Combined costs collection: overview of integrated reference costs and education and training collection guidance 2016/17

Transcription

1 Combined costs collection: overview of integrated reference costs and education and training collection guidance 2016/17 February 2017

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3 Contents 1.Introduction... 4 Purpose and context... 4 Essential resources... 5 Main changes for 2016/ Possible changes for Scope Timetable Resubmissions of data Queries Regulatory requirements and standards External assurance and Enforcement Board approval and sign-off Statement of directors responsibilities for the 2016/17 combined costs collection 19 Self-assessment quality checklist Combined costs collection survey Combined costs collection guidance: overview

4 1. Introduction Purpose and context 1. This guidance is part of the Approved costing guidance 2016/17. 1 previously produced by the Department of Health (DH) and now part of NHS Improvement s costing work. 2. In 2015/16 there were two mandatory national cost collections. The business as usual (BAU) reference costs collection and the integrated costs collection. The integrated costs collection consisted of the education and training (E&T) costs collection alongside a second reference costs collection in which the costs of E&T were netted off reference costs services. 3. The BAU and integrated costs collections ran over different timescales and didn t follow the same governance processes. 4. In 2016/17 we are bringing the two cost collections together into a single timetable with a single governance process. The new collection is called the 2016/17 combined costs collection. 5. The combined costs collection will consist of three separate guidance documents, plus this overview. 6. Table 1 shows which documents are relevant to which sector for each element of the combined costs collection. It reflects flow of how we expect providers to carry out the collection. 7. As the timetable and governance processes for the collections have now been aligned the information in this overview applies to all three elements of the 2016/17 combined costs collection. 1 Approved costing guidance available at: 4 Combined costs collection guidance: overview

5 BAU reference costs Education and training Integrated collection Acute Mental health Community Ambulance Table 1: Guidance documents and intended users Collection Sector Document Contents 1. Overview 2. Reference costs 3. Education and training 4. Integration guide 2016/17 combined costs overview: This details the purpose of the combined costs collection and outlines the timetable and governance processes. 2016/17 reference costs guidance: This is for the services element of the combined costs collection and should be used in both the BAU and the integrated costs collections. 2016/17 education and training guidance: This is for the E&T element of the integrated costs collection. 2016/17 integration guide, netting off E&T costs from reference costs: This advises providers how to net off their E&T costs from their reference costs 2 Essential resources 8. Table 2 details the resources providers will require to prepare and submit their combined costs collections. 2 Ambulance trusts only need to use this guidance document for the BAU collection, they are not required to complete the integrated element of the combined costs collection. 5 Combined costs collection guidance: overview

6 Table 2: Resources required for the 2016/17 combined costs collection Resource Unify2 3 The collection templates Approved costing guidance Combined costs collection system and workbook user guide Healthcare resource group 4+ (HRG4+) 2016/17 reference costs grouper and documentation 4 The Terminology Reference-data Update Distribution (TRUD) datasets Content The Department of Health (DH) corporate data collection system. The collections team will issue any communications relating to the combined costs collection on Unify2 and will no longer use DH Exchange. We will also communicate key messages via . There will be a single Microsoft Excel Macro-Enabled workbook (for which providers will require Excel 2007 or later to run) for the combined costs collection. The workbook will incorporate a BAU reference costs template, an integrated costs (IC) reference costs template, an E&T cost collection template and a further template to capture reconciliation and memorandum items. This includes the combined costs collection guidance and the new healthcare costing standards which should be used when preparing the 2016/17 combined costs collection return. It tells providers how to comply with the pricing conditions of NHS Improvement s provider licence that relate to recording of costs. A manual to help users submit their data in Unify2, which we will make available in the Unify2 forum in April. The National Casemix Office (NCO) 5 at NHS Digital publishes the grouper and supporting documentation, including the user manual, the code to group, individual chapter summaries, and a high level summary of changes from the previous costing grouper release The Terminology Reference-Data Update Distribution (TRUD) service 6 supply datasets (that are also available on the Unify2 forum 7 ) to support consistent coding of activity, including: the chemotherapy regimens list, including adult and paediatric regimens, with mapping to OPCS-4 codes that have one-to-one relationships with unbundled chemotherapy HRGs Please keep checking Unify2; we will also cost accountants when these are made available. 6 Combined costs collection guidance: overview

