News / Cost survey reflects increasing PLICS use

29 November 2013

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By Steve Brown


Nearly 85% of NHS trusts and foundation trusts – nine more trusts than last year – have implemented, are implementing or are planning to implement patient-level information and costing systems (PLICS), according to the Department of Health’s PLICS survey conducted as part of the annual reference cost return.

The Department published the 2012/13 reference costs at the end of November. Just 37 out of 244 trusts taking part in the cost collection said they were not planning to implement systems. Reasons given included focusing on service line reporting (17 trusts) and uncertainty over the organisation’s future structure.

The 37 trusts included nine ambulance trusts, seven of which say they are unconvinced of the benefits of PLICs to them.

Monitor, now responsible for pricing alongside NHS England, has made it clear that the long-term ambition is to move to patient-level cost data as the main information source to underpin price setting.

Of 121 trusts to have systems in place, 110 are acute and eight are in the mental health sector. They are joined this year for the first time by two community trusts and one ambulance trust. Some 33 trusts are implementing and a further 53 are still in the planning stage.

All but five of the ‘implemented’ trusts used their systems to inform some or all of their 2012/13 reference costs return. These five cited reasons including: differences in reference costs and PLICS methodology; data quality issues; or incomplete development.

The survey found that PLICS data is mostly being used to inform reference costs in established clinical areas with good data flows. These areas included outpatients, admitted patient care and day care, emergency medicine, critical care and diagnostic imaging.

For example, 96% of the admitted patient care quantum of 106 acute trusts was underpinned by PLICS data. In total, £15.4bn (66%) of all admitted patient care costs were derived from PLICS.

The HFMA’s Clinical costing standards, which set best practice in patient-level costing, were used by 118 trusts to support their reference costs return.

See Counting the Cost

Clinical and financial engagement

Fifty six trusts (23%) now consider themselves to be the top level of the Department of Health-defined engagement scale. The scale describes four levels of engagement from level 1 (engagement only at board level) to level 4 (joined up, collaborative work is the norm). There has been a general improvement up the levels in the past year, with 56 level 4 trusts compared with 49 last year, as the table below demonstrates.

  Level 1 Level 2 Level 3 Level 4
2012 20 94 85 49
2013 7 89 92 56