NHS Improvement defends PLICS timescale and support plans

NHS Improvement is to develop a procurement framework for patient level information costing systems in a bid to provide assurance to more than100 trusts that have yet to invest in a system.

This will replace an earlier proposal to develop an accreditation framework for PLICS as the NHS moves towards mandatory patient level information submissions from 2019 onwards. The framework would cover only the base costing engine and system.

A meeting is due to take place next week [2 June] between NHS Improvement and system providers, some of whom have told Digital Health News that they are unhappy about the change.

Steve Haines, managing director of Civica’s public sector costing division said: “I do not think that the costing supplier community necessarily thinks it’s the best mechanism.”

Other procurement frameworks are already in place and procurement is not the place for deciding on nuances around software development, he said.

Robin Bellis-Jones, managing director of Bellis-Jones Hill, disgreed. He said: “Accreditation was introduced as a way of standardising. But that does not deal with the difficult decision of which system to buy and I think a procurement framework is the right way to support trusts to make an informed choice.”

Richard Ford, costing director at NHS Improvement, said his major concern was to assure trusts that have yet to purchase a PLICS that they are able to buy a system that is fit for purpose and capable of meeting costing standards set by NHS Improvement.

He said: "If we have over 100 trusts, including 40 to 50 acute trusts, that have not bought a PLICS and will be buying one in the next 18 months, it makes sense for us to do the procurement once and provide assurance that systems are fit for purpose."

Ford said the primary purpose of moving to patient level costing – which requires systems capable of carrying out 25 million calculations compared to 10,000 for the aggregated reference costs currently used in most trusts – is to provide clinicians with high quality information about services.

He said: "The Costing Transformation Programme is all about improving performance in trusts so that they are able to understand what services cost them. It is focused on getting good information to clinicians that they can believe."

But he also revealed that NHS Improvement will establish a central costing database. He said: "This is about creating a single data services platform that will provide the one source of truth. The aim is to build a repository from PLICS data and move it into a service platform.

"[Lord Carter's report] is driving all trusts to develop good quality source data that will allow business decisions to be made effectively."

In an interview with Digital Health News, Ford also answered questions about the timeframe for moving to patient level costing and costing patient pathways.

Suppliers and other experts interviewed for the latest special report on PLICS questioned NHS Improvement’s timetable, which specifies 2019 for acute providers; 2020 for mental health and ambulance trusts; and 2021 for community trusts.

They expressed concerns that it significantly lags behind the policy objectives that PLICS is expected to support – namely the ‘Five Year Forward View’ plan for reform that is intended to close a gap between funding and demand that could otherwise rise to £30 billion by 2020-21, and the Carter review of productivity and efficiency, which addresses immediate variations in cost and processes.

Ford said: "Yes, we are outside the timeframe for Carter and the Five Year Forward View but we cannot get it to happen any quicker. It is a big exercise that is complex and difficult to do."

He expected to see considerable progress ahead of the mandatory timelines. "By next September [2017], we hope to have 93 acute trusts submitting data to us using our standards. We think that will be a sufficient proportion to get some benchmarking and best practice data and allow us to set a tariff based on that data."

He also answered questions about whether patient level costing will be able to cost patient pathways rather than patient episodes within one provider.

He said:  "We are focused on secondary care and primary care is outside our scope. However, the Costing Transformation Programme sits within the Pricing Directorate and we have a pricing development team working with NHS England on future tariffs and capitation models."

Digital Health has published its annual special report on patient level information costing systems today. Read the report in the analysis hub.