approved costing guidance review and feedback - acute, mental … · 2019. 11. 15. · if you...

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Approved Costing Guidance review and feedback - acute, mental

health and community services

Overview

Acute, mental health and community sector survey

Please note this survey relates only to acute, mental health and

community trusts. Ambulance trusts should complete this survey.

This survey is part of the review and feedback exercise of the Approved Costing

Guidance (previously known as 'the consultation') which gives all stakeholders

the opportunity to express their thoughts on the proposed standards with regard to

their practicality, achievability and implementation. For the first time, we are also

asking more detailed questions relating to specific changes made to individual

standards and to the technical document.

We appreciate your time in completing this survey. If you do not have time to review

all of the material, we would ask that you prioritise changed areas and those that are

most important to your trust. There is a link at the bottom of this page to the full suite

of Tranche 1 documentation on the Online Learning Platform

(including one which summarises the major changes).

In giving your answers please remember to include the paragraph number when

referring to specific areas of the documentation.

Contents Introduction ......................................................................................................................... 2

Overview of Standards ....................................................................................................... 3

Integrated Information Requirements ................................................................................ 4

Integrated Costing Processes ............................................................................................ 7

Integrated Costing Methods ............................................................................................. 11

Integrated Technical Document ....................................................................................... 17

Acute Costing Methods .................................................................................................... 21

Acute Costing Approaches .............................................................................................. 22

Mental Health Costing Methods ....................................................................................... 24

Community Costing Methods .......................................................................................... 27

General Comments ........................................................................................................... 30

http://engage.improvement.nhs.uk/pricing-and-costing/approved-costing-guidance-review-and-feedback-ambu

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Introduction

1.What is your name?

2.What is your email address?

If you enter your email address then you will automatically receive an

acknowledgement email when you submit your response.

3.What is your organisation?

4.In which sector does your organisation work? (tick all that apply)

Acute

Mental health

Community

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Overview of Standards

1.Please rate the Tranche 1 documentation of the Approved Costing Guidance

according to the following criteria

Clarity of language in the documents

Ease of navigating the documents

Ease of understanding the aim of the documents

Standards having a logical approach

Completeness of the standards

Soundness of the technical content

2.The PLICS collections requirements have been removed from the standards to

avoid duplication and reduce confusion. Do you support this change?

Yes No

3.Each standard grouping has an introduction, which has been shortened where

possible. Which statement best represents your opinion on the introductions?

I prefer the shorter introductions.

I like the introductions in the existing standards; they should be reinstated.

The introductions aren’t necessary; they should be removed.

4.Development area: We currently do not have costing methods for Diagnostics.

Would you benefit from the development of a standard, or standards, covering this

area? For example, on pathology or diagnostic imaging?

Yes No

4

Integrated Information Requirements

1.IR1: Collecting information for costing. Please indicate how closely you feel this

standard meets the following objectives

It's practical to use

The aims are achievable

It can be fully implemented

It delivers transformative change

2.IR1: This standard is now integrated for acute, mental health and community

services. Does this make it easier to manage all the feeds?

Yes No

3.IR1: Does the standard include enough detail on how to treat each feed?

Yes No

If you answered yes, would you suggest removing any areas? If so, which ones?

If you answered no, which areas do you think should be strengthened and how?

4.IR1: Critical Care: We have given further information to Feed 6a, 6b and 6c for

critical care, to accommodate the different ways critical care is recorded in PAS and

therefore how costing software is able to attach cost to the critical care record. Is the

standard improved in this area?

Yes No

5.IR1: Critical Care: Does it cover the way your trust has both information and

costing process set up? (If you have any examples of how either factor might show

critical care differently to the standard, please indicate here in your comments, and

we will contact you)

Yes No

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6.IR2: Managing information for costing. Please indicate how closely you feel this






7.IR2: Data quality is repeatedly raised as a challenge for costing practitioners. Does

this standard give clear guidance on how to work with your trust to improve data

quality?

Yes No

If you answered no, how would you suggest improving it? (please use examples

from your trust)

8.IR2: This standard has not had major changes this year. Are there any areas you

think require urgent review? (please specify paragraph numbers where appropriate)

9.IR3: Using patient level information as part of the decision-making toolkit (new

standard). Please indicate how closely you feel this standard meets the following

objectives





10.IR3: Does this standard cover all usual uses of PLICS information?

Yes No

If no, what could be added?

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11.IR3: Is the standard clear about which are the prescribed elements, and which

are superior methods?

