New push for trusts to join EQC

The EQC was announced in August last year to help establish an understanding of the costs of delivering Covid care and the impact that the Covid pandemic has had on the unit costs of non-Covid care. The information will help inform the recovery of services in the NHS, as the service looks to address a significant backlog of activity while continuing to deliver Covid care and observing ongoing infection control requirements.

The Treasury, the Department of Health and Social Care and several other stakeholders are all interested in understanding the impact of Covid-19 on NHS costs. Unit costs for non-Covid care are expected to have increased as fixed and semi-fixed costs are spread across reduced levels of activity. But there will also be interest in the costs of virtual outpatient appointments, which have seen a major expansion over the last year.

The virtual approach slashes the number of patient journeys involved in an attendance and there have also been anecdotal reports about improvements in did-not-attend rates. But it is not clear if virtual outpatients also deliver reduced costs.

The EQC programme is voluntary and was only ever intended to involve a sample of NHS providers. It is completely separate from the mandatory National Cost Collection (NCC) and any plans to move to more frequent mandatory collections. However NHS England and NHS Improvement chief financial officer Julian Kelly did highlight the EQC when he raised the possibility of more frequent mandated national collections at the HFMA annual conference last year.  ‘We ran an emergency cost collection in the second or third quarter as we were trying to get our heads around the impact of Covid,’ he told the December conference. ‘Can we not do some sort of quarterly cost collection?’ he said. ‘The data would be useful for local, system, regional, and national organisations, commissioners and providers to see where the productivity opportunities lie. It’s about getting a balance between good costing data and timeliness.’

However there are significant differences between the current mandated NCC and the voluntary EQC. Fundamentally, EQC submissions are made at the aggregate level – for example with trusts submitting average costs for healthcare resource groups. There is a more limited scope, currently covering just acute activity with a number of exclusions including high-cost drugs, chemotherapy and renal services. And submissions do not include a breakdown into component resources and activities at the patient level, as mandated for the NCC.

Trusts are asked to submit costs for emergency attendances, inpatient episodes, critical care periods, acute rehabilitation and outpatient attendances, classified by fixed, semi-fixed and variable costs.

It has also been designed to impose a minimal burden on NHS costing teams. Costing teams can choose to use a costing model that is compliant with the national Costing Transformation Programme. However, where trusts also use a separate business-as-usual costing model to compile local costing reports, they can choose to use this instead, if that reduces effort required to complete the template.

To date the programme has focused on acute providers – the main deliverers of Covid-related care. But cost collections manager for NHS England and NHS Improvement Daniel Clark (pictured) said the programme was now looking to expand. ‘We have just reached out to mental health providers – those that have been early implementers [of patient-level costing] in recent years,’ he said. ‘And a number have come back and expressed an interest in looking at mental health data. We are just exploring this at the moment and what would be needed in terms of guidance and submission sheets.’

Mr Clark added that the central costing bodies were also keen to re-engage with some providers and increase participation from the acute sector too. While 18 acute providers submitted returns for Q1 in 2020/21, this fell to just 10 in Q3. ‘We are looking at pushing this programme and getting a few back in for Q4,’ he said.

New trusts would also be welcomed. And Mr Clark said the central team would happily receive retrospective voluntary data covering the whole of the 2020/21 year*.

There are concerns about the comparability of the cost submissions given both the different cost models organisations are using, different interpretations of the guidance and the amount of time and effort costing teams can put into the voluntary submissions. Practitioners said the costing capacity and software capabilities in different organisations meant contributions ranged from the ‘light touch’ to very detailed.

One of the big concerns is the ability to reflect staff redeployments during the pandemic response. For example, orthopaedic consultants may have stopped elective lists and taken shifts supporting frontline Covid care. However, in many organisations this won’t have been captured in a specific data feed – it certainly won’t have been captured in consultant job plans, which are typically used to inform the allocation of clinical costs.

Some organisations with good data trails may have captured the real full costs of delivering Covid care. Others will have made reasonable estimates. While in some organisations, overall specialty costs may have remained relatively unchanged, but been spread over significantly different levels of activity. The treatment of unbundled services, such as chemotherapy and radiology, is another area of potential variability.

Mr Clark recognises the challenges. However, he says that a survey included as part of the EQC template enables trusts to highlight any areas of concern with their data so that this can be fed into any analysis.

He adds that NHS England and NHS Improvement will be sharing data back with trusts. To date only a very high-level dashboard has been distributed and Mr Clark said the central bodies were committed to providing more feedback. Specific organisations will be anonymised, but the aim is to show how trusts’ costs during Covid-19 compared with others across the country.

‘This is an important exercise and we want to have as good a sample from as many trusts as possible,’ he said, ‘so that what trusts are actually experiencing is represented fairly. The smaller the sample, the weaker the data you can draw from it and I’d really like to get back to the 18-20 mark for acute trusts.’ Revised guidance for Q4 is due to be published imminently.

For further details about joining the EQC submission contact [email protected]