2009 HRG4 Road Shows Finance Costing Break Out Session Reference Costs 2008

2. 2007/08 Data THANKS!! Data collected from over 400 organisations Total quantum of approx £44bn Analysis and Data Quality Data published on DH website and Unify2 tool by end of March ’09 (Unify2 replaces DVD)

3. 2008/09 Timescales HRG4 Ref Costs Grouper out 13 Feb Ref Cost Guidance / Costing Manual published early March Collection Timescales back to prior year timescales New structure to 2007-08 Timescales: 3 week submission (Jun 8 – Jun 26) 2 week analysis period (Jun 29 – Jul 10) 4 week resubmission (Jul 13 – Aug 7) All designed around ensuring data quality (getting it right first time should always be the priority)

4. 2008/09 Guidance No fundamental change (currency / collection system) Refinement and Improvement Further clarification Changes to further align with PbR Tariff development Interventional Radiology – no longer unbundled Diagnostic Imaging – APC no longer unbundled Critical Care Adult Paediatrics / Neonatal Community Consistency with community work (Development Sites)

5. 2008/09 Collection System As per 2007/08 – Unify2 User Accounts still active from 2007/08 SHA Leads first port of call for new accounts Concise / Updated Guidance (summary + detailed) Involving Software Suppliers in update – workbooks/validations We advise NHS users re-familiarise themselves with system in advance of collection

6. 2008/09 Communications route

7. Key Messages Timetable back in-line with previous years “Business as usual” No major change to collection requirements in 2008/09 No new currency No new collection system (see below) Unify2 continues to be the collection tool Refinement and improvement of Guidance A year of stability and driving up the data quality

8. For info – SHA Leads Q30 North East jonathan.storey@northeast.nhs.uk Q31 North West martin.mcdowell@northwest.nhs.uk Q32 Yorkshire & Humber neil.lester@yorksandhumber.nhs.uk Q33 East Midlands abdul.samih@eastmidlands.nhs.uk Q34 West Midlands helen.o’riordan@westmidlands.nhs.uk Q35 East of England chris.gardner@eoe.nhs.uk Q36 London damien.mcmahon@london.nhs.uk Q37 South East Coast alistair.hoptroff@southeastcoast.nhs.uk Q38 South Central julie@renfrewconsulting.co.uk Q39 South West lynne.abbott@southwest.nhs.uk

10. HRG4 changes summary

11. Grouper design changes – Concepts Removal of sub-chapter and HRGs Known areas of difficulty Sub-chapter RB (Interventional Radiology) removed Differential between shoulder and elbow surgery Better split of anatomical sites Creation of new sub-chapters Traumatic or non traumatic HRGs? Sub-chapter HR (Orthopaedic Reconstructions) created

12. Grouper design changes – Tweaks Code movements – hundreds made to refine the HRGs. When reviewed, there was often a handful of codes that would sit better in a different HRG that it’s current position. This was either clinical opinion (a minor procedure in a major category) or data driven (los for one daycase procedure could be distorting the average LOS for mainly long stay activity). The two codes below have a significantly higher LOS than the rest of the codes within PA18 Minor Infections so would be more appropriately mapped to PA17 Intermediate Infections:). Labels – clarification. SA used to be Haem disorders but with the introduction of HRGs for bone marrow transplants then ‘procedures and disorders’ better reflected the activity now captured in that chapter. Code movements – hundreds made to refine the HRGs. When reviewed, there was often a handful of codes that would sit better in a different HRG that it’s current position. This was either clinical opinion (a minor procedure in a major category) or data driven (los for one daycase procedure could be distorting the average LOS for mainly long stay activity). The two codes below have a significantly higher LOS than the rest of the codes within PA18 Minor Infections so would be more appropriately mapped to PA17 Intermediate Infections:). Labels – clarification. SA used to be Haem disorders but with the introduction of HRGs for bone marrow transplants then ‘procedures and disorders’ better reflected the activity now captured in that chapter.

