Healthcare costing standards for England. Education and training. Development version 1

Transcription

1 Health costing standards for England Education and training Development version 1

2 We support providers to give patients safe, high quality, compassionate within local health systems that are financially sustainable.

3 Contents Introduction... 2 E&T1: Collecting information for costing... 5 E&T2: Clearly identifiable costs and income E&T3: Appropriate cost allocation methods E&T4: Patient versus E&T apportionments E&T5: Matching E&T costs to student and trainee groups E&T6: Netting off E&T income E&T7: Reconciliation Contents

4 Introduction We are pleased to introduce version 1 of the Health costing standards for England education and training (E&T), to be used alongside the E&T technical document by acute, ambulance, community and mental health providers to cost their E&T activities. Significant work has been done in recent years to develop E&T guidance and cost collections. Our intention is to build on this while working towards aligning E&T costing with patient-level costing, and achieving a single integrated cost collection. While we will not run an E&T cost collection in 2018, we will work with E&T roadmap partners to implement these standards and then take part in a pilot collection in autumn this year. However, we stress that costing E&T is important and we encourage you to continue to cost E&T as you would any other service in your organisation, using these standards as far as you can. We intend to develop resources to support implementation of development version 2 of these standards, due to be published early in 2019, and to collect 2018/19 E&T costs next summer. We recognise that E&T cost calculation currently may be a separate exercise in many organisations, but we intend for E&T costs to be calculated in the costing software systems alongside patient-level costing. This will help improve the accuracy of both E&T and patient-level costs; for example, type 1 support costs will be allocated in the same way to resources that deliver E&T and those that deliver other activities. To support this, E&T is included in the PLICS minimum software requirements as a should, giving software suppliers up to two years to develop models that incorporate E&T costing. Currently it is national policy to use health cost data net of E&T income, and the national cost collections will continue to collect service costs net of E&T income but not net of E&T costs. 2 Introduction

5 The standards provide guidance on: information requirements to cost E&T an integrated costing process for E&T and patient-level costing using resources and activities consistent apportionment of costs to patient and E&T for consultants and non-consultant, where these activities happen concurrently reconciliation of E&T and patient-level costs consistent approach to netting off E&T income from patient-level costs for national cost collections. These standards should be used in conjunction with the information requirement and costing process standards for patient-level costing. Where helpful, crossreferences to patient-level standards are given, and unless otherwise stated these are to acute final version standards. This version of the standards supersedes previous guidance. All paragraphs have equal importance. These standards apply to any E&T programme that: is a recognised part of the E&T curriculum and approved by the relevant higher education institute and the relevant regulatory body receives clinical and mentoring support as defined by the relevant regulatory body falls within a costing period that is the financial year, not the academic year. The costing of E&T programmes should not include mandatory training, continuing professional development, software training or other general education required to fulfil the day-to-day requirements of a job. These are classified as type 1 support costs and should be apportioned using the prescribed costing allocation methods in Spreadsheet CP2.2 in the technical document. The standards define students as those receiving E&T from a health service provider who are not paid a salary, and trainees as those who are paid a salary. 3 Introduction

6 The standards refer to the time students and trainees spend with a health provider as a placement. A placement needs to be longer than one week (five working days) and linked to defined learning outcomes. The duration may add up to one week but the placement completed over a period of months: for example, one day a week for six weeks. The standards do not discuss loss of productivity due to delivering E&T. We understand that productivity may be affected when a member of the medical team concurrently delivers training and patient, but as trainees also deliver a significant amount of service we believe the net impact is zero. You may wish to calculate loss of productivity locally for business intelligence purposes, but the standards do not provide guidance on this. If you would like to give us feedback on this version of the E&T standards please complete the evidence pro forma and send it to costing@improvement.nhs.uk. 4 Introduction

7 E&T1: Collecting information for costing Purpose: To set out the minimum information requirements to cost E&T. Objectives 1. To ensure all providers collect the same information on students and trainees on a placement as part of a training programme for costing and collection. 2. To collect the information required to cost E&T at student/trainee group level, 1 that is: undergraduate (student) groups by both course and year of study postgraduate trainee groups by both course and year of training. Details of the undergraduate and postgraduate courses and year of study/training can be found in Spreadsheet Appendix ET1 to Appendix ET3 in the technical document. 3. To collect the required information to identify E&T resources. 4. To collect the required information to identify E&T activities. 5. To collect the required information to support the allocation of the correct quantum of cost to the correct activity using the prescribed cost allocation method. 1 As required by Health Education England (HEE) and the Department of Health and Social Care for tariff development. 5 E&T1: Collecting information for costing

8 Scope 6. All E&T programmes that: are a recognised part of the E&T curriculum and approved by the relevant higher education institute and the relevant regulatory body receive clinical and mentoring support as defined by the relevant regulatory body fall within a costing period that is the financial year, not the academic year. 7. This standard specifies the minimum information required for E&T costing and cost collection. Overview 8. Accurate information is essential to costing E&T activity properly, but we understand that obtaining this information can be challenging as there is no nationally mandated E&T activity information collection. 9. We recognise that many providers and Health Education England (HEE) have developed local methods to collect and record E&T information. 10. Courses and placements begin at different points during the year and run for different lengths of time. 11. This standard specifies the information required to cost E&T. This means you can work with the relevant departments to close identified information gaps, which will improve the accuracy of E&T costing for your organisation. 12. Three types of feed support the matching process: master feeds: the core E&T activity feeds that the other feeds are matched to, eg number of trainee placement hours auxiliary feeds: the E&T activity feeds that are matched to the master feeds, eg supervision and assessment standalone feeds: the E&T information feeds that are not matched to any trainee or student groups but do contain information needed for the costing process, eg costs incurred in delivering E&T activities. 6 E&T1: Collecting information for costing

9 The feeds are classified in column E in Spreadsheet ET1.1 in the technical document. 13. Information for costing E&T should be collected twice a year first to capture the new E&T information as prescribed in the E&T activity feeds for the start of the academic year, 2 and then to confirm it is still correct at the beginning of the financial year: at the beginning of each financial year for the remainder of the academic year (eg April to August) at the beginning of the new academic year within the financial year (eg September to March). 14. The standards prescribe the information to be collected, but not how it is collected. 15. You may be using additional sources of information for costing E&T. If so, continue to use these and document them in your costing manual. 16. This information should then be included in your costing systems. 17. If you do not currently collect the minimum information, you should follow Acute Standard IR2: Managing information for costing to start collecting the information required. 18. Your organisation may not provide clinical placements for every year of a programme. You are not required to collect an information feed if your organisation does not provide that activity. 19. Your E&T costing should be calculated at the same time and with the same frequency as your patient-level costing. This ensures that your in-year patientlevel cost reporting is as accurate as possible. 2 An academic year can start at various times of the year. 7 E&T1: Collecting information for costing

10 What you need to implement this standard Costing principle 2: Good costing should include all costs for an organisation and produce reliable and comparable results Costing principle 4: Good costing should involve transparent processes that allow detailed analysis Costing principle 5: Good costing should focus on materiality Acute Standard IR2: Managing information for costing purposes Spreadsheet ET1.2 to ET1.10d: E&T information feeds required Spreadsheet Appendix ET1 to ET3: E&T programmes by year of study Spreadsheet Appendix ET4 to ET6: E&T survey templates Approach E&T information for the costing process 20. The information required to cost E&T includes: number of student and trainee placement weeks and hours (feeds 1a, 1b and 2) costs incurred in delivering E&T activities (feed 3), which include: resources used to deliver E&T activities only (Spreadsheet ET2.1 in the technical document) resources used to deliver both E&T and other activities, eg patient and research and development (feed 3 and Spreadsheet ET2.1 in the technical document) E&T activities that have taken place and their duration and frequency (feeds 4 to 6) information to correctly apportion costs between: E&T and non-e&t activities (Standard E&T2: Clearly identifiable costs and income) providing training and delivering patient when the two happen in the same process (Spreadsheet ET1.10a to ET1.10d in the technical document) receiving training and delivering patient when the two happen in the same process (Spreadsheet ET4.1 to ET4.3 in the technical document). 8 E&T1: Collecting information for costing

