News / Better costing needed for pathway decisions

Care pathways are altered and decisions made to improve patient care, often without a full understanding of the cost implications, the Audit Commission and ACCA have said.

According to the briefing Costing care pathways: understanding the cost of the diabetes care pathway, the most common barrier to costing pathways is poor-quality data in outpatient and community settings.

It uses diabetes care to illustrate how organisations can chart spending at a high level using nationally available data. This could then be used to track pathway changes and their impact on costs, and to compare costs between primary care trusts in order to identify savings.

The report said the biggest driver of costs in diabetes is medication, which accounts for three-quarters of the cost of diabetes care. It added that average primary care trust inpatient spend varies from £19 to £175 per diabetic patient.

The greatest variation was found in community and outpatient costs, but the commission and ACCA felt the data was not sufficiently accurate to use in their analysis.

Andy McKeon, the commission’s managing director of health, said changes were being made to improve quality and make care more convenient for patients. But the NHS had to find a better way to cost the changes, he added.

‘Our report shows what can be done using reliable national data to cost the diabetes care pathway,’ said Mr McKeon. ‘PCTs can also use it to compare their spending and to identify areas where they are likely to make the most savings and improve care.’

Mark Millar, ACCA council member and Milton Keynes Hospital NHS Foundation Trust chief executive, added: ‘Our research has clearly shown the potential for patient pathway analysis to contribute to the challenges facing the NHS and the need to improve the data collection and analysis to measure the potential benefits.

‘In the meantime, it is enormously difficult for the NHS to deliver effective plans for efficiency savings we know are needed.’

The bodies have also published an online tool that allows organisations to monitor and evaluate the cost of diabetes care in their area, and compare against others. ?