Data blamed for non-progress in costing

Commissioners have made little or no progress in calculating the cost of care pathways over the past decade, accountancy experts have concluded.

In a report out this morning, the Association of Chartered Certified Accounts and the Audit Commission revisit work they carried out ten years ago into how patient centre care pathways were being implemented in the acute sector and how finance managers could calculate their cost.

They conclude that although reviewing care pathways to meet quality and efficiency challenges “has been the focus of policy for several years” – and has already been identified as a key task for GP Commissioning Consortia – “little progress has been made.”

The report says the biggest barrier to progress is a lack of reliable data, although other problems identified in visits to six organisations that have tried to cost some of their pathways included inadequate administrative support and poor patient record systems.

“There were problems retrieving information due to the different approaches taken by departments, problems with sharing information, and a lack of clarity about recorded information,” it adds.

“The biggest barrier, however, was insufficient and poor quality data across outpatient, prevention and community services.

“This caused particular difficulty as organisations were usually seeking to rearrange and move care into these areas.

"It was not possible for them to work out the cost of existing provision for a disease category, nor to make any meaningful comparisons about future activity.”

As a result, the ‘Counting the cost of patient care: Understanding the cost of the diabetes care pathway’ report says some organisations have changed pathways without understanding the financial costs of doing so.

To help commissioners, the report looks a diabetes pathway and the nationally available data for costing it. It finds that the biggest driver of costs is spending on mediation, although inpatient spend varies from £19 to £175 per diabetic patient.

Even the two accountancy bodies were unable to find enough data to make estimates about the variation in costs for outpatient attendances and community care, although they note these “showed the greatest variation.”

Andy McKeon, managing director, health, at the Audit Commission, said: “We know that healthcare organisations are striving to improve patient pathways to provide higher quality and more convenient care for patients, but we need to find better ways to cost these changes.

“Our report shows what can be done using reliable national data to cost the diabetes care pathway. PCTs can use it to compare their spending and to identify areas where they are likely to make savings and improve care.”