Mental health development PLICS cost collection guidance 2017/18

Mental health development PLICS cost collection guidance 2017/18 April 2018

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

Contents 1. Introduction... 2 2. Scope... 4 3. Collection timetable... 9 4. Applying the Healthcare costing standards mental health... 10 5. Information governance... 11 6. Treatment of specific costs and services/ activities: additional guidance... 14 7. Reconciliation tables... 17 8. Collection extract files overview... 21 1 > 1. Introduction

1. Introduction Purpose of this guidance This guidance gives the technical specifications we are asking mental health early implementers and roadmap partners to adhere to for a patient-level information and costing systems (PLICS) collection in autumn 2018. We specify the scope of the collection and provide additional guidance to support the consistent allocation of costs. The guidance covers: the collection s scope NHS Digital s role how we will use the data collection specification files how to report specific costs. We do not cover the submission process and data validations; we will provide details of these topics later in the year. Background The NHS in England currently makes one national cost collection for mental health the national cost collection (reference costs). The education and training cost return is not required for 2018, but it will be required in 2019. One common issue for providers in the 2015/16 reference costs collection was their costing approaches not aligning with our approved costing guidance. Inaccurate costing approaches can distort the national average. In response to this issue, we are developing the collection with a view to moving to a patient-level mental health collection by 2019/20. This will improve the consistency of the costing methods applied across the national collection and, once established, will reduce the burden on providers. The costing transformation programme 1 (CTP) 1 https://improvement.nhs.uk/resources/transforming-patient-level-costing/ 2 > 1. Introduction

focuses on patient-level costing to achieve a step change in the quality of cost information: the patient-level cost collection is vital to achieving this. We expect the cost collection, coupled with the implementation of the Healthcare costing standards for England, will: improve the quality and consistency of cost information available to the service ensure organisations can understand their costs allow organisations to benchmark their costs against those of their peers. 3 > 1. Introduction

2. Scope 2.1. In scope Early implementers of the cost collection this year are asked to submit activity and financial data for NHS mental health services relating to them. This includes any qualified provider (AQP) and overseas reciprocal activity. Activity and costs should be reported for all: hospital provider spells, 2 including patients not discharged as at 31 March 2018 care contacts, 3 including contacts made with patients while providing improving access to psychological therapies (IAPT) services. 2.2. Out-of-scope services and reconciliation items Services outside the scope of this collection should not be reported in the patientlevel cost collection extracts, but should be costed and reported in the reconciliation to ensure the correct total cost is generated. Table 1 and Table 5 below describe the services out of scope. All the services listed in Table 1 must be costed. However, only those services that fall under the own-patient care cost group should be reported in the patient-level extracts. All other cost groups form part of the reconciliation tables outlined in Section 6 below. 2 Total continuous stay of a patient using a hospital bed https://www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/h/hospital_provider_spell _de.asp?shownav=1 3 A contact made with a PATIENT for the delivery of care https://www.datadictionary.nhs.uk/data_dictionary/classes/c/care_contact_de.asp?shownav=1 4 > 2. Scope

Table 1: Reporting services by cost group in the reconciliation (see Section 6 for information on reconciliation) Cost groups Service description Reconciliation or patient-level extracts Own-patient care Own-patient care (out of scope) Other activities All mental health NHS services in England not listed in any other cost group below, including: costs related to the provider s own-patient activity overseas (reciprocal) activity Learning disabilities Addictions and substance misuse Physical healthcare eg sexual health Private, overseas non-reciprocal and non-nhs England patients (Wales, Scotland and Northern Ireland) Any patients not thought to have a mental illness eg: smoking cessation services some alternative therapy services some counselling services Mental health learning disabilities and autism spectrum disorder services provided only at a primary care level Did not attends and cancelled contacts (activity only) Group sessions 4 Contracted-out services Prison health services (physical healthcare only) Mental health specified services: acquired brain injury and neuropsychiatry Named provider services: Fixated threat assessment centre: Barnet, Enfield and Haringey Mental Health NHS Trust Activities contracted in from other providers, eg psychiatric liaison services Out-of-area placements, both the receiving provider and sending provider Patient-level extracts Reconciliation Reconciliation 4 Only group sessions that cannot be directly linked to each of the patients attending the group session should be included: ie this excludes group therapy sessions for a number of registered patients, which should be reported as a care contact for each individual patient. 5 > 2. Scope

