Technical / Monitor provides final guidance ahead of patient cost collection

Monitor provides final guidance ahead of patient cost collection

Sector regulator Monitor last month published supplementary guidance to support NHS bodies taking part in the third annual, voluntary patient-level cost collection.

The collection window was due to close at the start of October and September’s guidance highlighted a known technical issue with the PLICS (patient-level information and costing system) collection template. It provided clarity on a number of areas that had caused some confusion.

Some 66 trusts took part in the first patient cost collection in 2013, with a similar number, although not all the same organisations, also submitting costs in 2014.

In both cases, the cost collection covered costs of about £14bn relating to more than seven million episodes of care. The 2015 collection remains primarily focused on acute providers and guidance was included in this year’s Approved costing guidance.

Last month’s supplementary guidance confirmed that impairments should be included in the cost submission and reported in the overheads cost pool. Impairments arise where an asset has been assessed as having a reduced value. Any excess ‘loss’ – the amount exceeding previous increases in the asset’s value recorded in the revaluation reserve – is included as expenditure in the statement of comprehensive income. Impairments are excluded from reference costs, but should be included in the PLICS quantum, Monitor said.

Monitor also answered queries about the treatment of orthotics costs, which should be included where they relate to admitted patient care. ‘If the service is broadly dispensatory in nature, these costs should be assigned to “Other clinical supplies and services”, but if it is therapy-based at your trust (for example, with an orthotist clinic) you should report these costs in the “Therapies” cost pool.’

Admitted patient care-related patient transport services costs should be included in the ‘Wards’ cost pool – a more specific bit of advice than existing HFMA guidance. The additional guidance also confirms that theatre medical staff costs should be reported in the appropriate medical staff cost pool, as per the HFMA guidance, rather than in ‘Operating theatres’.

Participants in the voluntary PLICS collection will be given access to a benchmarking tool that uses the submitted data, enabling providers to compare cost and activity data against other providers using predefined reports. Participation is also seen as good preparation for Monitor’s Costing Transformation Programme (CTP). The CTP will lead to a mandatory patient-level cost collection, replacing the currently separate reference costs and education and training cost collections (see page 21).

New guidance is being developed to accompany a revised costing methodology that maps costs from the general ledger to resource groups, then to activities and on to patients. The acute sector will lead the way with a first mandated cost collection covering services delivered in 2018/19.

In brief

Overpayments will not be recovered and payment of arrears will not be made if mileage allowances change this year, the NHS Staff Council has agreed . The council’s 2015/16 data on motoring costs has yet to be published, leading to the decision on arrears and overpayments.

NHS England is to hold a series of events for clinical commissioning groups on its work to refresh the allocations formula. The half-day events will take place in London, Bristol, Solihull and Leeds this month – a chance to hear about the work to date and to influence the development of revisions. Details can be found in the latest CCG bulletin .

The Department of Health has opened a consultation on changes to how prices of branded medicines are determined. The consultation, which closes on 4 December, also seeks to realign the statutory scheme (those outside the pharmaceutical price regulation scheme, PPRS) with savings made by the PPRS. The consultation sets out a number of options, including a further cut in the maximum price of products in the statutory scheme. 

For all the latest technical guidance, log on to www.hfma.org.uk/news/newsalerts

NICE update: Extra home care spending could reap rewards

New guideline NG22 covers how person-centred home care should be planned and delivered. In 2013/14 about 470,000 people in England used home care funded by local authorities – 186 million hours of contact time. Most (372,000 or 79%) were people aged 65 or older. The range and type of services varies, as does frequency and duration. There is significant variability in the commissioning and provision of home care in England. NG22’s recommendations cover:

• Considering home care for people who have low to moderate needs
• Ensuring visits are long enough – less than 30 minutes only in defined circumstances
• Recruiting, training and supporting home care workers.

 
These are expected to lead to an increase in the number of people receiving home care and in the hours of home care provided overall. This is likely to mean additional costs for extra home care workers and training support for the workers. Local authorities and home care providers will need to work in partnership to address how to meet these.

There will be savings for commissioners of health and social care if improved provision of home care avoids the need for high-intensity home care, residential care, hospital care or community healthcare. Local authorities should be working towards supporting people in their own homes, as an alternative to residential care settings or healthcare. This needs integrated and joint working with healthcare and other support services.

Health and wellbeing boards should use the better care fund to improve integrated working between health and social care so that people receive the most appropriate level of care and vulnerable people are identified.

The pooled fund gives the NHS and local government an incentive to work more closely and focus on people’s wellbeing. It may be used to help implement the guideline recommendations once outcomes for the population and pooled budget have been defined. Commissioners and providers must develop new models of care and agree how to share investment and risk through payment and contracting models.

If hospital care is avoided or shortened, there will be savings for NHS England and clinical commissioning groups from reduced accident and emergency attendance and admissions trim point. Hospital providers may realise efficiency savings from reduced lengths of stay through higher bed availability.

Nicola Bodey, NICE senior business analyst