News / Watchdog urges action on short-stay data

By Seamus Ward

The Audit Commission has called for greater consistency in the classification of short-stay patients under payment by results (PBR).

Its report, By definition – improving data definitions and their use by the NHS, said inconsistencies in how short-stay treatments (where the patient is in hospital less than 24 hours) are recorded are leading to poor data quality. This was a major cause of disputes between commissioners and providers.

The commission found that patients getting the same treatment might be classified as an inpatient in one hospital and an outpatient in another. This simple variation could multiply charges five times or more. An 18-year-old boy needing a simple operation with a short theatre time, for instance, could be classified as a day case (provider gets £729) or an outpatient (£116).

Routine short-stay treatments cost the NHS £6.8bn a year. The values of disagreements in contracts have been significant, running to millions of pounds.

Audit Commission managing director for health Andy McKeon, said confusion over how treatments were recorded hampered comparisons between providers and made planning and commissioning care difficult.

He added: 'We have also found that NHS managers are spending valuable time debating how patient treatment is recorded or described, time that would be much better spent focusing on the treatment itself. The arguments are only likely to increase as money gets tighter, and GPs in clinical commissioning groups begin examining what happens to patients and how much they are being charged.'

Inconsistent descriptions of treatment were affecting patients, skewing management information and wasting funding.

The commission recommended the Department of Health, NHS Connecting for Health, and the NHS Information Centre should provide a single point of contact for PBR data recording queries, and a consistent and authoritative source of guidance.

It also urged providers and commissioners to use the Audit Commission's PBR national benchmarking tool to identify areas where their activity classification differs from the national picture.

The report said the short stay issue was symptomatic of a wider problem. The national datasets, which classify the treatments, had to change. As more care is provided in outpatients or outside hospitals the data is not being captured, the report added.