11 21. This section describes each of the feeds that together collect the required information, explaining: collection source feed scope. Feed 1a: Number of medical and dental trainee placement hours 22. Spreadsheet ET1.2 in the technical document describes the data fields required for this feed. 23. For postgraduate medical and dental trainees, collect the number of whole time equivalent (WTE), weeks of placement and hours per week by: course year of training. 24. For programmes that are not among the training programmes listed on Spreadsheet Appendix ET1, collect information on the number of trainee hours by course and year of training from the separate schedules for each programme. Collection source 25. From the national list of training programmes, identify those your organisation runs. We request costing data on the programmes listed in Spreadsheet Appendix ET1 in the technical document. 26. Information about the programmes you currently run should be available in your Learning Development Agreement (LDA) or any other agreements you have with HEE. 27. Once you have identified the programmes your organisation runs, you need to identify the years of the programmes. The programme years are listed in Spreadsheet Appendix ET2 in the technical document. 28. Once you have identified your organisation s training programmes, you need to identify who can best act as the lead for each. Some organisations, but not all, have nominated education leads. Budget holders for the relevant staff 9 E&T1: Collecting information for costing

12 group are useful initial contacts if you are unclear who the lead or education supervisor is. Feed scope 29. All years and all medical and dental postgraduate programmes run by your organisation for trainees. Feed 1b: Number of non-medical trainee placement hours 30. Spreadsheet ET1.3 in the technical document describes the data fields required for this feed. 31. For non-medical postgraduate trainees, collect the number of WTE, weeks of placement and hours per week by: programme year of training. 32. For programmes that are not among the training programmes listed in Spreadsheet Appendix ET1, collect information on the number of trainee hours by programme from the separate schedules for each programme. Collection source 33. From the national list of training programmes, identify those your organisation runs. We request costing data on the programmes listed by training year in Spreadsheet Appendix ET1 in the technical document. 34. Information about the programmes you currently run should be available in your LDA or any other agreements you have with HEE. 35. Once you have identified your organisation s training programmes, you need to identify who can best act as the lead for each. Some organisations, but not all, have nominated education leads. Budget holders for the relevant staff group are useful initial contacts if you are unclear who the lead or education supervisor is. 10 E&T1: Collecting information for costing

13 Feed scope 36. All years and all non-medical postgraduate programmes run by your organisation for trainees. Feed 2: Number of student placement hours 37. Spreadsheet ET1.4 in the technical document describes the data fields required for this feed. 38. For medical and non-medical students, collect the number of weeks of placement and hours per week by: programme year of study. 39. For programmes that are not among the training programmes listed in Spreadsheet Appendix ET3, collect information on the number of student hours by programme and year of study from the separate schedules for each programme. Collection source 40. From the national list of training programmes, identify those your organisation runs. We request costing data on the programmes listed by study year in Spreadsheet Appendix ET Information about the programmes you currently run should be available in your LDA or any other agreements you have with HEE. 42. Once you have identified your organisation s training programmes, you need to identify who can best act as the lead for each. 43. For medical undergraduates, there is likely to be a co-ordinator for each year of the programme. 44. For some non-medical programmes: an individual will likely have been designated responsible for the programmes related to a specific profession, eg pharmacy 11 E&T1: Collecting information for costing

14 you may need to identify the overall lead, eg the head of midwifery, but also individual leads for the programme s different elements, such as antenatal and postnatal for nursing students, who can be significant in number and have placements across the wards in your organisation, your head of nursing can be the overall lead but you also need an established group to include representative leads from the different types of placement, eg wards, theatres, outpatients, critical units nominating leads for specific aspects of E&T that cover a few programmes may be appropriate. Feed scope 45. All years and all non-salaried E&T programmes run by your organisation for students. Feed 3: Costs incurred in delivering E&T activities 46. Spreadsheet ET1.5 in the technical document describes the data fields required for this feed. 47. Use the template to collect information on the costs incurred in delivering E&T activities. This template is designed so that you can identify: where in the general ledger E&T costs sit whether or not these costs are incurred by delivering E&T activities only. 48. The template will also help you identify where costs: delivering E&T activities sit in a dedicated E&T cost centre delivering E&T activities sit in a dedicated E&T line in a non-e&t cost centre are incurred for non-e&t activities are incurred for E&T activities across multiple programmes. 49. Where the costs sit in a dedicated E&T cost centre there is no need to itemise them at account code level in the template. 12 E&T1: Collecting information for costing

15 50. This information then needs to be transferred to columns L to O in the standardised cost ledger in Spreadsheet ET2.1 in the technical document. Collection source 51. Work with your education leads and finance colleagues to identify what costs are involved in delivering E&T activities and where these costs sit in the general ledger. 52. Where costs of delivering E&T activities sit in a dedicated E&T cost centre these are straightforward to identify. 53. Identifying costs of delivering E&T activities is more challenging where they sit in cost centres that are incurred by both E&T and non-e&t activities for example, an administrative role that delivers E&T activities and also mandatory training, or a consultant who delivers both E&T activities and patient activities. Guidance on how to apportion costs between E&T and non-e&t activities is provided in Standard E&T2: Clearly identifiable costs and income. 54. The same staff, facilities and other items are likely to deliver E&T activities across multiple programmes. Guidance on how to apportion costs between programmes is provided in Standard E&T2: Clearly identifiable costs and income. 55. Identifying the information for the feed is a significant task. You should apply the principle of materiality and focus on the high value items first. 56. You should have a rolling programme to review this information feed over time. Feed scope 57. All costs in the general ledger incurred by E&T activities. Feed 4a: Courses and practices attended by trainees 58. Spreadsheet ET1.6 in the technical document describes the data fields required for this feed. 13 E&T1: Collecting information for costing

16 Collection source 59. Work with your education leads to identify the courses and practices your organisation s trainees attend. 60. See paragraphs 55 and 56 above. Feed scope 61. All courses and practices attended by your organisation s trainees. Feed 4b: Courses and practices delivered by tutors, health professionals or others from your organisation 62. Spreadsheet ET1.7 in the technical document describes the data fields required for this feed. Collection source 63. Work with your education leads to identify courses and practices that are delivered by tutors, health professionals and others in your organisation. These are courses and practices delivered for your organisation s or another organisation s trainees and students. 64. See paragraphs 55 and 56 above. Feed scope 65. All courses and practices delivered by tutors, health professionals and others in your organisation. Feed 5: Assessments and follow-up meetings attended by trainees 66. Spreadsheet ET1.8 in the technical document describes the data fields required for this feed. Collection source 67. Work with your education leads to identify the assessments and follow-up meetings attended by your organisation s trainees. 14 E&T1: Collecting information for costing

17 68. See paragraphs 55 and 56 above. Feed scope 69. All assessments and follow-up meetings attended by your organisation s trainees. Feed 6: Supervision and assessments delivered by tutors, health professionals or others from your organisation 70. Spreadsheet ET1.9 in the technical document describes the data fields required for this feed. Collection source 71. Work with your education leads to identify all supervision and assessments delivered by tutors, health professionals or others from your organisation. These are supervisions and assessments delivered for your organisation s or another organisation s trainees and students. 72. One way to collect information on the time spent on supervision is to survey consultants. An example survey can be found in Spreadsheet Appendix ET4 in the technical document. 73. See paragraphs 55 and 56 above. Feed scope 74. All supervision and assessments delivered by tutors, health professionals or others from your organisation for your organisation s or another organisation s trainees and students. Other considerations 75. When requesting information from clinicians, try to arrange a face-to-face meeting. Feedback from clinicians suggests this is their preferred way of communication. 76. You may obtain some of what you need easily from routinely available finance information. But you may need more information than that gathered by the identified leads. 15 E&T1: Collecting information for costing

18 77. We recommend that you start by talking to your top five specialties by expenditure and contact everyone else electronically. 78. It is important to validate any information with senior education leads. 79. Table E&T1.1 shows suggested sources of information. Table E&T1.1: Suggested sources of information Source of information E&T contracts with HEE and other external funding bodies Potential use Helping to highlight and understand the programmes and resources funded by HEE Contacts/examples Contracts with local HEE offices such as an LDA E&T programme leads Face-to-face discussions/interviews with relevant staff, either one-to-one or in a focus group Helping to build the detailed information required about each placement Consultants Consultant s personal assistants Placement managers Admin staff Mentors Teaching staff Staff in areas where teaching takes place during patient Workplace-based assessment documents for postgraduate trainees by assessor Helping to identify the time involved in marking assessments Case-based discussion, miniclinical evaluation exercise and direct observation of procedural skills 16 E&T1: Collecting information for costing

19 E&T2: Clearly identifiable costs and income Purpose: To identify all the costs incurred and income received in delivering E&T activities. Objectives 1. To ensure all costs incurred in delivering E&T activities are correctly identified. 2. To ensure all E&T costs are in the correct starting position and correctly labelled for the costing process. 3. To ensure the same E&T costs are mapped to the same E&T resources. 4. To ensure E&T income is correctly identified. 5. To ensure all E&T costs and income are classified in a consistent way. Scope 6. This standard applies to all lines in the general ledger. Overview 7. This standard is additional to Acute Standard CP2: Clearly identifiable costs, to specify the costing process for E&T. You need to understand Acute Standard CP2 before implementing this standard. 17 E&T2: Clearly identifiable costs and income

