NHS Digital analysis provides first insight into 2020/21 costs

NHS England and NHS Improvement have yet to publish data from its national cost collection (NCC) for the year, which includes patient-level and aggregate cost data for the financial year ending March 2021. Due to be published in the middle of March, the national bodies said the delay was due to ‘ongoing work to better understand the implications of the cost data and its potential impact on the provision of health services’.

The NHS Digital publication presents the data in a different format to the NCC. It does not provide the usual schedules broken down by healthcare resource group for acute care or the NCC index, which provides a measure of relative cost difference between providers.

However, the NHS Digital analysis provides headline costs and costs broken down by provider and region. Some 141 providers reported a total cost of £56.5bn, with just over £35bn relating to admitted patient care. The total cost covers 14.4 million emergency care attendances, 14.3 million admitted patient care episodes and 66.3 million outpatient appointments.

Fifty-two mental health providers reported a total cost of £8bn, roughly split between care contacts and hospital spells. Some four million improving access to psychological therapies appointments, delivered by 47 providers, cost £548m. England’s 10 ambulance trusts responded to more than 10 million incidents at a cost of £2.7bn.

The analysis also provides a breakdown by gender. For example, of the £4.5bn emergency care costs, the split between females and males was 47% and 45% respectively, with gender unspecified for the remainder of reported costs. For admitted patient care, 51% of costs related to females and 43% to males – again with the remainder of costs relating to cases in which gender was unspecified in the data.

The distribution of cost and count is also analysed across the primary diagnoses for the episode recorded. For example, for admitted patient care, the most frequent diagnosis group was ‘diseases of the digestive system’, while ‘diseases of the circulatory system’ had the highest proportion of total costs recorded.

For mental healthcare, costs and counts can be explored using cluster codes, with just over half of contacts and inpatient spells being assigned to a cluster. The cluster with the highest associated costs for non-admitted contacts was ‘Enduring non-psychotic disorders (high disability)’ at £191m, while the most contacts by volume involved ‘Ongoing or recurrent psychosis (low symptoms)’ and ‘Ongoing or recurrent psychosis (high disability)’, which both recorded around 960,000 attendances.

For ambulance services, half of all reported incidents were ‘see and convey’, accounting for 64% of the total reported cost. A further nearly 30% of incidents were ‘see and treat’ responses.

Speaking to last week’s HFMA Healthcare Costing for Value Institute’s costing conference, NHS England and NHS Improvement director of costing and pricing Chris Walters (pictured)  said the patient-level cost collection (PLICS) was going from strength to strength. Delays to the NCC submission were not related to data quality, which he said was higher than ever across the three mandated collections for acute, ambulance and mental health services.

However, he said that unit costs had increased across all points of acute care delivery, with activity falling in all areas other than non-elective inpatient care – understood to be the consequence of the Covid pandemic. He also said the data provided the first understanding of the costs of treating patients with Covid, with adult unit costs ranging from £2,700 to £4,500 per episode, depending on severity.