Technical review - September 2018

NHS Improvement is consulting on making it a mandatory requirement for ambulance services to record and report patient-level costs. If agreed, this would require costs to be calculated for 999 activity in line with the Healthcare costing standards for England starting from the financial year 2019/20. Under the preferred option, there would be no dual running of reference costs, with ambulance trusts’ final reference costs collection covering 2018/19. Submission of patient-level costs has already been mandated for acute trusts starting from 2018/19 cost data. Seven out of 10 ambulance trusts are voluntarily submitting data for 2017/18. Most have patient-level cost and information systems (PLICS) in place and two are currently implementing. An impact assessment looked in detail at three options, including the status quo, but concluded that the mandatory approach with no dual running of reference costs represented the best value for money. 

The HFMA has produced an NHS corporate governance map to bring together the key guidance and models to support effective corporate governance in the NHS. The map is aimed at NHS boards, governing bodies, audit committees and all staff with an interest in governance. It follows a similar structure to the earlier NHS efficiency map published by the HFMA and NHS Improvement, dividing content into three sections: strategic framework; enabling good governance; and specific areas for assurance. The map will be updated regularly. 

HMRC has confirmed that income from the non-elective treatment of overseas visitors is exempt from VAT. In a letter, it said urgent care is provided under a duty to treat and charged under restrictions that the NHS is legally obliged to enforce. As a result, it is non-business activity that is outside the scope of VAT. HMRC said it did not consider this a change of policy. Some providers will have interpreted Department of Health and Social Care guidance as indicating this income stream is exempt and accounted for it accordingly. However, others can seek a refund, subject to time limits, the letter added.

NHS England is consulting on proposed contracting arrangements for integrated care providers (formerly accountable care organisations) and has published documents to support the consultation. Depending on the outcome of the consultation, the new ICP contract would join existing contract forms, including the NHS standard contract and primary medical services contracts, as options for commissioning care to meet local needs. In particular, it would provide a single contract through which general practice, wider NHS and, in some cases, local authority services could be commissioned from a lead provider responsible for delivering integrated services. The contract envisages commissioners using an integrated budget – a whole population annual payment paid in monthly instalments. This will initially be set based on existing spend on the in-scope services. A proportion of the contract value would be paid to the ICP on achieving certain goals.

An HFMA survey of NHS bodies about their experience of the 2017/18 year-end process has highlighted what went well and where there were problems. With no major accounting changes, most issues related to particular circumstances at individual NHS bodies. There were concerns about the audit process with bodies complaining about auditors raising last minute issues and sometimes not seeming to be prepared. In terms of third party information, a number of bodies reported problems with pensions data for senior managers and asset valuation was a significant issue raised by auditors. However, respondents reported that the agreement of balances exercise was as smooth or better than previous years.