20 Cost and income classifications for E&T 8. E&T costs are those that relate directly and only to delivering E&T, and are driven by E&T activity only. They should have a clear activity-based allocation method, and will be both pay and non-pay, eg postgraduate centres and simulation training centres. 9. All other costs should be classified using the cost classifications in Acute Standard CP2: Clearly identifiable costs for patient-facing and type 1 and 2 support costs: patient-facing costs can deliver patient-facing, E&T and other activities type 1 support costs can apply to patient-facing, E&T and other activities type 2 support costs do not apply to E&T. 10. E&T income refers to both tariff 3 and non-tariff 4 income, including: tariff postgraduate medical tariff undergraduate medical tariff non-medical non-national tariff. 11. E&T income includes income from HEE and other external sources. E&T facilities and provision 12. Follow Acute Standard CP2: Clearly identifiable costs for how to allocate type 1 support costs. 13. The only exception is the allocation of E&T facilities and provision costs. For E&T costing these are classified as E&T costs, not type 1 support costs. 14. Where a facility provides patient-facing, E&T and other activities, you must apportion the correct percentage of costs to the different activity types and then use the appropriate cost allocation methods for that percentage of cost. 3 See 2017/18 Education and training tariff guidance: e/629492/ _et_tariff_guidance_final_july_v2.pdf 4 E&T income that is not specified in the E&T national tariff guidance. 18 E&T2: Clearly identifiable costs and income

21 15. For example, a postgraduate centre has a running cost of 1,000,000 per annum and the following activity profile: 80% of the cost relates to delivering E&T activities and 20% to patient-facing activities. This means 800,000 (80% of running costs) should be classified as E&T provision costs and allocated using the appropriate cost allocation method. The remaining 200,000 (20% of the running costs) should be classified as type 1 support costs and allocated using the appropriate cost allocation method. Identifying E&T income 16. As income needs to be treated differently for costing and collection purposes, you need to ensure that all the income related to E&T activities is clearly identified in your cost ledger. 17. This is because: For E&T costing purposes do not net E&T income off costs. As explained in Acute Standard CP2: Clearly identifiable costs, costs and income should be reported together. For local reporting purposes, net off E&T costs not E&T income from reported patient-level costs, so that users of the cost data understand the true costs to the organisation of delivering all the services. For national cost collections you need to net off E&T income, not E&T cost, from service costs. Please note currently there is no requirement to collect patient-level costs with E&T costs netted off. What you need to implement this standard Costing principle 2: Good costing should include all costs for an organisation and produce reliable and comparable results Costing principle 3: Good costing should show the relationship between activities and resources consumed Costing principle 4: Good costing should involve transparent processes that allow detailed analysis Costing principle 5: Good costing should focus on materiality Adult Standard CP2: Clearly identifiable costs Spreadsheet CP2.1: Standardised cost ledger (with mapping to resources) Spreadsheet ET1.5: Costs incurred in delivering E&T activities Spreadsheet ET2.1: The standardised cost ledger including E&T 19 E&T2: Clearly identifiable costs and income

22 Approach 18. To identify the costs incurred in delivering E&T activities you need to know: where in the general ledger the E&T costs sit whether these costs are incurred delivering E&T activities only or non-e&t activities as well. 19. The template in E&T information Feed 3: Costs incurred in delivering E&T activities (Spreadsheet ET1.5 in the technical document) will help you identify costs: sitting in a dedicated E&T cost centre that deliver E&T activities sitting in a dedicated E&T line in a non-e&t cost centre that deliver E&T activities incurred by delivering both E&T and non-e&t activities incurred by delivering E&T activities across multiple programmes. 20. You also need to identify whether the costs are involved in delivering E&T activities for: medical and dental postgraduate trainees medical undergraduates non-medical trainees and students non-national tariff trainees or students. 21. Work with your finance and education colleagues to collect this information using feed 3 (Spreadsheet ET1.5 in the technical document). 22. This information then needs to be transferred into columns L to O in your standardised cost ledger in Spreadsheet ET2.1 in the technical document. Dedicated E&T cost centres 23. Map the dedicated E&T cost centres to the appropriate lines in the E&T cost centres in the standardised cost ledger in Spreadsheet ET2.1 in the technical document. 20 E&T2: Clearly identifiable costs and income

23 24. Table E&T2.1 is an example of the dedicated E&T cost centres in the standardised cost ledger. Table E&T2.1: E&T cost centres in the standardised cost ledger Cost centre name Central education Simulation training centre A Library Postgraduate centre Undergraduate centre Clinical academy Cost centre code XXX700 XXX701 XXX702 XXX703 XXX704 XXX705 Dedicated E&T expense lines sitting in non-e&t cost centres 25. Map the dedicated E&T expense lines sitting in other cost centres to the appropriate lines in the E&T cost centres in the standardised cost ledger in Spreadsheet ET2.1 in the technical document. Expense lines for costs incurred by delivering both E&T and patient-facing activities 26. Ensure you flag costs that deliver both E&T and patient activities as delivering both types of activities in column M in your standardised cost ledger. Type 1 support costs 27. Follow Acute Standard CP2: Clearly identifiable costs for how to allocate type 1 support costs both to and within E&T cost centres. 28. The only exception is the allocation of E&T facilities and provision costs. For E&T costing these are not classified as type 1 support costs and therefore should be allocated as follows: identify E&T facilities and provision costs in the general ledger 21 E&T2: Clearly identifiable costs and income

24 Income map these costs to the correct line in the cost ledger; this maps to the E&T facilities and provision resources allocate the E&T facilities and provision resources using the prescribed allocation method for E&T facilities and provision costs in Spreadsheet ET3.4 in the technical document. 29. Work with finance and education colleagues to identify all the income lines in the general ledger and map them to the income centres in the standardised cost ledger. 30. Table E&T2.2 is an example of the dedicated E&T income centre in the standardised cost ledger. Table E&T2.2: E&T income centres in the standardised cost ledger Income centre name Income centre code Income code description E&T national tariff income XXX706 Tariff non-medical E&T national tariff income XXX706 Tariff undergraduate medical E&T national tariff income XXX706 Tariff postgraduate medical E&T national tariff income XXX706 Salary contribution F1 E&T national tariff income XXX706 Salary contribution F2 E&T national tariff income XXX706 Salary contribution F1D E&T national tariff income XXX706 Salary contribution F2D E&T national tariff income XXX706 Salary contribution F1 Community E&T national tariff income XXX706 Salary contribution F2 Community E&T national tariff income XXX706 Salary contribution ST1/CT1 E&T national tariff income XXX706 Salary contribution ST2/CT2 E&T national tariff income XXX706 Salary contribution ST3/CT3 E&T national tariff income XXX706 Salary contribution ST4 E&T national tariff income XXX706 Salary contribution ST5 22 E&T2: Clearly identifiable costs and income

25 Income centre name Income centre code Income code description E&T national tariff income XXX706 Salary contribution ST6 E&T national tariff income XXX706 Salary contribution ST7 E&T national tariff income XXX706 Salary contribution GPST1 Hospital E&T national tariff income XXX706 Salary contribution GPST2 Hospital E&T national tariff income XXX706 Salary contribution GPST3 Hospital E&T national tariff income XXX706 Salary contribution GPST Hospital placement (point not specified) E&T non-tariff income Programme A XXX707 Non-tariff funding 23 E&T2: Clearly identifiable costs and income

26 E&T3: Appropriate cost allocation methods Purpose: To ensure that the correct quantum of costs is allocated to the correct E&T activity using the most appropriate cost allocation method. Objectives 1. To ensure E&T resources are allocated to E&T activities using a single appropriate method, ensuring consistency and comparability in collecting and reporting cost information, and minimising subjectivity. 2. To ensure resources delivering both E&T and non-e&t activities are appropriately apportioned between E&T and other activities. 3. To ensure resources are allocated to E&T activities using an appropriate information source. 4. To ensure relative weight values reflect how costs are incurred. Scope 5. All costs reported in the cost ledger and all E&T activities undertaken by the organisation. Overview 6. This standard is additional to Acute Standard CP3: Appropriate cost allocation methods, to specify the costing process for E&T activities. Ensure that you understand Acute Standard CP3 before implementing this standard. 24 E&T3: Appropriate cost allocation methods

