organisations. This consistency will maximise the value of the data produced, making it more useful for tariff-setting and benchmarking purposes. The HFMA believes the natural next step would be to mandate the use of the standards. While we recognise there are challenges – with different trusts at different stages of their patient costing journey – mandated standards would quicken the pace of development and send a clear message to suppliers on where to focus system development.

But the improvement of the standards – and therefore of costing itself – is completely dependent on the finance community including both costing practitioners and finance managers. The HFMA already has a fantastic set of finance professionals working across its acute and mental health costing groups, but they can only do so much.

We need the support of the whole community to help us identify what does and doesn’t work at the most detailed levels. For example, do you have allocation mechanisms that aren’t reflected in the MAQS self-assessment tool? Or do you disagree with the relative ratings of the allocation methods already identified for some cost types?

It is finance staff who will identify what doesn’t work at the moment, what could work better and where further guidance would be helpful.

And – on the subject of the MAQS – we need everybody doing it – particularly within mental health trusts and community trusts – and giving us their feedback. That’s how we’ll all get it better and provide maximum value both locally and nationally.

Finance staff will get their annual opportunity to give the association their feedback on the costing standards as part of the costing standards survey, which this year will be sent out in May. But if you’ve got something to tell us, don’t wait – contact the HFMA costing team using the details below. Help us to get you the support and guidance you need.

John Graham is chairman of the HFMA Costing Practitioner Groups. Contact the costing team on [email protected]