Yes No

12.IR3: The intention is to use case studies to illustrate this standard, so that trusts

can share their good work with others. Do you have any case studies we can include

in the companion to this standard?

Yes No

13.IR3: Is the standard clear about when this standard will be included in the

assurance process?

Yes No

14.IR3: Do you have any comments on individual paragraphs in this standard?

(please specify paragraph numbers where appropriate)

15.IR Appendices: We have created appendix 1 by moving it from the technical

document. Do you support this change?

Yes No

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Integrated Costing Processes

1.CP1: Role of the general ledger in costing. Please indicate how closely you feel

this standard meets the following objectives





2.CP1: Paragraph 11 - The table from the integrated technical document has been

moved into this standard. This is to reduce the size of the integrated technical

document. Do you support this change?

Yes No

3.CP1: This standard has not had major changes this year. Are there any areas that

you think require urgent review? (please specify paragraph numbers where

appropriate)

4.CP2: Clearly identifiable costs. Please indicate how closely you feel this standard

meets the following objectives





5.CP2: Is the new section on the two-level compliance for GL to CL mapping clear?

Yes No

If you have any comments on two-level compliance, please add them here

6.CP2: Is it clear in ‘Allocating type 1 support costs’ that type 1 support costs need to

be separated from patient-facing resources in collection?

Yes No

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If you have any comments on allocating type 1 support costs, please add them here

7.CP3: Appropriate cost allocation methods. Please indicate how closely you feel






8.CP3: Paragraph 39 has been amended to a permissible substitution rather than a

superior method. Do you support this change?

Yes No

9.CP3: The Type 2 resource SPR105 CNST payment has been changed to a patient

facing resource to be linked to activities. Do you support this change?

Yes No

10.CP3: The activity SPA149 CNST has been deleted. The cost of CNST should

now be treated as a patient-facing resource and CP3.3 shows how this can be linked

to activities in the same way as consultant costs. Do you agree that CNST should

not be classed as an activity?

Yes No

11.CP3: Do you have any further comments on this standard?

12.CP4: Matching costed activities to patients. Please indicate how closely you feel






13.CP4: Is this standard clear?

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Yes No

14.CP4: Is there the right amount of detail on the matching process?

Yes

No - there's not enough detail

No - there's too much detail

If you answered no, please let us know what you would like added or removed

15.CP4: Do you have suggestions for additional areas?

16.CP5: Reconciliation. Please indicate how closely you feel this standard meets the

following objectives





17.CP5: This standard has not had major changes this year. Are there any areas you


18.CP6: Assurance of cost data. Please indicate how closely you feel this standard






19.CP6: There has been detail added in regarding assurance on information

governance. Do you support this change?

Yes No

20.CP6: This standard has not had major changes this year. Are there any areas you


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21.Changes to names of Costing Processes

The following are suggested new names for each of the six costing processes.

Please indicate whether you support or oppose changing to the new name

CP1: Ensuring the correct cost quantum

CP2: Clearly identifying costs

CP3: Allocating costs to activities

CP4: Matching costed activities to patients

CP5: Reconciling cost and other data

CP6: Assuring cost data

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Integrated Costing Methods

1.CM2: Incomplete patient events. Please indicate how closely you feel this standard






2.CM2: This standard has not had major changes this year. Are there any areas you


3.CM5: Theatres & special procedure suites (SPS). Please indicate how closely you

feel this standard meets the following objectives


aims are achievable



4.CM5: This standard has had a full rewrite following a Costing Expert Working

Group. Do you feel this is an improvement on the existing standard?

Yes No

5.CM5: Does this standard clearly explain how to treat the costs of staff working in

theatres?

Yes No

If not, how could we improve it?

6.CM5: The standard now combines guidance for medical and non-medical staff.

Does this give enough detail?

Yes No

If not, what other detail should it give?

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7.CM5: Should this standard be published as a replacement for the existing CM5?

Yes No

8.CM6: Critical care. Please indicate how closely you feel this standard meets the






9.CM6: Does this standard clearly explain how to cost the different units of:

a. critical care

b. high dependency

c. patients on general wards

d. critical care outreach

e. pre/post-operative support teams using critical care staff

f. how to cost for critical care staff attending A&E

g. transport

If you answered 'partially' for any of the above, please give your reasons here

10.CM6: We have changed the costing of critical care transport at patient level to be

a superior method. Do you support this change?

