Trusts offered choice on cost collection dates

A letter at the beginning of April had confirmed no data would be collected in June, but that ‘any collection will be later in the year’. Some costing practitioners had read this as meaning the collection was still being considered, but if it did go ahead it would be delayed.

However, it now appears clear that NHS England and NHS Improvement are determined to continue with the collection and continue the push towards the whole NHS costing at the patient level. Their survey, which is open until 6 May, asks NHS providers to select a preferred collection window from four choices and does not include an option to cancel the collection altogether.

All four options come after the revised date for submitting audited financial statements. They include:

Some costing practitioners feel that both the 2020 and 2021 collections should be treated as exceptional. Both years are likely to produced distorted costs with Covid-19 having an impact in both years. Time might be better spent, they argue, allowing trusts to develop their costing models while the centre reviews the methodology.

Practitioners have a number of concerns about the next two collections, although some believe 2019/20 is more achievable than 2020/21.

For 2019/20, there were significant changes in activity in March as acute providers shut down elective activity to increase capacity for Covid-19 patients. A&E attendances also started to decrease dramatically. But perhaps the biggest challenge is with the actual compilation of cost data.

Many finance teams have moved to home working, with differential access to key systems. Some costing practitioners have been redeployed to support other areas – supporting accounts payable colleagues for example as they look to speed up supplier payment and keep cash flowing. Arguably more importantly, costing practitioners still working on costing will not have the chance to engage with clinicians and service leads making it impossible to validate activity and cost data.

For 2020/21, there are concerns about the usefulness of any data produced. Covid-19 means that 2020/21 will be a unique year. Many costs will be higher than usual – personal protective equipment and higher staffing costs are good examples. But it could also be extremely challenging to allocate costs to the right patients. Consultants’ job plans, for example, are unlikely to provide an accurate reflection of how these key clinicians are spending their time during the response.

And significant costs will have been incurred developing capacity in preparation of a patient surge, which may not necessarily emerge. How would these costs be meaningfully allocated to patients?

As part of its collection window survey, NHS England and NHS Improvement are also asking about whether costing staff have been redeployed and have access to systems – as well as whether suppliers can provide the necessary updates and training to comply with the 2019/20 extract specification.

Acute providers made their first mandatory submission of patient-level cost data last year – after a number of years increasing voluntary submissions and parallel submission of traditional reference costs, which provided average costs at the healthcare resource group and outpatient attendance level. However there are some key changes to the submission this year, requiring new data feeds, which adds to the complexity of the submission.

This year also marks a key milestone in the overall move to patient-level costing as part of the Costing Transformation Programme with mental health and ambulance trusts due to make their first mandatory submissions. Mental health trusts had already raised concerns about their readiness to move to patient-level costing and about the complexity of the standards they are expected to adhere to. Some practitioners have said that they are still looking for clarity on the expectations for this year’s mental health collection.