13. Grouper design changes – Logic Age splits amended: Orthopaedics (added to specific HRGs) Obstetrics (between 16 and 40 / under 16 or over 40) Length of Stay splits amended: To group off diagnosis rather than “incidental” procedures Insertion of catheters, ECGs Complications and Co-morbidities (CCs): PA02 Epilepsy syndrome (added) N390 Urinary tract infection added as a CC to Chapter M (Gynaecology)

14. Datasets and Software Inclusion of Paediatric Critical Care and Neonatal Critical Care datasets Updated data quality report Multiple HRG4 Groupers can now be loaded onto the same PC. Currently, installation of a new HRG4 grouper removes any previous versions.

15. Key messages Understand the changes from previous years Double check that you are using the correct version of the Grouper Make use of the Casemix helpdesk! enquiries@ic.nhs.uk

16. Further information www.ic.nhs.uk/casemix/prepare Introduction to HRG4 HRG4 Concepts HRG Coding Validation HRG4 Chapter Summaries, Definitions & Comparative Analysis HRG4 Code to Group [what goes where and how] Guide to Data Field validation Top 10 Tips / FAQs

17. 2009 HRG4 Road ShowsPLICS & Acute Health Clinical Costing Standards - Quality in Costing Peter Donnelly, Suzanne Ibbotson Department of Health

18. PLICS & Costing Standards Summary PLICS Acute Health Clinical Costing Standards Collection

19. PLICS  What is PLICS? Patient Level Information & Costing Systems Records individual interactions and events which are connected directly with a patient’s care from the time of admission until the time of discharge. Ascribes to the patient the direct and indirect cost of the resources used during those interactions The more detailed the record of what happens to the patient, the better the costing can be

20. PLICS - Benefits Better quality costing Allows an organisation to understand their costs better – highlighting inefficiencies and cost drivers Improved transparency, time, costs etc Improved costing of clinical activity allows meaningful comparison and dialogue with clinicians, including care pathways and treatment of similar patients and links to quality Better quality data to inform tariff

21. Costing Standards Background Why have Standards? What are they ? Who developed them ? How to use? Quality Extension to other areas

22. Costing Standards - Why? Evolve : what was good enough yesterday will not be good enough tomorrow Economic downturn will put extra pressure on getting the tariff right and maximising efficiency. Need to maximise the benefit /cost equation of better data quality.

23. What are they? A set of guidelines for excellent practice Designed to improve costing of services within NHS Will provide a basis for benchmarking Will provide a platform for continuous development in line with international best practice

24. Development Starting point Australian Costing Standards, adapted and revised for England Drafting Committee: - 12 practitioners from Acute hospitals - 3 from DH - 1 from Audit Commission Consultation with major stakeholders

25. How to use? Acute Clinical Costing Standards should be used by all PLICS users & those seeking to implement PLICS Provides consistent methodologies for allocating costs, and sets out best practice guidelines – shows real costs Still need NHS Costing Manual & Reference Cost Guidance for cost collection Standards seek to promote improved costing within NHS not directly to support cost collection

26. Quality Quality of data - Need good quality information as well as cost data Concept - Materiality of the amount allocated and how accurately the allocation is done Application - MAQS score (self assessment)

27. Extension of Standards Mental Health: Out for Consultation Cystic Fibrosis: In Action, use by PbR Development Sites

28. Next Steps/Collection Direction of travel towards PLICS & use of PLICS to help inform tariff – focus on improving and proving quality first Review 2007/08 PLICS data from small sample of hospitals (drafting committee members) Review of Cost Collection commencing this year Reference Costs still mandatory for all NHS providers Approximately 60 organisations reported using PLICS for 2009/10 and having data available Additional 60 - 80 organisations planning on implementing PLICS during 2009/10

29. Feedback & Questions PLICS @ dh.gsi.gov.uk www.dh.gov.uk/pbr (PLICS/Costing Standards)