Cost groups Service description Reconciliation or patient-level extracts Reconciling items (no corresponding activity) Services with no patient-level activity captured Reconciliation If the service is not listed in the own-patient care (out-of-scope) or other activities cost group, the service is in scope for the PLICS collection. Collection year The collection year begins on 1 April 2017 and ends on 31 March 2018. All hospital provider spells and care contacts (including IAPT contacts) completed within the collection year, or hospital provider spells still open at the end of the collection year, are in scope of this collection. Only resources used and activities undertaken within the collection year should be included, regardless of when the hospital provider spell started or ended. For example, only costed ward care bed days that are within the collection year should be reported. Figure 1: In-scope spells and contacts 6 > 2. Scope

2.3. NHS Digital s role and minimum datasets NHS Digital NHS Digital provides a range of services used by healthcare professionals, research bodies, public sector organisations and commercial entities across England. NHS Digital is experienced in specifying, acquiring and processing national data collections. For the CTP, NHS Improvement will request that NHS Digital establishes and operates a system to collect patient-level costing information under Section 255 of the Health and Social Care Act 2012. The collection system will be requested to: enable providers to submit patient-level costing information to NHS Digital in a secure manner link patient-level costing information to the mental health services dataset (MHSDS) and IAPT dataset conduct data validation and quality checks supply pseudonymised patient-level costing information to NHS Improvement for onward data processing and analysis. Mental health services dataset (MHSDS) MHSDS is a patient-level, output-based, secondary uses dataset that delivers robust, comprehensive, nationally consistent and comparable person-based information for children, young people and adults who are in contact with mental health services. 5 IAPT dataset The IAPT dataset is a patient-level dataset for services that provide evidence-based treatments for people over the age of 18 with anxiety and depression. IAPT services for people under the age of 18 are recorded in MHSDS. 5 http://content.digital.nhs.uk/mhsds 7 > 2. Scope

IAPT services are characterised by: evidenced-based psychological therapies routine outcome monitoring regular and outcomes-focused supervision. 6 6 https://www.england.nhs.uk/mental-health/adults/iapt/ 8 > 2. Scope

3. Collection timetable Table 2 outlines the timetable for the mental health PLICS collection for 2018. Table 2: Timetable for mental health development PLICS cost collection* Date January 2018 April 2018 May 2018 August 2018 October 2018 December/January 2019 Description Minimum software requirements published Collection guidance and costing standards released Collection files with examples and data validation tool released Submission process released Collection window** Collection feedback and lessons learned shared * There may be separate submission windows for MHSDS and IAPT costs. We will confirm this later in the year. ** We will confirm providers submission dates closer to the collection window opening. 9 > 3. Collection timetable

4. Applying the Healthcare costing standards mental health The cost collection should be completed in line with the guidance in the Healthcare costing standards mental health. 7 The standards specify how you should map costs to resources and activities, and the allocation methods you should use. Where the costing standards do not provide guidance on how to treat specific costs for collection, see Section 6 in the first instance. If this does not resolve your question, please email NHS Improvement s costing team for clarification: costing@improvement.nhs.uk. 7 https://improvement.nhs.uk/resources/approved-costing-guidance-standards/ 10 > 4. Applying the Healthcare costing standards mental health

