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31.01.17

First-ever PLICS standards developed for mental health and ambulance providers

The first-ever costing standards for mental health and ambulance providers have been published in draft format by NHS Improvement (NHSI), with mandated patient-level cost collection (PLICS) due in 2019-20 for these organisations. 

The regulator has also released the new Healthcare Costing Standards for England, which are the standards to which the PLICS returns will be made in 2017 by over 80 volunteer acute trusts. 

Speaking to NHE, Richard Ford, NHSI’s director of costing, said that the costing teams programme forms a co-ordinated approach to PLICS, the reference costs collection and the reference costs assurance programme. 

Discussing implementation for acute providers, he said: “Last September we asked for volunteers to become early implementers from the acute sector. What we are doing at the moment is taking this cohort of trusts through a fairly intense programme of adoption of our standards, and the ability to submit PLICS data to us in July. 

“That is the intention for the first half of the acute sector. Then, from September until March, we are going to run wave two, so this is going to be when anyone who didn’t volunteer can decide to come forward. We are hoping to back that up with some intent to mandate. If they didn’t volunteer last time, we need to motivate them this time. 

“These are probably ‘challenged trusts’ because they don’t have a costing system or they are in financial distress or special measures. “That may leave us with a small number of trusts that probably aren’t in the position where they can submit anything. NHSI will be working with these trusts in the future to support them in making submissions”. 

“But the intention is still in 2018-19 to mandate the use of the standards and the collection of those data in what will be July 2019 [for acute providers].” 

Mental health and ambulance trusts 

As well as working with the 80+ acute providers, NHSI is working with three mental health providers as roadmap partners, who will undergo rigorous PLICS implementation, and five others as contributors. It is also working with three ambulance trusts (see full list below) to test the draft standards for these trusts. 

“For mental health and ambulance these are the first-ever standards developed for PLICS,” said Ford. “We went to Australia, Germany and Canada when we developed our acute standards. When it came to mental health and ambulance nobody has actually done this. I know they are only the first draft, but it is quite pioneering.” 

He added that the regulator will now be working with its mental health and ambulance roadmap partners on their PLICS implementation and development. Mandation of PLICS for these providers is due a year after the acute sector.

Chris Skilbeck, who is NHSI’s head of sector engagement, added that PLICS has “so much potential to radically change a lot of what we do, but also to really inform what trusts do”. 

“The bottom line of this is that trusts get a way of understanding their costs and managing them,” he argued. “That is what is quite exciting about this PLICS data.” 

Mapping to the new cost ledger 

The latest publication consists of a quick-start guide to the standards, plus policy and technical guidance. And although the new standards do not currently cover community providers, the regulator has asked that they too adopt the costing principles and the costing process. 

As well as launching the standards, NHSI requires providers to map their general ledger to a new cost ledger. 

“We are giving them guidance on how to map, but ultimately there are loads of local variations that mean they have to be done themselves,” explained Ford. “What we are doing, however, is standardising the cost ledger. 

“People may map it differently, but, ultimately, they will end up with a cost ledger that is consistent. And then from the cost ledger we are working with the software suppliers to make sure what is available, from an output point of view, is collectable.” 

He added that Lord Carter’s efficiency review was calling for a standardised general ledger in the NHS. “This cost ledger is the answer to that conundrum,” noted Ford. “We couldn’t ever standardise general ledgers because of the diversity of the NHS. So we have worked this cost ledger mapping as the means to overcome that inconsistency. 

But as we start driving the Carter metrics as part of the model hospital, it will, again, provide the necessary output data that goes into the model hospital.” 

The cost ledger has been formed from taking the NHS SBS standard general ledger and north east patches general ledger, because they are the two big general ledgers that are used by most trusts.

“We have used those and mapped both of those ledgers with thousands of account code combinations,” continued Ford. “What we’re developing is a benchmark tool, which allows you to compare yourself to a similar-sized trust or teaching hospital with a certain speciality.” 

He added that by September, the regulator hopes to have this function available for when trusts start to do their cost improvement plans. 

“Our motivator is that we are assured that the trusts are using the best information to make decisions,” said Skilbeck. “It goes into their business cases and how they configure their services. That is why this benchmarking is so important.” 

List of mental health and ambulance trust roadmap partners: 

Ambulance RMP

  • London Ambulance Service NHS Trust
  • West Midlands Ambulance Service NHS Foundation Trust
  • Yorkshire Ambulance Service NHS Trust 

MH RMPs

  • West London mental health Foundation Trust
  • Oxford health NHS Foundation Trust
  • Central and north west London NHS Foundation Trust 

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