27 7. For resources that deliver both E&T and non-e&t activities: their total cost needs to be apportioned between E&T and other activities those costs apportioned to patient-facing activities need to be further apportioned between: delivering patient (reported under patient activities) teaching or receiving training while delivering patient (reported under E&T activities). 8. Information for costing E&T is collected twice a year, in contrast to the monthly patient-level activity feeds available for costing patient-level activities. To calculate E&T costs at the same time and frequency as the patient-level activity costs, use the information collected as it will not change month on month. What you need to implement this standard Costing principle 2: Good costing should include all costs for an organisation and produce reliable and comparable results Costing principle 3: Good costing should show the relationship between activities and resources consumed Costing principle 4: Good costing should involve transparent processes that allow detailed analysis Costing principle 5: Good costing should focus on materiality Acute Standard CP3: Appropriate cost allocation methods Spreadsheet ET3.1: E&T resources that deliver E&T activities only Spreadsheet ET3.2: Patient-facing resources that may deliver E&T activities for medical and dental postgraduate trainees Spreadsheet ET3.3: Patient-facing resources that may deliver E&T activities for medical undergraduate and non-medical trainees and students Spreadsheet ET3.4: E&T activities Spreadsheet ET3.5: Prescribed allocation methods to allocate E&T resources and patient-facing resources, first to activities and then to trainee/student groups 25 E&T3: Appropriate cost allocation methods

28 Approach 9. Before proceeding, review the Spreadsheet E&T flowchart in the technical document (Figure E&T3.1 below). This is a high-level visual aid to the costing process described in the steps below. 10. We describe the process in steps to make it easier to understand, but in reality the steps may happen simultaneously in the costing system. 11. The process can be delivered by various software solutions. We are not prescribing which software solutions should deliver the process. E&T resources that deliver E&T activities only 12. There are four E&T resources, as described in Spreadsheet ET3.1 in the technical document, 100% of which should be allocated to E&T activities: ETR400: E&T provision ETR401: E&T facilities ETR402: E&T teaching ETR403: E&T external conferences and courses. 13. ETR400: E&T provision is a broad category of costs that includes: pre-placement costs: relocation costs and local recruitment costs train the trainer costs: cost of the courses and of teaching staff time spent on training courses central education costs: costs of library/education centres, running the E&T programmes and student/trainee mentoring. 14. Costs that are mapped to the ETR400: E&T provision resource sit in the following dedicated E&T cost centres in Spreadsheet ET2.1 in the technical document: XXX700: Central education XXX702: Library XXX704: Undergraduate medical centre XXX703: Postgraduate centre. 26 E&T3: Appropriate cost allocation methods

29 Figure E&T3.1: Integrated process to cost E&T E&T cost centres allocate E&T costs Type 1 support costs allocate map E&T resources allocate E&T activities match student/trainee group by specialty and year Type 1 support cost centres allocate Patient-facing cost centres involved in E&T programmes map Patientfacing resources allocate Legend allocate Patient-facing activities match patients E&T only Shared between E&T and patient Patient only 27 E&T3: Appropriate cost allocation methods

30 15. ETR401: E&T facilities includes the costs of E&T facilities such as simulation training centres and lecture rooms. 16. These costs sit in the following E&T dedicated cost centres in the standardised cost ledger: XXX701: Simulation training centres XXX705: Clinical academy. 17. ETR402: E&T teaching includes the costs of teaching staff who are not involved in patient-facing work other costs that are directly related to delivering the E&T activities, such as recruiting people to role play patients, and trainee conference and course fees. 18. These costs sit in the following dedicated E&T cost centres in the standardised cost ledger: XXX701: Simulation training centres XXX705: Clinical academy. 19. ETR403: E&T external conferences and courses includes the costs of external courses and conferences that trainees attend as part of their E&T programme. These costs include travel expenses and can sit in different places in the cost ledger. 20. These four E&T resources should be allocated to E&T activities using the prescribed allocation methods in Spreadsheet ET3.5 in the technical document. 21. You need to develop relative weight values to use these prescribed allocation methods to apportion E&T resources to different E&T activities; for example, apportioning the E&T provision resource to E&T administration for students and E&T administration for trainees. 22. Use the information collected from information feeds 1a, 1b and 2 to inform the development of these relative weight values. 28 E&T3: Appropriate cost allocation methods

31 Apportionment of resources that deliver both E&T and non-e&t activities 23. In many cases resources deliver both E&T and non-e&t activities. Therefore you need to identify these resources and be consistent in how you apportion each resource between: E&T only activities other activities. 24. By populating your cost ledger with the information from feed 3 (Spreadsheet ET1.5 in the technical document) you will have identified in your cost ledger the resources that deliver both E&T and other activities. 25. Work with your finance colleagues, health professionals and service managers to identify the correct apportionment of cost between E&T and other activities. 26. Use job plans or other sources of information to inform your apportionment values. Figure E&T3.2 below shows what this apportionment looks like. 27. This apportionment should happen at resource level, not costing account code level. 28. Patient-facing resources can also be used to deliver E&T activities for: medical and dental trainees as listed in Spreadsheet ET3.2 in the technical document medical undergraduates and non-medical trainees and students as listed in Spreadsheet ET3.3 in the technical document. 29. Only human resources in the prescribed patient-facing resources are considered when costing the delivery of E&T activities. For example, patient consumables and facilities are considered necessary for the delivery of patient and therefore are not considered when costing the delivery of E&T activities. 29 E&T3: Appropriate cost allocation methods

32 Figure E&T3.2: Apportionment between E&T and other activities (apportionment 1) Patient-facing 80% Patient-facing Consultant 100,000 other Ward rounds 25% Theatre 25% Cancer MDTs 10% Outpatients 20% Ward 25,000 Theatre - surgical 25,000 Cancer multidisciplinary meeting 10,000 Outpatient 20,000 E&T only Legend E&T only Shared between E&T and patient E&T 20% Courses and practices 15% Assessment and 5% follow-up E&T Courses and practices 15,000 Assessment and follow-up 5,000 E&T activities 30. Five E&T activities are described in Spreadsheet ET3.4 in the technical document: ETA001: E&T administration for trainees (salaried) ETA002: E&T administration for students (non-salaried) ETA003: Courses and practices ETA004: Assessment and follow-up ETA005: Training while delivering. 30 E&T3: Appropriate cost allocation methods

33 31. E&T activities can be delivered in a variety of settings, including: direct teaching in a lecture room supervision meetings and sessions in office settings teaching while delivering patient across all health settings, from ward to theatre, home visits to therapies, giving clinical advice on the phone to conveying patients to where they will be treated. 32. E&T administration includes the range of activities providing administrative support for the provision of E&T programmes, including recruitment of trainees, induction and ongoing administrative support for the programmes. Activities for E&T administration for students and trainees are prescribed separately. 33. The other three E&T activities, ETA003: Courses and practices, ETA004: Assessment and follow-up and ETA005: Training while delivering, consist of two elements: delivering teaching and training being taught and supervised. 34. ETA003: Courses and practices activity includes all lecture room-based direct teaching activities and practice sessions in a simulated clinical environment. 35. Information Feed 4a and 4b: Courses and practices informs this activity. 36. ETA004: Assessment and follow-up activity includes assessment sessions, marking papers, supervision meetings and mentoring meetings. 37. Feed 5: Assessments and follow-up and Feed 6: Supervision and assessments inform this activity. 38. ETA005: Training while delivering is discussed further in Standard E&T4: Patient versus E&T apportionments. 39. Use the E&T information feeds to build into your costing system the rules about when and how frequently each E&T activity occurs. 31 E&T3: Appropriate cost allocation methods

34 40. The E&T information feeds may not contain all the information needed to identify when E&T activities have taken place. Record in your costing manual any additional information you use to record E&T activities. Allocation of E&T and patient-facing resources to E&T activities 41. Resources should be allocated to E&T activities using the prescribed allocation methods in Spreadsheet ET3.5 in the technical document. 42. You need to develop relative weight values to use the prescribed cost allocation methods to apportion resources to different E&T activities (see Figure E&T3.2 above). 43. Use the information collected from E&T information feeds 1 to 6 to inform the development of these relative weight values. 44. Column I in Spreadsheet ET3.5 in the technical document indicates whether the information source is a prescribed information feed or another source is required. 45. Table E&T3.1 shows the resource/activity combinations for E&T-only resources (extracted from Spreadsheet ET3.5 in the technical document). Table E&T3.1: Resource/activity combinations for E&T-only resources and activities Link ID Resource Activity ETR400 ETA001 E&T provision E&T administration for trainees ETR400 ETA002 E&T provision E&T administration for students ETR400 ETA003 E&T provision Courses and practices ETR400 ETA004 E&T provision Supervision and assessments ETR401 ETA003 E&T facilities Courses and practices ETR401 ETA004 E&T facilities Supervision and assessments ETR401-ETA005 E&T facilities Training while delivering patient ETR402 ETA003 E&T teaching Courses and practices 32 E&T3: Appropriate cost allocation methods