5. Information governance This section describes how the patient-level costing (mental health) dataset (PLCMHDS) and patient-level costing (IAPT) dataset (PLCIADS) will be used. 5.1. Information governance The patient-level costing (mental health) dataset (PLCMHDS) contains unit costs for inpatient admissions and care contacts for NHS providers in England. The patientlevel costing (IAPT) dataset (PLCIADS) contains unit costs for IAPT contacts for NHS providers in England. NHS Digital will collect the PLCMHDS and PLCIADS information from providers (subject to NHS Digital accepting a mandatory request from NHS Improvement). We expect that NHS Digital may publish and/or disseminate data collected and/or created under that request. This may include dissemination of data to other organisations. The acceptance of the mandatory request and any subsequent use of PLCMHDS and/or PLCIADS data collected under that mandatory request would be subject to the appropriate information governance processes and approval. If you have any questions or concerns about how the data will be used, please contact us at costing@improvement.nhs.uk. 5.2. How NHS Improvement will use PLCMHDS and PLCIADS MHSDS-PLCMHDS and IAPT-PLCIADS would be created by NHS Digital at NHS Improvement s request. NHS Digital will collect PLCMHDS and PLCIADS data from NHS providers, match these datasets with the MHSDS and IAPT datasets respectively, add key identifiers (to allow NHS Improvement to subsequently link these datasets with MHSDS and IAPT) and pseudonymise the data before the resultant data (MHSDS-PLCMHDS and IAPT-PLCIADS) is provided to NHS Improvement. 11 > 5. Information governance

We intend to use the MHSDS-PLCMHDS and IAPT-PLCIADS data in connection with any of our pricing or other functions, including: 8 informing the national tariff producing and distributing patient-level data in our tools for NHS providers, eg national PLICS portal and PLICS data quality tool 9 supporting efficiency and quality of care improvement programmes, eg Getting It Right First Time (GIRFT) 10 and operational productivity in NHS providers informing and modelling new methods of pricing NHS services informing new approaches and other changes to currency design improving future cost collections informing the relationship between the provider costs and their patient casemix developing analytical tools and reports to help providers improve their data quality, identify operational and clinical efficiencies, and review and challenge their patient-level cost data. As well as sharing the MHSDS-PLCMHDS and IAPT-PLCIADS data within NHS Improvement, we intend (subject to NHS Digital s approval) to share pseudonymised MHSDS-PLCMHDS and IAPT-PLCIADS patient-level data with participating trusts and arm s length bodies. The benefits of sharing the pseudonymised MHSDS-PLCMHDS and IAPT-PLCIADS patient-level data include: Across providers, it will support the implementation of integrated care systems and organisations, as well as additional functionality in new releases of our tools. For the Department of Health and Social Care, NHS England, NHS Digital and other organisations and individuals, it will help to: identify operational and clinical efficiencies, eg NHS RightCare 11 8 See Section 70 of the Health and Social Care Act 2012. 9 https://improvement.nhs.uk/resources/tools-for-using-costing-data/ 10 http://gettingitrightfirsttime.co.uk/ 11 www.england.nhs.uk/rightcare/what-is-nhs-rightcare/ 12 > 5. Information governance

provide comparative costs to support evaluation of new or innovative medical technologies respond to Freedom of Information requests and parliamentary questions benchmark performance against other NHS and international providers inform academic research. 13 > 5. Information governance

6. Treatment of specific costs and services/ activities: additional guidance 6.1. Mental health clusters and hospital provider spells Due to the nature and length of mental health hospital provider spells and clusters, the reference cost collection expresses the costs of clusters in days rather than complete hospital provider spells or on a complete cluster basis. The 2017/18 mental health development cost collection collects costs based on an incomplete cluster basis. However, the requirement for this collection is for hospital provider spell costs to be reported against the relevant clusters. This may mean allocating spell costs across multiple clusters when patients change cluster during the collection year. Table 3 below provides an example of how a hospital provider spell with multiple clusters would be reported in the collection. Table 3: Hospital spell provider and cluster cost report Hospital provider spell number Cluster Patient-level costing collection activity identifier Patientlevel costing collection activity count Patientlevel costing collection resource identifier Cost 151351531 99 WRD001 62 CPF022 1500.0263 151351531 99 WRD001 62 CPF002 1000.2065 151351531 99 WRD001 62 CPF024 300.5650 151351531 02 WRD001 22 CPF002 750.52605 151351531 02 WRD001 22 CPF024 480.56418 14 > 6. Treatment of specific costs and services/ activities: additional guidance