Yes No

Please let us know if you think this change is not clear in the standard

11.CM7: Private patients and other non-English NHS funded patients. Please

indicate how closely you feel this standard meets the following objectives





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12.CM7: This standard has not had major changes this year. Are there any areas


appropriate)

13.CM8: Clinical and Commercial Services or Received. Please indicate how closely

you feel this standard meets the following objectives





14.CM8: The standard has been renamed to aid understanding. Do you support this

change?

Yes No

15.CM8: The terminology 'contacted in' and 'contacted out' has been revised. Do you

support this change?

Yes No

16.CM8: The direct access and screening programme guidance will be moved to a

new standard. Do you support this change?

Yes No

17.CM8: Do you have any further comments regarding this standard?

18.CM10: Pharmacy and medicines. Please indicate how closely you feel this






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appropriate)

20.CM11: Integrated providers. Please indicate how closely you feel this standard








appropriate)

22.CM12: The income ledger: With the agreement of the Costing Expert Working

Group this standard has been revoked because it is not required in its current format.

Do you support this change?

Yes No

23.CM14: Group sessions. Please indicate how closely you feel this standard meets

the following objectives





24.CM14: This standard has been updated to clarify treatment of group contacts

where patient identifiable information should be available, and groups (such as

education groups) where no patient information is recorded. Is this distinction and

the treatment of costs clear?

Yes No

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25.CM14: Please let us know if you are aware of multiple staff running group

sessions in your locality

26.CM15: Cost classification. Please indicate how closely you feel this standard



aims are achievable





appropriate)

28.CM20: Costing GP services in secondary care settings. Please indicate how

closely you feel this standard meets the following objectives


aims are achievable





appropriate)

30.CM21: Clinical Non-Pay Items (new standard). Please indicate how closely you

feel this standard meets the following objectives


aims are achievable



31.CM21: Does the standard state clearly which clinical non-pay items should be

identified to patient level?

Yes No

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32.CM21: Does the standard state clearly which clinical non-pay items may be

identified to patient-level as a superior method?

Yes No

33.CM21: Does the standard state clearly how to allocate items that are not

expected to be identified to patient-level?

Yes No

34.CM21: Does this standard reduce repetition in other standards effectively? Or

would you rather the treatment of clinical non-pay items is repeated within the

standard describing the service for ease of reference?

Keep this standard – it’s easier to reference

Revert to the formatting in the published standards

35.CM22: Audiology services (new standard). Please indicate how closely you feel



aims are achievable



36.CM22: Does the standard clarify how to treat direct access audiology separately

from audiology support of ENT (and other specialties)?

Yes No

37.CM22: Does the standard describe how the activity takes place in your trust?

Yes No

38.CM22: Do you have the information required to disaggregate the costs of direct

access audiology from support to ENT (and other specialties)?

Yes No

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Integrated Technical Document

1.The Integrated Technical Document: please indicate how closely you feel this

document meets the following objectives


The information is technically sound



Can help deliver transformative change

2.Do you use the contents page?

Yes No

3.Do you find the transition path helpful for planning your 3-year phased

implementation?

Yes No

4.Is the costing diagram easy to understand?

Yes No

5.Do you find the likely sector column helpful in understanding which sections apply

to your sector?

Yes No

6.Do you use this filter to manage use of the large spreadsheets?

Yes No

7.Do you use the ‘My Organisation’ column to tailor spreadsheets to include the

services/resources/activities that your trust needs?

Yes No

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8.IR1.1 has had several columns removed as the information is duplicated in costing

standard IR1. Do you support this change?

Yes No

9.CP2.1: Do you complete the whole GL to CL exercise as part of your costing

process?

Yes No

If you answered no skip to question 11

10.CP2.1 Do you find the standardised cost ledger easy to apply as part of your

costing process?

Yes No

11.CP2.1 Does the GL to CL mapping process enhance your knowledge of the costs

in your organisation?

Yes No

12.CP2.1 On advice of the Costing Expert Working Group, the costing process for

GL to CL mapping has been spilt into two levels of compliance. Do you support this

change?

Yes No

13.CP2.1 The column ‘final audited accounts collection reconciliation codes’ has

been removed. Do you support this change?

Yes No

14.CP2.2 The allocation methods have been updated. Do you support this change?

Yes No

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15.CP2.2 Allocation methods have been combined where similar duplications

existed. Do you support these changes?

Yes, some of them

Yes, all of them

No

If you answered 'Yes - some of them' please indicate which changes you support

16.Are there any tabs in the technical document that you feel are not useful or would

be best placed in a particular standard?

17.Should CP4.1 be combined for all sectors or left as sector specific tabs?