35 Link ID Resource Activity ETR402 ETA004 E&T teaching Supervision and assessments ETR403 ETA003 E&T external conferences and courses Courses and practices 46. Table ET3.2 shows the resource/activity combinations for patient-facing resources and E&T activities (extracted from Spreadsheet ET3.5 in the technical document). Table E&T3.2: Resource/activity combinations for patient-facing resources (all sectors) and E&T activities Link ID Resource Activity AMR137 ETA003 Frontline staff Band 3 and below AMR137 ETA004 Frontline staff Band 3 and below AMR137 ETA005 Frontline staff Band 3 and below Courses and practices Supervision and assessments Training while delivering patient AMR138 ETA003 Frontline staff Band 4 Courses and practices AMR138 ETA004 Frontline staff Band 4 Supervision and assessments AMR138 ETA005 Frontline staff Band 4 Training while delivering patient AMR139 ETA003 Frontline staff Band 5 Courses and practices AMR139 ETA004 Frontline staff Band 5 Supervision and assessments AMR139 ETA005 Frontline staff Band 5 Training while delivering patient AMR140 ETA003 Frontline staff Band 6 Courses and practices AMR140 ETA004 Frontline staff Band 6 Supervision and assessments AMR140 ETA005 Frontline staff Band 6 Training while delivering patient AMR141 ETA003 Frontline staff Band 7 Courses and practices 33 E&T3: Appropriate cost allocation methods

36 Link ID Resource Activity AMR141 ETA004 Frontline staff Band 7 Supervision and assessments AMR141 ETA005 Frontline staff Band 7 Training while delivering patient AMR142 ETA003 AMR142 ETA004 AMR142 ETA005 AMR143 ETA003 AMR143 ETA004 AMR143 ETA005 Frontline staff Officer or manager Frontline staff Officer or manager Frontline staff Officer or manager Frontline staff Non- AfC Frontline staff Non- AfC Frontline staff Non- AfC Courses and practices Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments Training while delivering patient CLR013 ETA003 Radiographer Courses and practices CLR013 ETA004 Radiographer Supervision and assessments CLR013 ETA005 Radiographer Training while delivering patient CLR014 ETA003 Radiography assistant Courses and practices CLR014 ETA004 Radiography assistant Supervision and assessments CLR014 ETA005 Radiography assistant Training while delivering patient CLR015 ETA003 Technician Courses and practices CLR015 ETA004 Technician Supervision and assessments CLR015 ETA005 Technician Training while delivering patient CLR017 ETA003 Clinical scientist Courses and practices CLR017 ETA004 Clinical scientist Supervision and assessments 34 E&T3: Appropriate cost allocation methods

37 Link ID Resource Activity CLR017 ETA005 Clinical scientist Training while delivering patient CLR018 ETA003 Medical physicist Courses and practices CLR018 ETA004 Medical physicist Supervision and assessments CLR018 ETA005 Medical physicist Training while delivering patient CLR019 ETA003 Other clinical staff Courses and practices CLR019 ETA004 Other clinical staff Supervision and assessments CLR019 ETA005 Other clinical staff Training while delivering patient CLR020 ETA003 Clinical photographer Courses and practices CLR020- ETA004 Clinical photographer Supervision and assessments CLR020 ETA005 Clinical photographer Training while delivering patient CLR022 ETA003 Sonographer Courses and practices CLR022 ETA004 Sonographer Supervision and assessments CLR022 ETA005 Sonographer Training while delivering patient CMR300 ETA003 School nurse Courses and practices CMR300 ETA004 School nurse Supervision and assessments CMR300 ETA005 School nurse Training while delivering patient CMR301 ETA003 Health visitor Courses and practices CMR301 ETA004 Health visitor Supervision and assessments CMR301 ETA005 Health visitor Training while delivering patient CMR304 ETA003 Community nurse/ district nurse Courses and practices 35 E&T3: Appropriate cost allocation methods

38 Link ID Resource Activity CMR304 ETA004 CMR304 ETA005 CMR305 ETA003 CMR305 ETA004 CMR305 ETA005 Community nurse/ district nurse Community nurse/ district nurse Community psychiatric nurse (CPN) Community psychiatric nurse (CPN) Community psychiatric nurse (CPN) Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments Training while delivering patient MDR031 ETA003 Neurophysicist Courses and practices MDR031 ETA004 Neurophysicist Supervision and assessments MDR031 ETA005 Neurophysicist Training while delivering patient MDR032 ETA003 MDR032 ETA004 MDR032 ETA005 Neurophysiologist assistant Neurophysiologist assistant Neurophysiologist assistant Courses and practices Supervision and assessments Training while delivering patient MDR033 ETA003 Dietician Courses and practices MDR033 ETA004 Dietician Supervision and assessments MDR033 ETA005 Dietician Training while delivering patient MDR034 ETA003 Optometrist Courses and practices MDR034 ETA004 Optometrist Supervision and assessments MDR034 ETA005 Optometrist Training while delivering patient MDR035 ETA003 Orthoptist Courses and practices MDR035 ETA004 Orthoptist Supervision and assessments 36 E&T3: Appropriate cost allocation methods

39 Link ID Resource Activity MDR035 ETA005 Orthoptist Training while delivering patient MDR037 ETA003 Orthotics assistant Courses and practices MDR037 ETA004 Orthotics assistant Supervision and assessments MDR037 ETA005 Orthotics assistant Training while delivering patient MDR038 ETA003 Orthotist Courses and practices MDR038 ETA004 Orthotist Supervision and assessments MDR038 ETA005 Orthotist Training while delivering patient MDR039 ETA003 Audiologist Courses and practices MDR039 ETA004 Audiologist Supervision and assessments MDR039 ETA005 Audiologist Training while delivering patient MDR040 ETA003 Audiology assistant Courses and practices MDR040 ETA004 Audiology assistant Supervision and assessments MDR040 ETA005 Audiology assistant Training while delivering patient MDR042 ETA003 Pharmacist Courses and practices MDR042 ETA004 Pharmacist Supervision and assessments MDR042 ETA005 Pharmacist Training while delivering patient MDR043 ETA003 Pharmacy assistant Courses and practices MDR043 ETA004 Pharmacy assistant Supervision and assessments MDR043 ETA005 Pharmacy assistant Training while delivering patient MDR053 ETA003 Dental laboratory technician Courses and practices 37 E&T3: Appropriate cost allocation methods

40 Link ID Resource Activity MDR053 ETA004 MDR053 ETA005 Dental laboratory technician Dental laboratory technician Supervision and assessments Training while delivering patient MDR054 ETA003 Pharmacy technician Courses and practices MDR054 ETA004 Pharmacy technician Supervision and assessments MDR054 ETA005 Pharmacy technician Training while delivering patient MDR055 ETA003 Chiropodist Courses and practices MDR055 ETA004 Chiropodist Supervision and assessments MDR055 ETA005 Chiropodist Training while delivering patient MDR056 ETA003 Chiropody assistant Courses and practices MDR056 ETA004 Chiropody assistant Supervision and assessments MDR056 ETA005 Chiropody assistant Training while delivering patient MDR057 ETA003 Dentist Courses and practices MDR057 ETA004 Dentist Supervision and assessments MDR057 ETA005 Dentist Training while delivering patient MDR058 ETA003 Dental nurse Courses and practices MDR058 ETA004 Dental nurse Supervision and assessments MDR058 ETA005 Dental nurse Training while delivering patient MHR250 ETA003 Psychiatric nurse Courses and practices MHR250 ETA004 Psychiatric nurse Supervision and assessments MHR250 ETA005 Psychiatric nurse Training while delivering patient MHR252 ETA003 Support worker Courses and practices 38 E&T3: Appropriate cost allocation methods

