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NHS charges and data skewed by definitions of short-stay patients

19th April 2012

A new publication by the Audit Commission highlights a major cause of dispute between those who commission NHS services and those who provide them - how to classify a patient who stays in hospital for less than 24 hours.

Inconsistency in how patients are described for short-stay treatments is leading to poor data quality, says the briefing By Definition – Improving data definitions and their use by the NHS. It warns that the NHS is suffering from ‘incorrect recording and incorrect payments’.
The Commission has found that the same treatment may be recorded as an inpatient at one hospital, and as an outpatient at another. This simple variation can greatly increase charges, even multiplying them five times or more. Inconsistent treatment descriptions are affecting patients, skewing management information and wasting NHS funding.

This has serious financial implications. Routine short-stay treatments cost the health service £6.8 billion a year, so discrepancies in contract values can vary by millions. There are frequent contract disputes over this specific issue.

Audit Commission MD for Health, Andy McKeon, says: ‘Confusion over how to record what has happened to a patient makes it impossible to compare like with like, compromising patient choice. It also makes planning and commissioning care difficult when treatment data gives an unclear picture.

‘We have also found that NHS managers are spending valuable time debating how patient treatment is recorded or described, time that would be much better spent focusing on the treatment itself. The arguments are only likely to increase as money gets tighter, and GPs in Clinical Commissioning Groups begin examining what happens to their patients and how much they are being charged.’

All NHS hospital activity is classified according to nationally set definitions. They affect the way each treatment is funded under the Payment by Results (PbR) regime. Most of the definitions are clear and are properly applied, but the briefing says that the PbR tariff is sometimes based on data that fails to represent the services delivered.

This, it says, is symptomatic of a wider problem - that NHS national datasets need to change to reflect the way care is now being provided. As more care is provided in outpatient settings, or outside hospitals altogether, much of the data is lost. This makes it difficult to record how patient needs are being met and to assess NHS productivity.

To illustrate the discrepancies the briefing gives two examples drawn from current NHS practice:

  • An 18 year old boy goes to hospital for a simple operation needing only a short amount of theatre time. In one trust this would be categorised as a day case (an admitted patient) and the trust would receive £729. But elsewhere the same activity treated in the same way could be recorded as an outpatient (not admitted) and would be paid £116, or 84 per cent less.

Problems with emergency activity are more complex.

  • A 10 year old girl is sent by her GP to a hospital paediatric ward. She is seen briefly by a consultant and then observed by a nurse for a few hours before going back home. At one trust this would be recorded as a ‘ward attender’ with  a follow-up outpatient attendance, which costs £113. But elsewhere she may be classified as an ‘admission’ and charged at £509 – more than four times as much.

To tackle the problem the Commission makes wide-ranging recommendations. The Department of Health, NHS Connecting for Health, and the NHS Information Centre are advised to provide a single point of contact for PbR data recording queries, and a consistent and authoritative source of guidance.

Providers and commissioners are also recommended to use the Audit Commission’s own PbR National Benchmarker to identify areas where their activity classification differs from the national picture.

 

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