7 Resource Content the National Interim Clinical Imaging Procedure (NICIP) code set of clinical imaging procedures, 8 with mapping to OPCS-4 codes that relate to unbundled diagnostic imaging HRGs the high cost drugs list and map to OPCS-4 codes the National Laboratory Medicines Catalogue, a national catalogue of pathology tests NHS Data dictionary Where possible, we have aligned the requirements of the combined costs collection with the definitions in the NHS Data model and dictionary 9 (the Data dictionary) and included links in this guidance. Main changes for 2016/17 9. The changes to the combined costs collection in 2016/17 are designed to: a. support the development of price-setting b. improve data quality, validation and assurance c. ensure the collection remains fit for purpose. 10. This is the first year that selected providers will submit their costing transformation programme (CTP) patient-level data. With this in mind we have made minimal changes to the combined costs collection to try to reduce the burden on the sector. 11. We will not require a submission of spells activity and costs in 2016/ The tables below summarise the changes. There is more detail in the changes will be available in the main text of the relevant guidance document. Table 3: Changes to the 2016/17 combined costs collection to support the development of price setting 8 The NICIP code set is released biannually on 1 April and 1 October each year. Providers should use the October release that matches the reference costs year, ie October 2015 for 2015/16 reference costs Combined costs collection guidance: overview

8 Reference costs Education and Training Integration guidance Guidance document Change Support the development of price-setting Acute services Reference costs grouper: We will continue to use reference costs grouper HRG4+ for the 2016/17 collection. NHS Digital will provide full documentation when the updated grouper is released. High cost devices: In 2016 NHS England introduced a central procurement scheme to procure some high cost devices centrally. While there is a roll-out of this scheme, we want to ensure that the cost of any affected HRGs collected are comparable, without losing the cost details incurred by providers not centrally procuring the devices. In vitro fertilisation (IVF) drugs: The drugs associated with IVF are not classed as high cost drugs and are therefore included in the reproductive medicine attendance or day case. To be able to set tariffs that are not distorted by the drug costs we are asking these be separated out in 2016/17 and reported in the drugs and devices sheet. Cancer multi-disciplinary teams (CMDTs): There is a requirement this year to collect CMDT data for all patients, it was previously solely for outpatients.. The guidance for CMDT has therefore moved away from the outpatient section. Maternity pathway: During the 2015/16 collection the reference costs team received queries about the payment of maternity attendances to providers that did not receive the pathway payment from the commissioner. These charges are dealt with in the provider s ledger rather than in their service level agreements. We have expanded the guidance on this so treatment will be clear and standard across all providers. Maternity outpatients, scans, screens and tests: NHS England is also keen to look at the collection of activity and cost data for maternity services in the maternity pathway. Renal services: The reference costs team has worked with the renal clinical network to look at the reasons for variations in the costs of renal dialysis collected as part of previous reference costs returns. At the August regional network meeting members present reviewed the guidance and suggested areas of improvement. The clinical network group is keen to take a closer look 8 Combined costs collection guidance: overview