41 Link ID Resource Activity MHR252 ETA004 Support worker Supervision and assessments MHR252 ETA005 Support worker Training while delivering patient MHR253 ETA003 Consultant MH Courses and practices MHR253 ETA004 Consultant MH Supervision and assessments MHR253 ETA005 Consultant MH Training while delivering patient MHR256 ETA003 Nurse manager Courses and practices MHR256 ETA004 Nurse manager Supervision and assessments MHR256 ETA005 Nurse manager Training while delivering patient MHR257 ETA003 Primary MH worker Courses and practices MHR257 ETA004 Primary MH worker Supervision and assessments MHR257 ETA005 Primary MH worker Training while delivering patient MHR258 ETA003 Support assistant Courses and practices MHR258 ETA004 Support assistant Supervision and assessments MHR258 ETA005 Support assistant Training while delivering patient MHR260 ETA003 Counsellor Courses and practices MHR260 ETA004 Counsellor Supervision and assessments MHR260 ETA005 Counsellor Training while delivering patient MHR262 ETA003 Nursery nurse Courses and practices MHR262 ETA004 Nursery nurse Supervision and assessments MHR262 ETA005 Nursery nurse Training while delivering patient SGR062 ETA003 Consultant Courses and practices 39 E&T3: Appropriate cost allocation methods

42 Link ID Resource Activity SGR062 ETA004 Consultant Supervision and assessments SGR062 ETA005 Consultant Training while delivering patient SGR063 ETA003 SGR063 ETA004 SGR063 ETA005 medical staff medical staff medical staff Courses and practices Supervision and assessments Training while delivering patient SGR064 ETA003 Consultant Anaesthetist SGR064 ETA004 Consultant Anaesthetist SGR064 ETA005 Consultant Anaesthetist Courses and practices Supervision and assessments Training while delivering patient SGR065 ETA003 SGR065 ETA004 SGR065 ETA005 SGR066 ETA003 SGR066 ETA004 SGR066 ETA005 SGR067 ETA003 SGR067 ETA004 medical staff Anaesthetist medical staff Anaesthetist Non consultant medical staff Anaesthetist Operating department assistant Operating department assistant Operating department assistant Operating department practitioners Operating department practitioners Courses and practices Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments 40 E&T3: Appropriate cost allocation methods

43 Link ID Resource Activity SGR067 ETA005 Operating department practitioners Training while delivering patient SGR068 ETA003 Perfusionist Courses and practices SGR068 ETA004 Perfusionist Supervision and assessments SGR068 ETA005 Perfusionist Training while delivering patient SGR069 ETA003 Perfusion assistant Courses and practices SGR069 ETA004 Perfusion assistant Supervision and assessments SGR069 ETA005 Perfusion assistant Training while delivering patient SLR081 ETA003 Nurse Courses and practices SLR081 ETA004 Nurse Supervision and assessments SLR081 ETA005 Nurse Training while delivering patient SLR082 ETA003 Specialist nurse Courses and practices SLR082 ETA004 Specialist nurse Supervision and assessments SLR082 ETA005 Specialist nurse Training while delivering patient SLR083 ETA003 SLR083 ETA004 SLR083-ETA005 Advanced nurse practitioner Advanced nurse practitioner Advanced nurse practitioner Courses and practices Supervision and assessments Training while delivering patient SLR084 ETA003 Health assistant Courses and practices SLR084 ETA004 Health assistant Supervision and assessments SLR084 ETA005 Health assistant Training while delivering patient SLR085 ETA003 Midwife Courses and practices 41 E&T3: Appropriate cost allocation methods

44 Link ID Resource Activity SLR085 ETA004 Midwife Supervision and assessments SLR085 ETA005 Midwife Training while delivering patient SLR090 ETA003 Psychologist Courses and practices SLR090 ETA004 Psychologist Supervision and assessments SLR090 ETA005 Psychologist Training while delivering patient SLR092 ETA003 SLR092 ETA004 SLR092 ETA005 Orthopaedic casting team Orthopaedic casting team Orthopaedic casting team Courses and practices Supervision and assessments Training while delivering patient SLR093 ETA003 Safeguarding Courses and practices SLR093 ETA004 Safeguarding Supervision and assessments SLR093 ETA005 Safeguarding Training while delivering patient SLR096 ETA003 Assistant psychologist Courses and practices SLR096 ETA004 Assistant psychologist Supervision and assessments SLR096 ETA005 Assistant psychologist Training while delivering patient SLR097 ETA003 Neuropsychologist Courses and practices SLR097 ETA004 Neuropsychologist Supervision and assessments SLR097 ETA005 Neuropsychologist Training while delivering patient THR001 ETA003 Therapist Courses and practices THR001 ETA004 Therapist Supervision and assessments THR001 ETA005 Therapist Training while delivering patient 42 E&T3: Appropriate cost allocation methods

45 Link ID Resource Activity THR002 ETA003 Therapy assistant Courses and practices THR002 ETA004 Therapy assistant Supervision and assessments THR002-ETA005 Therapy assistant Training while delivering patient THR003 ETA003 Physiotherapist Courses and practices THR003 ETA004 Physiotherapist Supervision and assessments THR003 ETA005 Physiotherapist Training while delivering patient THR004 ETA003 Physiotherapy assistant Courses and practices THR004 ETA004 Physiotherapy assistant Supervision and assessments THR004 ETA005 Physiotherapy assistant Training while delivering patient THR005 ETA003 Occupational therapist Courses and practices THR005 ETA004 Occupational therapist Supervision and assessments THR005 ETA005 Occupational therapist Training while delivering patient THR006 ETA003 THR006 ETA004 THR006 ETA005 THR007 ETA003 THR007 ETA004 THR007 ETA005 THR008 ETA003 Occupational therapy assistant Occupational therapy assistant Occupational therapy assistant Speech and language therapist Speech and language therapist Speech and language therapist Speech and language therapy assistant Courses and practices Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments Training while delivering patient Courses and practices 43 E&T3: Appropriate cost allocation methods

46 Link ID Resource Activity THR008 ETA004 THR008 ETA005 Speech and language therapy assistant Speech and language therapy assistant Supervision and assessments Training while delivering patient THR009 ETA003 Psychotherapist Courses and practices THR009 ETA004 Psychotherapist Supervision and assessments THR009 ETA005 Psychotherapist Training while delivering patient THR010 ETA003 Play therapist Courses and practices THR010 ETA004 Play therapist Supervision and assessments THR010 ETA005 Play therapist Training while delivering patient THR011 ETA003 Play therapy assistant Courses and practices THR011 ETA004 Play therapy assistant Supervision and assessments THR011 ETA005 Play therapy assistant Training while delivering patient THR012 ETA003 Art therapist Courses and practices THR012 ETA004 Art therapist Supervision and assessments THR012 ETA005 Art therapist Training while delivering patient THR013 ETA003 Music therapist Courses and practices THR013 ETA004 Music therapist Supervision and assessments THR013 ETA005 Music therapist Training while delivering patient THR014 ETA003 Family therapist Courses and practices THR014 ETA004 Family therapist Supervision and assessments THR014 ETA005 Family therapist Training while delivering patient 44 E&T3: Appropriate cost allocation methods

47 Link ID Resource Activity THR015 ETA003 THR015 ETA004 THR015 ETA005 THR016 ETA003 THR016 ETA004 THR016 ETA005 Cognitive behavioural therapist Cognitive behavioural therapist Cognitive behavioural therapist Emotional and wellbeing therapist Emotional and wellbeing therapist Emotional and wellbeing therapist Courses and practices Supervision and assessments Training while delivering patient Courses and practices Supervision and assessments Training while delivering patient THR017 ETA003 Practitioner Courses and practices THR017 ETA004 Practitioner Supervision and assessments THR017 ETA005 Practitioner Training while delivering patient THR018 ETA003 Assistant practitioner Courses and practices THR018 ETA004 Assistant practitioner Supervision and assessments THR018 ETA005 Assistant practitioner Training while delivering patient 47. Table E&T3.3 below is an example of the output for E&T costs for a trainee group (medical postgraduate, emergency medicine, ST1) in the resource and activity matrix. 45 E&T3: Appropriate cost allocation methods

48 Table E&T3.3: Example E&T costs in the resource and activity matrix Activity Resource Consultant Nonconsultant medical staff Nurse E&T facilities E&T teaching E&T provisions E&T administration trainees XX Courses and practices Assessment and follow-up Training while delivering patient XX XX XX X XX XX X XX XX XX Other considerations Loss of productivity 48. We understand many clinicians ask how the costing process reflects the loss of productivity when delivering patient in conjunction with E&T. 49. We define loss of productivity as the additional time it takes to deliver patient when trainees and students are present. 50. Loss of productivity costs are not reported in the general ledger. 51. Loss of productivity is a performance measure. As with other performance measures, the information needed to calculate it can be obtained from sources other than costing. 52. An example is over or underutilised theatre sessions. We do not cost theatre underutilisation in the costing process and instead report this in a higher cost per minute per patient. 46 E&T3: Appropriate cost allocation methods

