HFMA highlights concerns about MH costing plan

02 December 2019 Steve Brown

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NHS Improvement confirmed in February that trusts would be required to submit patient-level cost data for mental health services over a two-year period, with mental health trusts and integrated acute/mental health trusts submitting 2019/20 data next year.

The oversight body rejected calls for a delay as part of the original consultation on mandating patient-level costs for mental health, saying it would affect plans for community services and to end the collection of reference costs.

But the HFMA has written to NHS England and NHS Improvement arguing that the ‘2020 mandation is too soon’. The move follows feedback from mental health trusts during the autumn – many of which have taken part in this year’s voluntary collection.

Practitioners report that software suppliers’ and central bodies’ current focus on the acute sector – which led the way with a first mandatory collection over the summer – is having an impact on mental health trusts’ ability to implement patient-level costing.

Mental health trusts’ experience of their voluntary collection this year, which was complicated by late guidance and very tight timescales, has raised further doubts that the sector is prepared enough for the switch next year. Trusts have also not been able to test the NHS Digital system that will be used in the mandatory collection.

Costing practitioners have identified problems with the standards issued to cover the costing work, describing them as ‘overly complicated’, ‘challenging to implement’ in places, and having ‘too much focus on detail’.

Mental health trusts also questioned whether there was sufficient capacity in the sector to implement the costing standards. Trusts are starting from a low base in terms of infrastructure and those that are most advanced report that it requires significant additional investment. While mental health costing teams are typically small – smaller than those in acute providers – recruitment and retention are seen as challenges.

Catherine MitchellThe HFMA and its Healthcare Costing for Value Institute have been strong advocates for robust patient-level cost data for a number of years. And institute head Catherine Mitchell (pictured) believes progress across the NHS has been impressive. ‘However, the overall timelines for mental health were set before this year’s mandatory acute collection, and mental health trusts now have real concerns about the pace of change and the achievability of next year’s submission,’ she said.

The specific problems raised about the move to patient-level costing for mental health trusts come after the association highlighted concerns more broadly with the national cost collection this year. A document sent to the central bodies this summer highlighted general and specific issues with the standards, guidance, collection process and costing teams.

A November costing newsletter from NHS England and NHS Improvement said many of these issues had been addressed in new Approved costing guidance, which was published for comment recently. However, it promised a full response to the HFMA report would be published in early December.