9 Reference costs Education and Training Integration guidance Guidance document Change at the costs of renal dialysis. If you d like to take part in this work please contact the reference costs team who will pass your details onto the group. Community services Wheelchair services: To encourage more consistent cost collection for this service, we have added more definitions to the guidance.. School-based services vaccination/immunisations: During the Healthcare Financial Management Association (HFMA) costing meeting, the community providers present raised concern that people reading the guidance and interpreting the resulting national averages for immunisations, in a commissioning capacity, were not appreciating the range of costs that are applicable to the different types of vaccination given. For 2016/17 the guidance has been enriched to explain in more detail about the wide range of resulting average costs. Mental health services Improving Access to Psychological Therapies (IAPT) for adults: Following the change to collecting adult IAPT by cluster in 2015/16 we have made some minor changes to the guidance to improve the quality and consistency of the submissions in 2016/17. As this is the second year we will also include adult IAPT in the calculation of the reference costs indexes (RCIs) if the quality is high enough. Forensic and secure mental health services: There is a new proposal to collect forensic and secure mental health services occupied bed day costs by a cluster/pathway combination. Improve data quality, validation and assurance We are aligning the sign-off process across the collections, requesting that both the provider finance director and the education lead are sighted on and happy with the final data submitted, before it is signed-off on Unify2. All the elements of the combined costs collection should be signed off at the same time. Unlike in 2015/16 there will be a named days period, by region, for all elements of the collection. We intend to run the data quality checks throughout the collection as happened last year and hope to be able to publish the results alongside the non-mandatory validations on Unify2. 9 Combined costs collection guidance: overview

10 Reference costs Education and Training Integration guidance Guidance document Change Change in treatment of Service/training split submission and process: for the 2016/17 collection there is a change in how cost component 12 (Service/training split) is collected. The column in the workbook will be prepopulated with a percentage figure based on stakeholder engagement and analysis of previous year s data. An extra column will be available next to the pre-populated column which will allow providers to override the hard-coded percentage. Following the 2015/16 cost collection DH reviewed the existing cost component structure. Tor 2016/17, in line with feedback, providers will be asked to report on fewer cost components to reduce the burden on them. Following release of the 2015/16 final integrated guidance DH released supplementary guidance on lead employer arrangements. This has now been added to the main guidance with the changes in cost components reflected in the lead employer guidance. Education and training validations: As with previous years DH has made changes to the validations in the cost collection to improve the data quality and reduce the burden on providers. All non-mandatory validations will now be done within the workbook; no extra validations will be taken centrally in 2016/17. Training programmes year of study: We are including a year zero line for 2016/17 in response to difficulties experienced in separately identifying the costs and activity by year of a course within non-salaried programmes. For these programmes a year zero line will be included in the templates for providers to report their costs against where they cannot disaggregate by year of study. Section 6 of the education and training element of the guidance has been updated to reflect the support Health Education England (HEE) will provide as part of the overall cost collection process including the information they are able to provide to providers relating to costs and activity. 10 Combined costs collection guidance: overview

11 Reference costs Education and Training Integration guidance Guidance document Change Reconciliation statement: We have changed the reconciliation statement so it will now be used for both reference costs elements of the combined costs collection. Ensuring the collection remains fit for purpose Our aim is still to move to a single collection netting off education and training costs from reference costs. We will manage this move carefully so that we do not undermine the quality of the current collections and we ensure we understand any cross-subsidisation of costs. We intend to make further changes to the survey and will circulate these as part of the final guidance document. There are several minor amendments to some sections of the guidance where we have tried to make the requirements a little clearer. We have added/removed training programmes for collection. Scope of collection: The education and training team reviews the scope of the cost collection on an on-going basis, and has updated it since the publication of the final integrated collection guidance in March Possible changes for 2017/ At this stage there are no planned significant changes for the 2017/18 combined costs collection as we are conscious of the extra burden the costing transformation programme may bring. 14. Depending on the outcome of the combined costs collection we hope to be able to remove the requirement for the BAU reference costs return to reduce that burden. 15. One possible introduction is set out in the NHS Operational Planning and Contracting Guidance 2017 to 2019, and linked to the Advice and Guidance CQUIN. Local systems are encouraged to introduce advice and guidance services as part of plans to manage demand in secondary care acute services. 11 Combined costs collection guidance: overview