49 53. In a similar vein we believe any E&T-related loss of productivity can be measured by either the reduced income from seeing fewer patients in the allotted time or the higher cost per procedure as each takes longer. 54. We consider that if the percentage loss of productivity from training is to be calculated and included in the costing process, the amount by which nonmedical consultant staff increase productivity also needs to be calculated. Many clinics are run in the name of consultants but staffed by junior doctors who, by seeing patients, generate income for their service. 55. The key question is: What impact would withdrawal of non-consultant medical staff have on a service? If the service would be dramatically reduced or even closed, this indicates junior doctors are making a sizeable contribution to a service. 56. In this version of the standards we state that the net cost of the loss of productivity due to delivering E&T and the contribution made by nonconsultant is zero. 57. If you currently cost loss of productivity and this is useful to your organisation, continue to do so as we have adopted it as a superior method. As with all adopted superior methods, we do not provide guidance on how to do it. 47 E&T3: Appropriate cost allocation methods

50 E&T4: Patient versus E&T apportionments Purpose: To ensure patient and E&T are apportioned in a consistent way. Objectives 1. To ensure patient and E&T are apportioned in a consistent way when health professionals deliver training while delivering patient. 2. To ensure patient and E&T are apportioned in a consistent way when Scope health professionals receive training while delivering patient. 3. All health professionals who deliver training while delivering patient. 4. All health professionals who receive training while delivering patient. 5. Health professionals who receive training in a clinical setting but do not deliver patient should not be included in the apportionment. Overview 6. Use the apportionments of patient versus training for the trainees listed in Spreadsheets ET4.1 to ET4.3 in the technical document unless you have better local information to inform your apportionments. 7. When calculating the patient versus training apportionment, assume no procedure is undertaken solely for education purposes and therefore clinical delivery is the same whether or not trainees and/or students are present. 48 E&T4: Patient versus E&T apportionments

51 8. Delivering training while delivering patient is defined as when: The health professional delivering the patient stops talking to or treating the patient and instead addresses the trainees and/or students. This time is counted as E&T. Trainees and/or students have the opportunity to talk to the patient. This time is counted as E&T. 9. When trainees and/or students are observing and the health professional delivering the patient is talking to the patient, this time is counted as patient. 10. Receiving training while delivering patient is defined as when: a senior health professional is in attendance and observing or instructing the health professional receiving training is actively involved in delivering the patient the health professional receiving training is not backfilling for other staff members. 11. If the trainee or student is the named health professional in the patientlevel feeds, this is counted as patient. 12. We recognise that in many instances patient and E&T are delivered simultaneously. Where this is the case, use the survey template in Spreadsheet Appendix ET4 to ET6 in the technical document to survey and inform the apportionment between patient and E&T. 13. If you use a superior local apportionment, this should be based on the understanding stated earlier that clinical delivery is the same whether or not trainees and/or students are present. 14. If patient and E&T are delivered simultaneously and you are unable to determine an appropriate apportionment between the two, classify the cost as patient. 15. Do not calculate the loss of productivity for health professionals delivering training while delivering patient. We consider the loss of productivity for 49 E&T4: Patient versus E&T apportionments

52 health professionals delivering training while delivering patient and the contribution to productivity made by health professionals in training to have a net value of zero. 16. Where clinics or sessions over run due to the presence of trainees and/or students, this overrun will be captured by the relevant patient-level feed that collects duration and costed using patient-level costing. 17. The overrun time is counted as patient because there are many reasons why clinics and sessions overrun and it is too subjective to put this down solely to the presence of trainees and/or students. 18. At times trainees may deliver training while delivering patient to more junior trainees and/or students. Work with your clinical leads, service managers and education leads to see if this is the case for your organisation. 19. Where the standard states a cost is counted as patient, this means that 100% of the cost should be reported against patient and nothing apportioned to E&T. 20. Where the standard states a cost is counted as E&T, this does not mean that 100% of the cost is reported against E&T. Instead, the apportionment is applied and a proportion reported against E&T and the rest against patient. What you need to implement this standard Spreadsheet ET1.10a to ET1.10d: Flag of whether student(s) or trainee(s) present in patient-facing activity feeds across all sectors Spreadsheet ET4.1: Patient versus training split for postgraduate medical and dental programmes Spreadsheet ET4.2: Patient versus training split for non-medical postgraduate programmes Spreadsheet ET4.3: Patient versus training split for foundation year postgraduate medical and dental programmes 50 E&T4: Patient versus E&T apportionments

53 Approach Health professionals delivering training while delivering patient Apportionment of resources to be allocated to E&T-only activities and other activities (apportionment 1) 21. Figure E&T3.2 in Standard E&T3: Appropriate cost allocation methods is an example of the apportionment of the costs of a consultant resource between E&T and non-e&t activities. 22. As E&T activity can be delivered while delivering patient, a further apportionment for E&T activities from the patient-facing activities is needed. Apportionment of resources to be allocated to activities with trainees and/or students present and not present (apportionment 2) 23. The quantum of costs apportioned to delivering patient needs to be apportioned further between: delivering patient only (trainees and/or students not present) delivering both patient and E&T (trainees and/or students present). 24. Figure E&T4.1 below shows the proportion of cost and activity this second step relates to. 25. Use the flag trainees/students present in the patient-level feeds (see Spreadsheet ET1.10a to ET1.10d in the technical document) to identify when trainees and/or students were present in clinical settings. 51 E&T4: Patient versus E&T apportionments

54 Figure E&T4.1: Identifying the correct quantum of cost to be apportioned to E&T activities (apportionment 2) Patient-facing Ward 25,000 Theatre - surgical 25,000 Cancer multidisciplinary meeting 10,000 Legend Outpatient 20,000 Shared between E&T and patient Patient only Patient only (students/ trainees not present) Ward 30% Theatre surgical 80% Cancer MDTs 100% Outpatients 30% Students/trainee not present Students/trainee present Students/trainees present Ward 70% Theatre surgical 20% Cancer MDTs 0 Outpatients 70% No students/trainees present Ward 7,500 Theatre - surgical 20,000 Cancer multidisciplinary meeting 10,000 Outpatient 6,000 Students/trainees present Ward 17,500 Theatre - surgical 5,000 Cancer multidisciplinary meeting 0 Outpatient 14,000 Apportionment of resources to be allocated to patient and E&T for activities with trainees and/or students present (apportionment 3) 26. The quantum of costs apportioned to delivering patient activities with trainees and/or students present needs to be apportioned further between: patient (% reported as patient where trainees and/or students were present) E&T (% reported as training while delivering ). 27. Figure E&T4.2 shows the apportionment of cost this third step relates to. 52 E&T4: Patient versus E&T apportionments

55 Figure E&T4.2: Identifying the correct quantum of cost to be apportioned to patient and teaching while delivering (apportionment 3) 28. Work with clinical leads, service managers and education leads to build profiles of the cohort of trainees and students for each clinical setting, including: number of students by course and year of study number of trainees by course and year of training type of programme. Use these to develop the relative weight values. 29. Figure E&T4.3 shows the full apportionment process from the start (fully absorbed costs for a consultant) to the allocation of the correct quantum of costs for each activity. A larger version can be found in Spreadsheet ET4.4 in the technical document. 53 E&T4: Patient versus E&T apportionments

56 Figure E&T4.3: Full apportionment process of resources for E&T activities Legend No students/trainees present Patient Patient-facing activities E&T only Shared between E&T and patient Patient only Students/trainee not present Patient only (students/ trainees not present) Ward 30% Theatre surgical 80% Cancer MDTs 100% Outpatients 30% Ward 7,500 Theatre - surgical 20,000 Cancer multidisciplinary meeting 10,000 Outpatient 6,000 Patient : Ward rounds 80% Theatre 90% Cancer MDTs 0 Outpatients 80% Ward 14,000 Theatre - surgical 4,500 Cancer multidisciplinary meeting 0 Outpatient 11,200 Ward 21,500 Theatre surgical 24,500 Cancer multidisciplinary meeting 10,000 Outpatient 17,200 Patient Patient-facing 80% Patient-facing Students/trainee present Students/trainees present Consultant 100,000 other Ward rounds 25% Theatre 25% Cancer MDTs 10% Outpatients 20% Ward 25,000 Theatre - surgical 25,000 Cancer multidisciplinary meeting 10,000 Students/trainees present Ward 70% Theatre surgical 20% Cancer MDTs 0 Outpatients 70% Ward 17,500 Theatre - surgical 5,000 Cancer multidisciplinary meeting 0 Outpatient 20,000 Outpatient 14,000 E&T only Teaching while delivering E&T 20% Courses and practices 15% Assessment and 5% follow-up E&T Courses and practices 15,000 Assessment and follow-up 5,000 Teaching while delivering : Ward rounds 20% Theatre 10% Cancer MDTs 0 Outpatients 20% Teaching while delivering Ward 3,500 Theatre - surgical 500 Cancer multidisciplinary meeting 0 Outpatient 2,800 E&T activities Courses and practices 15,000 Assessment and follow-up 5,000 Teaching while delivering 6, E&T4: Patient versus E&T apportionments