Combined

Sector specific

18.The Theatres feed on IR1.2 has been amended to reflect feedback on the

availability of data on which staff are present in a particular theatre session/operation

at any one time. Does this make the costing of theatres more practical?

Yes No

19.Spreadsheet CP4.1 has been updated to include matching of auxiliary feeds

using ‘unique patient id/contact’ to ‘unique patient id/contact’, as the first matching

criteria.

a. Do you have this information in your feeds to use?

Yes No

b. Does this help to improve your matching process?

Yes No

20.CP3.3 Now includes the resource SPR105 CNST payment as a patient facing

resource and is linked to the same activities as ‘consultant’ with a step 1 and step 2

allocation method.

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a. Do you support these changes?

Yes No

b. Do you believe the resource should be linked to any other activities?

Yes No

If you answered yes, please explain your reasons

21.As explained in the previous question, the step 1 and 2 allocation methods for

CNST are now in 3.3. Do you agree with the wording in these steps?

Yes No

If you answered no, please explain how you would improve the wording

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Acute Costing Methods

Please note that this section applies only to acute providers

1.CM1: Consultant medical staffing. Please indicate how closely you feel this






2.CM3: Non-admitted patient care. Please indicate how closely you feel this standard






3.CM4: Emergency department attendances (including A&E, minor injury unit and

walk in centre). Please indicate how closely you feel this standard meets the






4.CM9: Clinical MDT meetings. Please indicate how closely you feel this standard






5.These standards have not had major changes this year. Are there any areas you


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Acute Costing Approaches

Please note this section applies only to acute providers

1.CA1: Tonsillectomy. Please indicate how closely you feel this standard meets the






2.CA2: Cochlear implant surgery. Please indicate how closely you feel this standard






3.CA3: Renal dialysis. Please indicate how closely you feel this standard meets the






4.CA4: Renal transplant. Please indicate how closely you feel this standard meets






5.CA5: Chemotherapy. Please indicate how closely you feel this standard meets the




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6.CA6: Cataract procedures. Please indicate how closely you feel this standard






7.CA7: Orthopaedics. Please indicate how closely you feel this standard meets the






8.Table CA7.1 uses multiple pages. Do you support reducing this to a shorter

example?

Yes No

9.CA8: Maternity . Please indicate how closely you feel this standard meets the






10.The standards in the Acute Costing Approaches have not had major changes this

year. Are there any areas you think require urgent review? (please specify paragraph

numbers where appropriate)

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Mental Health Costing Methods

Please note that this section applies only to mental health providers

1.CM1: Medical staffing. Please indicate how closely you feel this standard meets






2.CM1: Does this standard give enough detail to cost your services appropriately?

Yes No

3.CM1: We propose moving paragraph 17 to permissible substitution. Do you

support this change?

Yes No

4.CM1: Paragraph 17 also includes the following statement: 'All NHS organisations

have a financial duty to record payroll information in their general ledger, and to map

staff costs to the separate categories in the financial accounts. Therefore, the

information in the general ledger will be sufficient to understand staff types for

costing to more detailed resources'. Are you supportive of deleting this paragraph

and adding into the glossary?

Yes No








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Yes No

7.CM3: Using this standard are you able to cost learning disabilities NAPC services

appropriately?

Yes No

8.CM9: Clinical MDT meetings. Please indicate how closely you feel this standard






9.CM9: Have you implemented this standard yet?

Yes No


(irrespective of whether you have implemented it)

Yes No

11.CM13: Admitted patient care. Please indicate how closely you feel this standard







Yes No

13.CM13: Using this standard are you able to cost learning disabilities APC services

appropriately?

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Yes No

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Community Costing Methods

Please note that this section applies only to community services providers








Yes No

3.CM13: Admitted patient care. Please indicate how closely you feel this standard







Yes No

5.CM16: Sexual health services. Please indicate how closely you feel this standard







Yes No

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Yes No

8.CM17: Dental services. Please indicate how closely you feel this standard meets







Yes No



Yes No

11.CM19: Wheelchair services. Please indicate how closely you feel this standard







Yes No

13.CM19: Does this standard give enough detail to cost your staff appropriately?


Yes No

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14.CM19: Do you believe you have patient-level information about the wheelchair

equipment in your organisation to use for costing?

Yes No

15.CM19: Does this standard give enough detail to cost the wheelchair equipment

appropriately? (irrespective of whether you have implemented it)

Yes No

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General Comments

1.If you have any further comments about any aspect of the Tranche 1

documentation for the Approved Costing Guidance please let us know here

approved costing guidance review and feedback - acute, mental … · 2019. 11. 15. · if you...

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