12 16. To support this work we are planning to introduce a new collection of activity and costs related to advice and guidance services into the next cost collection in 2017/18. Further information on the Advice and Guidance CQUIN scheme can be found at: Scope The Review of Central Returns Committee 10 (ROCR) has previously approved this collection under reference number ROCR/OR/2132/FT6/002MAND under a threeyear rolling review. It is therefore mandatory for all NHS trusts and NHS foundation trusts in existence between 1 April 2016 and 31 March 2017 to comply with this guidance and its timescales. 18. Evidence to ROCR was based on the administrative burden of collating and submitting reference costs on findings from the 2014 reference costs survey. ROCR is also keen to receive feedback on central data collections from colleagues costing practitioners who submit returns, in particular information about the length of time data collections take to complete and any issues, suggested improvements or duplication. Feedback should be submitted to ROCR using an online form Providers should submit unit costs for all services relating to their own provider function, including services delivered under Any Qualified Provider (AQP) but excluding services listed in section 14 of the reference costs guidance. In line with guidance for provider-to-provider agreements, the receiving provider should include costs and activity for services it sub-contracted to other providers. 20. In line with Treasury s financial reporting manual, combining two or more public bodies or transferring functions from one part of the public sector is accounted for using absorption rather than merger accounting, as outlined below: a) Where provider A is dissolved in-year, eg on 30 June 2016, and is acquired inyear by provider B, eg on 1 July 2016, it is the responsibility of provider B to ensure a single 2016/17 combined costs collection return combining the costs and activity of both providers A and B and submitted by the mandatory deadline. When completing the reconciliation statement, provider B will need to reconcile to the sum of two sets of accounts: one covering provider A from 1 April 2016 to 30 June 2016, and one covering provider B from 1 April 2016 to 30 June 2016 and trust A and B combined from 1 July 2016 to 31 March b) Where provider C is dissolved on 31 March 2016 and acquired by provider D on 1 April 2016, a separate combined costs collection return will be required for 10 Now the Burden Advice and Assessment Service (BAAS) Combined costs collection guidance: overview

13 provider C, which will be completed by provider D in addition to provider D s own return. c) Where there is a transfer of function from provider E to provider F and neither provider dissolves, each provider will account for the transferred function for the period they provided the service. The combined costs collection will follow the financial accounts and no adjustment will be required. A complication with absorption accounting is that any assets transferred between the bodies could result in a gain or loss in the Statement of Comprehensive Income. Any such gain or loss should not be included when calculating combined costs collection costs and is not included in the reconciliation statement. 20. It may be necessary to speak to financial accounts colleagues about any such transfers within the organisation. 21. Successful applicants for NHS foundation trust status during the financial year must submit one full year s combined costs collection costs for the sum of the NHS trust and the NHS foundation trust. 22. Where a spell begins in the preceding reference costs year and continues into the current reference costs year, all associated finished consultant episodes (FCEs) should be included. Where a spell begins in the current reference costs year and continues into the next reference costs year all associated FCEs should be excluded. Timetable 23. Table 4 gives a high level timetable for 2016/17 combined costs collection. Table 4: Combined costs collection timetable Date February 2017 Spring April 2017 May 2017 Milestone Combined costs collection guidance for 2016/17 published Release of HRG /17 Reference Costs Grouper and documentation Release of Unify2 compliant draft workbook Release of Unify2 compliant final workbook 19 June 2017 Cost collection window opens 04 August 2017 Reference costs collection window closes for non-ctp patient level 12 We will advise providers of a more specific date as soon as we are able to. 13 Combined costs collection guidance: overview

14 Date Milestone collection providers 15 September 2017 September October 2017 October 2017 November - December 2017 Reference costs collection window closes for all providers Analysis and potential re-submissions of data Release of draft Reference Cost Index (RCI) on Unify2 Publication of national schedules of reference costs, final RCIs and source data 24. Table 5 describes the collection window in more detail. 25. Due to the increased burden on organisations that have volunteered to be early implementers in the NHS Improvement CTP patient level costing collection for 2016/17 they have a different timescale for completion of the combined costs collection. Table 5: Collection window Which Date providers Milestone Notes 19 June 2017 All Collection window opens Finance directors or education leads that are ready to sign off all elements of the collection may do so at any time from this date. 31 July 2017 Non-CTP 1 August August August2017 Non-CTP Non-CTP Non-CTP This is the named day submission period for non-ctp organisations. During this time there will be dedicated support for each region on their named day. Only finance directors or education leads will have Unify2 accounts with sign-off rights. Where they are unable to sign off on their designated date they should contact us to agree an alternative date within the window, or to agree a named deputy who will be granted a temporary Unify2 account with sign-off rights. London South of England Midlands and East of England North of England 14 Combined costs collection guidance: overview