57 Example As an example, for outpatient clinics apportionments 2 and 3 are as follows: outpatient clinic A is flagged Y (yes) indicating that students/trainees are present the outpatient quantum of cost for the named health professional for that clinic is apportioned between patient and E&T activities using the HEE research-informed relative weight value the E&T profile for that clinic shows how many students and trainees are present and their respective programmes the resource is consultant and this is linked to the activity outpatient a resource/activity combination needs to be activated for each E&T group/programme and the E&T outpatient quantum of cost allocated to each activity using the prescribed methods in Spreadsheet ET3.5 in the technical document. Figure E&T4.4: Example Apportionment of service versus training resources for outpatient clinics % allocated to patient where trainees/students not present Patient A based on duration Patient B based on duration Consultant's outpatient quantum of cost % allocated to patient where trainees/students present Patient C based on duration Patient D based on duration % allocated to E&T activitity for trainees/students present E&T group A E&T group B Table E&T4.1 shows all the patient-facing activities that the consultant resource can deliver. 55 E&T4: Patient versus E&T apportionments

58 Table E&T4.1: Patient-facing activities that the consultant resource can deliver Resource and activity link ID Resource Activity Prescribed patient-level feed SGR062 CLA014 Consultant Cardiac magnetic resonance imaging (MRI) Diagnostic imaging SGR062 CLA015 Consultant Computed tomography scan (CT) Diagnostic imaging SGR062 CLA016 Consultant DEXA scan Diagnostic imaging SGR062 CLA017 Consultant Mammogram Diagnostic imaging SGR062 CLA018 Consultant Magnetic resonance imaging (MRI) Diagnostic imaging SGR062 CLA019 Consultant Nuclear medicine Radionuclide imaging Diagnostic imaging SGR062 CLA020 Consultant Other diagnostic imaging Diagnostic imaging SGR062 CLA021 Consultant Ultrasound (non-obstetric) Diagnostic imaging SGR062 CLA022 Consultant Obstetrics ultrasound Diagnostic imaging SGR062 CLA023 Consultant X-ray Diagnostic imaging SGR062 CLA024 Consultant X-ray fluoroscopy Diagnostic imaging SGR062 CLA025 Consultant Microbiology testing Pathology SGR062 CLA026 Consultant Non-gynae cytology testing Pathology SGR062 CLA027 Consultant Organ transplantation compatibility testing Pathology 56 E&T4: Patient versus E&T apportionments

59 Resource and activity link ID Resource Activity Prescribed patient-level feed SGR062 CLA029 Consultant Serology testing Pathology SGR062 CLA031 Consultant Toxicology testing Pathology SGR062 CLA032 Consultant Virology testing Pathology SGR062 CLA036 Consultant Biochemistry testing Pathology SGR062 CLA037 Consultant Bone marrow transplantation compatibility testing Pathology SGR062 CLA038 Consultant Cellular pathology testing Pathology SGR062 CLA039 Consultant Cytology testing Pathology SGR062 CLA040 Consultant Other pathology testing Pathology SGR062 CLA041 Consultant Genetics testing Pathology SGR062 CLA042 Consultant Haematology testing Pathology SGR062 CLA043 Consultant Histopathology testing Pathology SGR062 CLA044 Consultant Immunology testing Pathology SGR062 CLA048 Consultant Urodynamic investigations APC/NAPC SGR062 CLA051 Consultant Nuclear medicine Radionuclide therapy NAPC SGR062 CLA052 Consultant Nuclear medicine Non-imaging radionuclide tests Diagnostic imaging 57 E&T4: Patient versus E&T apportionments

60 Resource and activity link ID Resource Activity Prescribed patient-level feed SGR062 CLA054 Consultant Neonatal pathology screening Pathology SGR062 CLA056 Consultant Histocompatibility and immunogenetics assessment Pathology SGR062 CLA057 Consultant Positron emission tomography (PET) Diagnostic imaging SGR062 CLA058 Consultant Fusion imaging Diagnostic imaging SGR062 CLA150 Consultant Mortuary services Admitted patient (APC) SGR062 MDA069 Consultant Refraction testing Diagnostic imaging SGR062 MDA070 Consultant A-scan biometry Diagnostic imaging SGR062 MDA071 Consultant Corneal topography Diagnostic imaging SGR062 MDA072 Consultant Optical coherence tomography (OCT) scan Diagnostic imaging SGR062 MDA080 Consultant Ophthalmic electrodiagnostic test Diagnostic imaging SGR062 SGA081 Consultant Theatre Surgical Theatres SGR062 SLA098 Consultant Ward round Ward stay SGR062 SLA099 Consultant Supporting contact Supporting contact SGR062 SLA102 Consultant Other non face-to-face contact Non-admitted patient (NAPC) SGR062 SLA104 Consultant Adult critical Medical Adult critical 58 E&T4: Patient versus E&T apportionments

61 Resource and activity link ID Resource Activity Prescribed patient-level feed SGR062 SLA106 Consultant Critical journey Critical transport SGR062 SLA109 Consultant Neonatal critical Medical Neonatal critical SGR062 SLA114 Consultant Paediatric critical Medical Paediatric critical SGR062 SLA118 Consultant Direct access services Pathology feed/diagnostic imaging SGR062 SLA121 Consultant A&E Medical A&E attendances SGR062 SLA122 Consultant Clinical decisions unit (CDU) Medical Ward stay SGR062 SLA125 Consultant Minor injuries unit (MIU) Medical Ward stay SGR062 SLA127 Consultant Cancer multidisciplinary meeting (MDT) Cancer MDT SGR062 SLA128 Consultant Other multidisciplinary meeting Local information source SGR062 SLA129 Consultant External beam radiotherapy delivery APC/NAPC SGR062 SLA131 Consultant Screening Pathology SGR062 SLA132 Consultant Endoscopy APC/NAPC SGR062 SLA134 Consultant Cardiac catheterisation laboratory Diagnostic imaging SGR062 SLA135 Consultant Outpatient NAPC SGR062 SLA136 Consultant Outpatient procedure NAPC 59 E&T4: Patient versus E&T apportionments

62 Resource and activity link ID Resource Activity Prescribed patient-level feed SGR062 SLA137 Consultant Other specialist procedure suites APC/NAPC SGR062 SLA138 Consultant Renal dialysis APC/NAPC SGR062 SLA139 Consultant Brachytherapy radiotherapy delivery APC/NAPC SGR062 SLA143 Consultant Pain management NAPC/supporting contacts SGR062 SLA145 Consultant High dependency unit Medical Adult/paediatric/neonatal critical SGR062 SLA146 Consultant Birthing suite APC SGR062 SLA149 Consultant Telemedicine contact NAPC SGR062 SLA151 Consultant Preoperative assessment NAPC SGR062 SPA152 Consultant Did not attend (DNA) DNA SGR062 SPA162 Consultant Infection control Supporting contact 60 E&T4: Patient versus E&T apportionments

63 Health professionals receiving training while delivering patient Apportionment of resources to be allocated to E&T only and other activities 30. Using the example of a non-consultant member, we have already apportioned their costs between their E&T activity and other activities. 31. Figure E&T4.5 shows the stage we have reached. Figure E&T4.5: Apportionment of E&T and other activities (apportionment 1) Patient-facing 50% Patient-facing Nonconsultant 50,000 other Ward rounds 25% Theatre 5% Outpatients 20% Ward 12,500 Theatre - surgical 2,500 Outpatient 10,000 E&T only E&T 50% Courses and practices 40% Assessment and 10% follow-up E&T Courses and practices 20,000 Legend E&T only Shared between E&T and patient Assessment and follow-up 5, Because training can be received while delivering patient, a second apportionment for E&T activities is needed. 61 E&T4: Patient versus E&T apportionments

64 Apportionment of resources to be allocated to patient and E&T 33. This means that the quantum of costs apportioned to delivering patient needs to be apportioned again as follows: receiving training while delivering patient (and % reported as E&T activity) delivering patient (% reported as patient ). 34. Figure E&T4.6 shows the proportion of cost and activity this second step relates to. Figure E&T4.6: Apportionment of costs of patient and receiving training while delivering (apportionment 2) 62 E&T4: Patient versus E&T apportionments