HFMA Awards 2019: costing
12 December 2019
This year’s costing winner, Gloucestershire Health and Care NHS Foundation Trust, is helping to lead the way in applying patient-level costing to community services. It is one of only three trusts nationally to submit patient-level costs for community services as part of a voluntary submission and has helped to shape national community costing standards. This puts the trust ahead of the game, with a mandatory submission of patient-level costs for all community service providers not expected until 2021.
The trust provides a diverse range of community health services to some 600,000 adults and children, including inpatient rehabilitation, public health nursing, community dental, district and specialist nursing.
It has made several improvements to its costing process in the past year. It now captures more detailed information in its clinical system to help distinguish between different episode and intervention types for therapy services. While these services can cover a wide range of activities – including caring for amputees, patients with neurological disorders and rehabilitation – national coding only allows for two options: one-to-one or group physio.
This change is helping the trust to understand if patients are receiving consistent treatment across localities for similar interventions and may help inform national community therapy currencies.
The trust has also for the first time included patient conditions and multi-morbidities as part of its patient data feeds, giving a powerful view of real clinical variation. Clinicians are very interested in the potential for this data to help them manage their services.
In terms of its work as one of NHS Improvement’s roadmap partners, the trust’s initial voluntary submission represented about 60% of its reference costs quantum and it is making a further submission based on 2018/19 data. As part of the move to patient-level costing, it uncovered several data inconsistencies, some down to data recording or reporting. By highlighting the scale of the problem, a solution could be found.
The trust has used patient-level data to highlight clinical variation in district nursing services and therapy services. Early results indicate that the complexity of therapy services had previously been underestimated, as had the extent of palliative work being undertaken by district nursing teams.
The trust – which was formed in October 2019 following the merger of 2gether NHS Foundation Trust and Gloucestershire Care Services NHS Trust – also plans to link cost to patient outcome measures to help understand the value being achieved, and to join up patient cost data across its integrated care system.
Jenny Richards, senior planning and costing manager at the trust, said clinicians were responding positively to the new costing information. ‘They are helping us form the next iteration of data – fully engaged and driving innovation equally as we go forward.’ The trust finance director – Sandra Betney – fully supported the approach, she added, which really helped.
Steven Wainwright, the trust’s former senior planning and costing manager, said the trust was starting to cascade the data down through the organisation. ‘There is a lot of interest in what it can show,’ he said.
The judges praised the improvements made. ‘They really showed the potential of good costing in a community environment and are forging the way to set standards of outcomes for community trusts nationally,’ they said. ’
Download our HFMA Awards 2019 supplement here
Barking, Havering and Redbridge University Hospitals NHS Trust was commended for its focus on costing data to improve outcomes and efficiency savings across the integrated care system. Traditional cost improvement approaches based on transactional gains and one-off savings were no longer sufficient, so the trust switched to gaining a better understanding of its cost base and its relationship with clinical activity. Costing data has played a key role in identifying deficit drivers and opportunities for services to achieve upper-quartile performance. This led to a financial recovery plan underpinned by well-understood cost and revenue drivers and the development of costing intelligence tools.
With a new costing system in 2018/19, the two-person Maidstone and Tunbridge Wells NHS Trust costing team completed mandatory reference cost submissions and the non-mandatory patient-level cost submission, as well as contributing to a corporate back-office submission and benchmarking returns for imaging and therapies. A quarterly report to the finance and performance committee highlights key metrics based on the Carter report and Model Hospital. The team works with heads of service to understand cost data and support improvement, and highlighted opportunities with the CNST rebate and medicines management.