costs. Critical care periods Record the number of critical care periods that have occurred within each hospital spell. A critical care period is a continuous period of care or assessment (i.e. a period of time) within a hospital provider spell during which a patient receives critical care in any one single unit function type of the critical care unit. A new critical care period commences with each new CCMDS record. Discrepancies can arise when counting critical care bed days for all types of critical care services activity. For reference costs, counting of adult, neonatal or paediatric critical care should follow the example in Table 11. Table 11: Critical care bed day count Critical care admission date and time Critical care discharge date and time Count with different dates of critical care admission and discharge 5 November 13:00 7 November 10.30 3 critical care bed days with same date of critical care admission and discharge 5 November 13:00 5 November 22:00 1 critical care bed day Given this counting convention, a critical care bed vacated and subsequently occupied by a second patient over the course of 24 hours should be counted as two critical care bed days. Costing critical care We would expect the following costs to be included in the cost per critical care bed day: Medical staff. Nursing and clinical staff. Therapies. Ward consumables. Drugs. Blood and blood products. Diagnostics undertaken whilst the patient is in critical care. Medical and surgical equipment. The of any theatre time must be reported against the core HRG and not the unbundled critical care HRG. If a patient’s TFC changes on admission to a critical care unit, a new FCE will begin, and theatre costs will not form part of the total cost for the critical care service. But even if a new FCE does not start on admission to critical care or an FCE is wholly within critical care under a critical care consultant from admission to discharge theatre costs should still be excluded from critical care, and reported against the core HRG. Where there is no theatre time, this may result in a relatively small or even zero cost against the core HRG. In these circumstances, trusts have the discretion to exclude these zero cost HRGs on the same principle that other zero cost HRG are excluded (paragraph 49). The key principle here is that critical care represents the highest level of complexity and only the daily costs of providing critical care should be recorded
patients with conditions covered by the mental health care clusters, the costs and activity should be included in the mental health care clusters in , otherwise the costs and activity should be reported here. Table 22 describes the currencies for intermediate care. Table : Intermediate care currencies Currency Setting Aim Period Activity measure Crisis response services Community based services provided to service users in their own home or a care home. Assessment and short term interventions to avoid hospital admission. Interventions for the majority of service users will last up to 48 hours or two working days. If longer interventions are provided the service should be included under home based intermediate care Unit cost per service user Home services Community based services provided to service users in their own home or a care home. Intermediate care assessment and interventions supporting admission avoidance, faster recovery from illness, timely discharge from hospital and maximising independent living. Interventions for the majority of service will last up to six weeks (though there will be individual exceptions). Unit cost per care contact Bed based services Service is provided within an acute hospital, community hospital, residential care home, nursing home, standalone intermediate care facility, independent sector facility, local authority facility or other bed basedsetting. Prevention of unnecessary hospital admissions and premature admissions to long term care and/or to receive patients from acute hospital settings for rehabilitation and to support timely discharge from hospital. Interventions for the majority of service users will last up to six weeks (though there will be Individual exceptions). Unit cost per occupied bed day currencies include: all admission avoidance schemes wherever their location, which should be included in crisis response (for example teams based in A&E department to identify patients for whom an admission could be avoided) early supported discharge in the home, which should be included in home based services, with the exception of condition specific schemes which are excluded as per paragraph 377(e) below. currencies exclude: NHS continuing healthcare and NHS-funded nursing care, eligibility for which might be considered after a patient has finished a period of intermediate care. Costs and activity should be excluded from reference costs against the “NHS
Home delivery of and supplies: administration and associated costs Trusts incur costs in delivering drugs, oxygen, blood products or supplies directly to patient’s homes, without any associated clinical activity at the time of delivery. On this line, trusts should include the administration and associated relating to home delivery of drugs and supplies, including: costs of enrolling patients and the managing of the home care service costs of contracting, ordering, invoice matching and payment nurse support of a non-clinical nature any other associated administrative costs. There is currently no national requirement to understand the unit costs of providing this service. Home delivery of drugs and supplies: drugs, supplies and associated costs On this line, trusts should include the costs of the: including oxygen or blood products supplies, e.g. continence pads or enteral feeding delivery of drugs or supplies any other associated drug or supply costs. is currently no national requirement to understand the unit costs of providing this service. Hospital travel costs scheme Scheme offering financial help with the cost of travel to and from hospitals and other NHS centres. Note that overnight stays are not part of the HTCS. However, the HTCS guidance states: " Where an overnight stay away from home is unavoidable, either because of the time of the appointment or length of travel required, and the patient is unable to meet the cost of this stay, the expense should be treated as part of treatment costs or met through non-Exchequer funds. This should be discussed with the relevant CCG before the overnight stay occurs." Providers should therefore include overnight as an overhead in their reference costs. Because this scheme fixed payments to eligible NHS patients there is no requirement to understand or benchmark provider unit costs. Learning disability services We will consider whether to include learning disability services in reference costs from 2015-16 Local Improvement Finance Trust (LIFT) and Private Finance Initiative (PFI) set up costs See paragraph 455 are one-off costs. Mental health trusts – specified services The following services delivered by mental health trusts: Acquired injury Neuropsychiatry No other service, and no other provider type to mental health trusts, may be excluded in this category without our permission. No suitable currencies exist.
Q3a Finance staff? [insert number of days] Q3b Information staff? [insert number of days] Q3c Senior managers? [insert number of days] Q4 Is your team responsible for returning any other cost collections for your organisation? Q4a Education and Training reference costs Yes/No Q4b Service Line Reporting Yes/No/n/a Q4c PLICS (locally used) Yes/No/n/a Q4d PLICS (national non-mandatory collection) Yes/No/n/a Q4e Other Please specify in Q25 Q5 What is the of clinical and financial engagement in your organisation? Level 1 Level 2 3 Level 4 Q6 Who is the supplier of your PLICS? Allocate Ardentia Belvan Bellis-Jones Hill / Prodacapo CACI/BPlan Civica Costflex Healthcost Internally provided Powerhealth Other supplier - please specify in Q25 Not yet chosen N/A – not planning to implement PLICS Q7 Have you used the materiality and quality score (MAQS) as detailed in the HFMA clinical costing standards? Yes/No Q8 If you answered yes to Q7, what is your current MAQS? (Voluntary) [0-100%] Implemented: trusts have implemented PLICS only Q9 How often are you producing and reporting patient level cost information? Every two weeks Every month Every quarter Twice a year Annually Not reporting Other – please specify in Q25 Q10 Did you use PLICS to support your reference costs return? Yes/No Q11 If you answered yes to Q10, which service areas in your reference costs return were supported by PLICS? (answer n/a if you don’t provide the service) Q11a Admitted patient care Yes/No/n/a