6.2. Other operating income (non-patient-care activity) The costing standards specify that income from non-patient care activity should only be netted off against costs in a few scenarios. Netting off other operating income against cost has been a key policy in the reference cost collection. In 2018, NHS Improvement will be exploring the impact of removing non-patient care costs from the national cost collection, through the collection of a memorandum item on non-patient care activity in reference costs. A decision will be made this year on the treatment of non-patient care activity in 2019 collections. For the 2017/18 mental health development PLICS collection, providers must net off the income for non-patient care activities, not costs. This includes income for research activities and education and training. 6.3. Unmatched drug costs Unmatched costs should not be reported separately. All unmatched costs should be allocated to hospital provider spells and care contacts using matched activity. Unmatched activity should be excluded from allocation methods so costs are allocated to matched activity only, with the exception of activities from non-integrated systems outlined in the costing standards. 6.4. Group sessions Group sessions should be reported in the MHSDS care contacts feed at a patient level per individual contact within the group. For example, group therapy sessions for five patients should be reported as five care contacts for each patient using the group session collection activity to identify that the contact was a group session. Group sessions where the patients cannot be identified should be excluded from the collection. All costs for the session should be reported in the reconciliation table for service and cost exclusions (see Section 7 below). 6.5. Did not attends and cancelled contacts Did not attends and cancelled appointments should not be costed for the PLICS mental health development cost collection. The costs need to form part of your attended care contacts. 15 > 6. Treatment of specific costs and services/ activities: additional guidance

6.6. Out-of-area placements Out-of-area placements (OAPs) are where patients are sent out of area because no bed is available for them locally, which can delay their recovery. 12 There is a data collection for OAPs to understand where and why they are happening. Findings from the data collection show 95% of organisations in scope are participating in the collection. In 2018, we will be undertaking a review of out-of-area placements. We want to understand how best to cost and report OAPs, using learning from the OAP dataset. For 2017/18, OAPs activity and costs must be excluded from the patient-level extracts and reported in the reconciliation tables only. This includes activity and costs from the sender and receiver of OAPs. 6.7. Resource and activities This section describes the resources and activities you should use to report costs for this collection. For more details on resources and activities see Healthcare costing standards mental health. 13 Spreadsheets CC.2 and CC.3 in the mental health costing standards technical document respectively contain a list of the resources and activities for collection. A resource activity matrix is included in Spreadsheet CC.4 to show the expected combinations for collection. However, other combinations of resources and activities will be accepted for this collection. Spreadsheet CP2.1 in the technical document maps the standardised cost ledger to the cost collection resources. This should assist you with your cost classifications for the PLICS collection. If you have combinations that do not appear in Spreadsheet CC.4, or costs in your ledger that are not represented in Spreadsheet CP2.1, please email us at costing@improvement.nhs.uk to discuss. Spreadsheet CP3.2 shows how to group local activities in the costing standards to produce the collection activities. 12 http://digital.nhs.uk/media/31482/out-of-area-placements-oaps-may-2017-report/default/oapsrep-may-2017 13 https://improvement.nhs.uk/resources/approved-costing-guidance-standards/ 16 > 6. Treatment of specific costs and services/ activities: additional guidance

7. Reconciliation tables Reconciliation forms an important part of the submission files. The reconciliation tables shown in this section help to establish the total costs covered by PLICS from your final audited accounts. The two reconciliation tables are: final audited accounts service and cost exclusions table. 7.1. Final audited accounts The final audited accounts table has been constructed to align to the top half of the reference costs reconciliation. This table should reconcile to your audited accounts. See the National cost collection guidance 14 for more information on what figures should populate the lines in this table. All your organisation s costs as well as other operating income and gains should be reported in the final audited accounts table (see Table 4 below). Contact us at costing@improvement.nhs.uk to discuss the treatment of rare items or if you are unsure how to report some costs. 14 https://improvement.nhs.uk/resources/approved-costing-guidance-collections/ 17 > 7. Reconciliation tables

