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National Cost Collection 2019/20 Report

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National Cost Collection 2019/20 Report Classification: Official Publication approval reference: PAR343 National Cost Collection 2019/20 Report For data relating to financial year 2019/20: commentary on headlines and introduction to the available data for acute, community, ambulance and mental health providers. Contents Foreword ..................................................................................... 2 1. Acute services .......................................................................... 6 2. Community health services....................................................... 8 3. Mental health services ............................................................ 10 4. Ambulance services ............................................................... 11 5. Introduction to the data ........................................................... 12 Annex 1 ..................................................................................... 14 1 | Contents Foreword National Cost Collection 2020 1. Our aim is that costing data should support the delivery of high-quality care for patients and deliver better value for the NHS. 2. As a result of the pandemic and the first year of mandation for ambulance and mental health trusts, the cost collections for 2019/20 were spilt into two separate windows. Table 1: Submission windows for financial year 2019/20 data Sector Timetable Acute and community 7 September 2020 to 13 November 2020 Ambulance, mental health and IAPT 11 to 29 January 2021 3. This document supports the publication of the National Cost Collection 2020 which comprises cost data for financial year 2019/20 (FY1920) for all sectors. 4. The cost data submitted by 208 NHS providers in England gives the most comprehensive insight into how the sector spent £72.6 billion delivering healthcare to patients in 2019/20. 5. The National Cost Collection is a nationally mandated collection of cost data from secondary care and tertiary care providers that are delivering services in the NHS. 6. In 2020, the publication comprises: • Aggregated costs1 – the average unit cost to the NHS of providing defined services to NHS patients in England. 1 Formally known as reference costs. 2 | Acute services • Patient-level costs2 – a unique cost that is based on the specific interactions a patient has and the events related to their healthcare activity. It provides data about how resources3 are used at a patient level. 7. The data underpinning this publication has many uses. It informs: • costing standards development • developments to National Cost Collection, including the impact assessment on mandating the submission of PLICS • development of benchmarking metrics and development and population of a benchmarking tool • modelling new methods of pricing NHS services or changes to currency design • public accountability to Parliament. 8. Therefore, the quality of a provider’s submission is extremely important. 9. It is a provider’s responsibility to improve its internal costing systems, ensuring that the costing model appropriately represents the costs of delivering services. 10. Due to this, providers are obliged to produce cost data under the conditions P1 and P2 of their provider licence (recording and report of costs). 11. National bodies have a responsibility to ensure the costs collected are fit for purpose through the production of comprehensive and clear guidance. Those providers that do not comply or do not meet the required standard of data in any given financial year will be subject to actions under the compliance and enforcement policy for the National Cost Collection ratified in 2019. 12. The following providers are excluded from the FY19/20 costing schedules used by NHS England and NHS Improvement:4 2 Also known as patient-level information costing system (PLICS). 3 For example, drugs, nursing and theatre costs. 4 NHS England and NHS Improvement is the operational name for the joint organisation formed from NHS England, Monitor and the NHS Trust Development Authority on 1 April 2019. 3 | Acute services • RA2 - Royal Surrey County Hospital NHS Foundation Trust: the trust failed to meet the mandatory validation requirement of balancing the total cost of services delivered to their reconciliation statement to within +-1%. • RN7 - Dartford and Gravesham NHS Trust: the trust failed to meet the mandatory validation requirement of balancing the total cost of services delivered to their reconciliation statement to within ±1%. • RWE - University Hospitals of Leicester NHS Trust: the 2019/20 financial statements have been audited and the auditors are unable to provide an unqualified opinion on one or more aspects of the accounts. • RJ2 - Lewisham and Greenwich NHS Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RGN - North West Anglia NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RBN - St Helens and Knowsley Teaching Hospitals NHS Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RC9 - Luton And Dunstable University Hospital NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • REN - The Clatterbridge Cancer Centre NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RYV - Cambridgeshire Community Services NHS Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RY2 - Bridgewater Community Healthcare NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. 