15 Date Which providers Milestone Notes 4 August 2017 Non-CTP Deadline for final, signed-off combined costs collection submissions. If you feel you will require an extension beyond this date please nhsi.referencecosts@nhs.net 11 September September September September 2017 CTP CTP CTP CTP This is the named day submission period for CTP organisations. During this time there will be dedicated support for each region on their named day. Only finance directors or education leads will have Unify2 accounts with sign off rights. Where they are unable to sign off on their designated date they should contact us to agree an alternative date within the window, or to agree a named deputy who will be granted a temporary Unify2 account with sign-off rights. London South of England Midlands and East of England North of England 15 September 2017 CTP Deadline for final, signed-off combined costs collection submissions. There will be no opportunity to resubmit after this date unless the cost collection team finds material errors as part of the post-submission analysis. Resubmissions of data 26. Once the collection has closed, providers will not be allowed to resubmit data via Unify During the analysis of submissions between September 2017 and October 2017, the combined costs collection team will contact providers if analysis suggests there may be a material error in their data. Providers will be required to investigate their submission further and report back on any errors found. The team will perform an impact analysis between the original submitted data and the corrected data. 28. The combined costs collection team will also carry out analysis to ensure that the quality of data submitted is as high as possible. This will involve, among other things, looking for data that shows services being delivered in impossible or unlikely settings. 15 Combined costs collection guidance: overview

16 29. Only where a provider has errors in its data that would materially affect national average unit costs will a resubmission via Unify2 be authorised. 30. Providers with data errors that do not have a material impact on national average unit cost but do affect their RCI will have their RCI annotated in the publication, so users of the data are aware, if, for example, they are making comparisons between Queries providers. 31. A number of national costing groups oversee the development of costing in areas such as mental health and ambulance services. Local costing groups provide an opportunity for providers to share best practice. If you have a local costing group, please let us know at nhsi.referencecosts@nhs.net and we will send a representative from the team if it would be helpful. 32. The Unify2 forum is an informal forum for NHS costing colleagues. We also use it to post other relevant materials in the lead up to the collection window and throughout the collection to post information about non-mandatory validations and any frequent queries. 33. In previous years information has been duplicated across Unify2 and DH exchange. To streamline communications for the combined costs collection we will use Unify2 only. 34. Queries about HRGs and the HRG /17 Reference Costs Grouper should be directed to enquiries@nhsdigital.nhs.uk, and queries about clinical coding and the NHS data dictionary to datastandards@nhs.net. 35. For combined costs collection queries requiring an official response, contact us at nhsi.referencecosts@nhs.net Where the query relates to the reference costs elements of the combined costs collection we will respond directly. Where it relates to the E&T element we may need to consult colleagues in DH or in HEE before replying. 16 Combined costs collection guidance: overview

17 2. Regulatory requirements and standards 36. Foundation trusts and NHS foundation trusts are required to submit their combined costs collection returns in accordance with the Approved costing guidance. The requirements include: a) the seven costing principles stakeholder engagement consistency data accuracy materiality causality and objectivity transparency totality b) combined costs collection guidance (comprising reference costs, E&T and integration guidance) c) clinical costing standards (on a comply or explain basis). 37. The combined costs collection guidance therefore constitutes the approved reporting currencies and approved guidance the guidance NHS foundation trusts and NHS trusts must apply to the recording and allocation of costs, in accordance with the provider licence (for foundation trusts) and the Accountability Framework (for NHS trusts). External assurance and enforcement 38. Combined costs collection submissions are subject to external audit as part of the costing assurance audit programme and all acute NHS trusts and foundation trusts will be selected for audit at least once every three years. The purpose of the audit programme is to provide assurance that reference costs have been prepared in accordance with the Approved costing guidance. 39. For 2016/17 an external auditor, on behalf of NHS Improvement, will provide assurance that reference costs have been prepared in accordance with the Approved costing guidance as detailed in paragraph 37 above. 17 Combined costs collection guidance: overview