Table 4: Final audited accounts reconciliation 7.2. Service and cost exclusion table The service and cost exclusion table provides a breakdown of the reconciling items, other activities and own-patient care services that are outside the collection s scope. This gives transparency to the services provided, and validates whether all services are costed and the correct services are removed from the quantum. 18 > 7. Reconciliation tables

This table has been aligned to the second half of the reference cost reconciliation. The reference cost reconciliation line number is provided to show where the value is the same. Please see Section 19 of the National cost collection guidance 15 for more detail on services to be excluded. In addition to the reference cost exclusions, some services outlined in Section 2 above are excluded from PLICS but included in reference costs. The cost for the following services should be reported using ID OUT31 in the reconciliation: community (physical health) group sessions 16 addictions and substance misuse out-of-area placements (receiving provider) out-of-area placements (sending provider) any patients not thought to have a mental illness (and not reported as community physical health) eg: smoking cessation services some alternative therapy services some counselling services mental health learning disabilities and autism spectrum disorder services provided only at a primary care level (if not reported under line 28w, see Table 5 below) any other services (no patient-level activity available). Table 5 below lists the out-of-scope services and costs. If you are unsure where to report some of your services, contact us at costing@improvement.nhs.uk. 15 https://improvement.nhs.uk/resources/approved-costing-guidance-collections/ 16 Only group sessions that cannot be directly linked to each of the patients attending the group session should be included: ie this excludes group therapy sessions for a number of registered patients, which should be reported as a care contact for each individual patient. 19 > 7. Reconciliation tables

Table 5: Service and cost exclusions Line number in reference Service ID Description Expected cost workbook sign 28a OUT004 Ambulance trusts - specified services - 28b OUT006 Cystic Fibrosis Drugs - 28c OUT007 Discrete External Aids And Appliances - 28d OUT022 Device Costs on the National Tariff High Cost Devices List - 28e OUT023 Health promotion programmes: Contraception and sexual health - 28f OUT024 Health promotion programmes: Oral health promotion - 28g OUT025 Health promotion programmes: Stop smoking education programme - 28h OUT026 Health promotion programmes: Substance misuse - 28i OUT027 Health promotion programmes: Weight management - 28j OUT028 Health promotion programmes: Other health promotion programme - 28k OUT029 Home delivery of drugs and supplies: administration and associated costs - 28l OUT008 Home delivery of drugs and supplies: drugs, supplies and associated costs - 28m OUT009 Hospital travel costs scheme - 28n OUT021 In vitro fertilisation (IVF) drugs - 28o OUT010 Learning disability services - 28p OUT020 Local Improvement Finance Trust (LIFT) and Private Finance Initiative (PFI) set up costs - 28q OUT005 Mental health trusts - specified services - 28r OUT011 Named providers - specified services - 28s NHS continuing healthcare, NHS-funded nursing care and excluded intermediate care for - OUT012 individuals aged 18 or over 28t OUT013 NHS continuing healthcare, NHS-funded nursing care for children - 28u OUT014 Patient transport services (PTS) - 28v OUT015 Pooled or unified budgets - 28w OUT016 Primary medical services - 28x OUT017 Prison health services - 28y OUT018 Screening programmes - 28z OUT019 Specified hosted services - 29aa OUT003 Actual cost of non-nhs private patients - 29ab OUT001 Actual cost of non-nhs overseas patients (non-reciprocal) - 29ac OUT002 Actual cost of other non-nhs patients - 29ad OUT030 Contracted out patient activity - n/a OUT031 Services excluded from PLICS but included in reference costs - 20 > 7. Reconciliation tables

