7 | Consultation on mandating patient-level costs for acute activity
summer 2019. Other trusts submitting reference costs, including ‘acute’ activity,
will not be required to submit patient-level cost data at this time. We will publish
details on our website of the plan for extending mandation of patient-level costs
to other relevant providers shortly. In the meantime, if you require further
information, please contact our costing team on firstname.lastname@example.org
23. Currently cost data is collected on an average basis as part of reference costs,
and the methods for calculating costs
have been on a comply-or-explain
basis rather than required. This has led to issues and differences in how costs
are calculated, reducing the benefits for users from benchmarking their costs
and pathways. Inconsistencies and poor methods of apportionment caused
about half the inaccurate costing audit results over the last three years.
24. The result is that this data, using average costs and differing methods of
apportionment, cannot easily be linked to an individual patient and can often
hide errors in how resources are allocated. Because of this, it does not promote
engagement with clinicians to identify and improve patient pathways. In
addition, costing processes vary across organisations, meaning there is no
consistency in costing processes or methodologies, affecting the usefulness of
data for comparison, both between trusts and within organisations.
25. Our assessment indicates that, based on trusts that have already implemented
patient-level costing, more accurate costing will bring a range of benefits,
including the following:
• Supporting the provision of care in the best environment for patients,
as envisaged in the 5YFV. Patient-level costs would allow providers and
commissioners to use anonymised activity to identify patient pathways
across providers. This could support plans for integrated care across
providers and contribute to a more joined-up and preventive approach
across NHS and other service providers.
• Improving comparison between peers – internally and with other
providers. Legacy patient-level cost data has allowed participating trusts to
identify unwarranted clinical variations and improve patient pathways.
Improving the consistency of data by mandating standards across all acute
Previously the Healthcare Financial Management Association Costing Standards, recently the
Healthcare Standards for England.
A regulatory approach used in the UK and other countries in corporate governance and financial
supervision. Rather than setting out binding laws, regulators set out a code, which listed companies
may either comply with, or if they do not comply, explain publicly why they do not.