18 40. NHS Improvement has enforcement powers that may be used where providers have not prepared reference costs submissions in accordance with the Approved costing guidance. 3. Board approval and sign off 41. The finance director and education lead are responsible for the accurate completion of the combined costs collection return. The submission should be subjected to the same scrutiny and diligence as any other financial returns submitted by the provider. 42. The board of each NHS trust and NHS foundation trust, or its audit committee or other appropriate sub-committee, is required to confirm the following in relation to the reference cost return (or provide details of non-compliance): (a) (b) (c) (d) (e) (f) the board or its appropriate sub-committee has approved the costing process ahead of the collection the finance director and education lead have, on behalf of the board, approved the final combined costs collection return before submission the return has been prepared in accordance with the Approved costing guidance, which includes the combined costs collection guidance information, data and systems underpinning the combined costs collection return are reliable and accurate there are proper internal controls over the collection and reporting of the information included in the combined costs collection, and these controls are subject to review to confirm that they are working effectively in practice costing and E&T teams are appropriately resourced to complete the combined costs collection return, including the self-assessment quality checklist and validations, accurately within the timescales set out in the guidance. 43. In 2015/16 there was a requirement to return the statement of directors responsibilities for the reference costs return to DH via In 2016/17 the statement covers the whole of the combined costs collection and should be signed by both the finance director and the education lead at each provider. However, there is no longer a requirement to return the statement to the reference costs team, instead it should be kept on site and be available for review by external auditors. 18 Combined costs collection guidance: overview

19 Statement of directors responsibilities for the 2016/17 combined costs collection In producing the annual combined costs collection return the provider must include a statement of the finance director and education leads responsibilities. This should be kept on site and made available if external auditors request it, in the following form of words: [NHS foundation trusts/nhs trusts] are required in accordance with the [NHS Provider Licence/Accountability Framework] [delete as appropriate] to comply with NHS Improvement s Approved costing guidance in the completion of the combined costs collection. In preparing the combined costs collection return the board or relevant sub-committee is required to take steps to satisfy themselves that: the cost return has been prepared in accordance with the Approved costing guidance, which includes the combined costs collection guidance the information, data and system underpinning the return are reliable and accurate there are proper internal controls over the collection and reporting of the information included in the combined costs collection, and these controls are subject to review to confirm that they are working effectively in practice costing and E&T teams are appropriately resourced to complete the return, including the self-assessment quality checklist and validations, accurately within the timescales set out in the reference costs guidance the content of the return is not inconsistent with internal and external sources of information. The finance director and education lead confirm to the best of their knowledge and belief the board has discharged its responsibilities above and the trust has complied with these requirements in preparing the combined costs collection return. By order of the board NB: sign and date in any colour ink except black...date...finance Director...Date...Education lead 19 Combined costs collection guidance: overview

20 Self-assessment quality checklist 45. It is the responsibility of each provider to produce sound, accurate and timely data that is right first time. 46. The self-assessment quality checklist will be in the workbooks when they are released and must be completed by all providers. Combined costs collection survey 47. There is going to be a new survey that covers all elements of the combined costs collection. It will be in the workbooks when they are released and must be completed by all providers. 20 Combined costs collection guidance: overview

21 Contact us: NHS Improvement Wellington House Waterloo Road London SE1 8UG improvement.nhs.uk Follow us on This publication can be made available in a number of other formats on request. NHS Improvement February 2017 Publication code: CG 14/17 21 Combined costs collection guidance: overview