8. Collection extract files overview This section details the requirements for the patient-level extracts to be submitted to NHS Digital. We will issue providers with a data validation tool in May 2018. This will validate costing outputs and produce the required XML files to be transferred to NHS Digital if required. The tool will process CSV or XML files, perform data validations, and generate and compress XML files ready for submission. The validation tool: ensures that data is in the correct format (XML) for submission, reducing the likelihood of resubmission allows providers to validate data and correct any issues, if needed, before submitting data to NHS Digital reduces the burden on software suppliers to create and validate XML files removes the need for manual compression of files. Providers must check their output files in the data validation tool before submission to NHS Digital. 8.1. File specification and data fields This section details the file format and data fields for the submission to NHS Digital. The output file must conform to the standard specified in the collection specification files. The extract specification files will be released in May. Files sent to NHS Digital must be in XML format. To reduce the burden on providers and suppliers, the data validation tool converts CSV files into XML and runs the collection data validations. Alternatively, if providers can produce XML files, the tool can be used to run the collection data validations and file compression only. We will provide example CSV extract files in May to support file creation. With the inclusion of resources and activities, the collection XML becomes multitiered: spell/contact (level 1) 21 > 8. Collection extract files overview

collection activities (level 2) collection resources (level 3). However, the hierarchy cannot be built in the CSV files as they are flat files the patient details repeat for each combination of resources and activities. If you have any questions about the file specification, please contact us at costing@improvement.nhs.uk. 8.2. File batching process The file batching process has been designed to future-proof the collection and to support monthly, quarterly and annual reporting. It will also ensure the file transfer process can upload the large data files produced by the new costing method. The submission files need to be batched in two steps: 1. Group the data into datasets: MH care contacts, MH hospital provider spells and IAPT (appointments). 2. Split each dataset into 12 months using Care contact date (care contact), Discharge date (hospital provider spell) and Appointment date (IAPT). Hospital provider spells must only be reported in the month of discharge to prevent duplication, except where the hospital provider spell is incomplete at the end of the collection year. Please include these records in the M12 file with the costs that relate to the collection year only. The only exception to batching is for the reconciliation dataset, which is grouped into one file for collection. 8.3. Extract file name convention Table 6 outlines the file-naming convention and gives examples. If the file names do not follow this convention, the submission will fail. 22 > 8. Collection extract files overview

Table 6: File name convention Field name CSV/XML field Description name Patient-level costing care activity type code FeedType The dataset the extract covers (MHPS = Hospital provider spells, MHREC = Reconciliation, MHCC = Care contacts, MHIA = IAPT) Financial year FinYr The financial year the extract covers, eg for 2017/18 the Financial month Organisation identifier (code of submitting organisation) Date and time dataset created FinMth OrgSubmittingID CreateDateTime value is FY2017-18 The month within the financial year the extract covers. For the 2017/18 collection the period equals month: M## = the month in the financial year M01 = April 2017 M02 = May M03 = June M04 = July M05 = August M06 = September M07 = October M08 = November M09 = December M10 = January M11 = February M12 = March 2018 This is not required for the reconciliation file The organisation identifier (code of submitting organisation) is the identifier of the organisation acting as the physical sender of a dataset submission The organisation code provided must be in the threecharacter format (XXX) The date and time the extract was created Format to be used: CCYYMMDDThhmm Examples of correctly named files: Patient level costing care activity type code _ Financial year _Financial month_ Organisation identifier (Code of submitting organisation) _ Date and time data set created MHPS_FY2017-18_M01_XXX_20180701T1730.csv or MHREC_FY2017-18 _XXX_20180701T1730.xml 23 > 8. Collection extract files overview

8.4. Collection process overview (To be confirmed) We are working with NHS Digital to finalise the submission process. We will send guidance to providers and suppliers later in May. This will include: a data validation tool file transfer set-up and process submission process an outline from start to finish. 24 > 8. Collection extract files overview

Contact us: costing@improvement.nhs.uk NHS Improvement Wellington House 133-155 Waterloo Road London SE1 8UG This publication can be made available in a number of other formats on request. NHS Improvement 2018 Publication code: CG 60/18