4 | Acute services • R1L – Essex Partnership University NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RRP – Barnet, Enfield, and Haringey Mental Health NHS Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RX2 - Sussex Partnership NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RY9 - Hounslow and Richmond Community Healthcare NHS Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. • RNK - Tavistock and Portman NHS Foundation Trust: failure to reconcile the cost quantum to within ±1% of the 2019/20 published provider accounts. 13. The excluded providers’ raw data will be published separately in a flat file alongside the national costing schedules. Costing Transformation Programme (CTP) 14. 2020 marked a significant step forward in delivering a single National Cost Collection that is submitted entirely from PLICS datasets. 15. The cost schedule for acute providers has been solely built from patient-level costs for admitted patient care (APC), outpatients (OP) and accident and emergency (AE) following the mandation of these services for acute providers. 16. In addition, 133 acute trusts submitted supplementary information (SI) and 69 acute trusts submitted adult critical care (SWC) at patient-level as part of the transition from the National Cost Collection workbook. 5 | Acute services 1. Acute services 17. The value of acute services in FY19/20, including APC, OP, AE, SWC and SI (see paragraphs 15 and 16), totalled £56.8bn. 18. Total costs for all acute services are shown in Table 25. Table 2: Total Cost by department from the Acute Sector FY15/16 FY16/17 FY17/18 FY18/19 FY19/20 Total cost by department (£bn) (£bn) (£bn) (£bn) (£bn) Day case 4.3 4.5 4.4 4.5 4.8 Elective inpatient 5.5 5.4 5.4 5.4 5.4 Non-elective inpatient 16.7 17 18 17.9 19.1 Sub-total core APC 26.5 26.9 27.7 27.8 29.3 Other acute services 10.6 11 11.4 11.2 12.1 Outpatient attendance 8.8 8.9 9.3 9.6 9.8 Outpatient procedure 1.6 1.8 1.8 2 2 Accident and emergency (AE) 2.7 3 3.2 3.4 3.6 Sub-total all acute services 50.2 51.6 53.4 54.1 56.8 Mental health 6.9 7.1 7.2 7.5 8.0 Community health services 5.4 5.6 5.5 5.4 5.5 Ambulances 1.7 1.9 1.9 2 2.3 Total 64.2 66.1 68 69 72.6 5 A detailed breakdown of the units of currency can be found in the organisation-level source data zip file. 6 | Acute services 19. The values in the above table for 2019/20 were calculated from costed patient-level datasets submitted as part of the first mandated PLICS collection. 20. For 2020, additional detail can be found in the PLICS portal.67 6 https://analytics.improvement.nhs.uk/#/views/NationalPLICSPortal/TermsandConditions?:iid=1 7 University College London Hospitals (ULCH) NHS Foundation Trust have flagged some changes in the recording of their activity data following the implementation of a new Patient Records System in 2019. While the trust’s submission passed all NCC validation checks, users are advised to be aware of this when using the UCLH data. 7 | Acute services 2. Community health services 21. The total value of community health services in FY19/20 was £5.5bn. 22. These services are collected using care contact8 as the unit of activity, with a few exceptions such as some audiology services, some elements of intermediate care and some wheelchair services. 23. Table 3 shows the unit cost and total costs for community health services between FY1718 and FY1920. Table 3: Costs by area for community health services FY17/18 FY18/19 FY19/20 Service area Unit cost Total cost Unit cost Total cost Unit cost Total cost (£) (£m) (£) (£m) (£) (£m) Allied health 63 880 73 895 78 919 professionals Audiology 57 201 61 187 69 193 Community 85 91 96 131 102 167 rehabilitation Day care facilities 131 32 70 15 162 14 regular attendances Health visiting and 61 1,053 67 938 74 778 midwifery Intermediate care 127 724 119 886 122 959 8 A detailed breakdown of the units of currency can be found in the organisation-level source data 4 zip file. 8 | Community health services FY17/18 FY18/19 FY19/20 Service area Unit cost Total cost Unit cost Total cost Unit cost Total cost (£) (£m) (£) (£m) (£) (£m) Medical and dental 137 205 148 199 169 190 Nursing 45 2,089 46 2,078 51 2,172 Wheelchair services 177 135 193 113 200 107 Total 5,404 5,444 5,500 9 | Community health services 3.
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