Patient Level Activity and Costing, 2020-21

This is an integrated publication on patient-level costing and activity in Acute, Mental Health, IAPT and Ambulance NHS services.  Specifically for Acute this uses data on Emergency care (EC), Admitted patient care (APC), Outpatients (OP) and Specialised ward care (SWC) activity submitted to the Patient Level Information and Costing System (PLICS) data collection for 2020-21 by NHS trusts in England, and additional information obtained through linkage to Hospital Episode Statistics (HES).  To note, some Supplementary Information (SI) services are included within both Acute and MH activity.   More detail on what these areas cover is in the Content - Key Definitions and Key Facts sections.

The PLICS data collection has been developed to support NHS England and NHS Improvement’s Costing Transformation Programme and is used to:

• Inform new methods of pricing NHS services
• Inform new approaches and other changes to the design of the currencies used to price NHS services
• Contribute to NHS England and NHS Improvement’s strategic objective of a single national cost collection
• Inform the relationship between provider characteristics and cost
• Help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence
• Identify the relationship between patient characteristics and cost
• Support an approach to benchmarking for regulatory purposes

The patient-level data submissions to The PLICS data collection replace the equivalent aggregate data submissions to the NHS reference costs collection (which was introduced in 1997-98).

During the phased transition to patient level collections, some data continues to be collected by NHS England and NHS Improvement at aggregate level.

This section aims to provide users with an evidence-based assessment of the quality of the statistical output of the PLICS 2020-21 publication by reporting against those of the nine European Statistical System (ESS) quality dimensions and principles appropriate to this output.  These dimensions and principles are also consistent with the UK Statistics Authority (UKSA) Code of Practice for Official Statistics.

For each dimension, this section describes how this applies to the publication.

This dimension covers the degree to which the statistical product meets user need in both coverage and content.

This publication contains analysis of PLICS data submissions from NHS providers, including:

• A HTML summary report
• A CSV file containing the aggregate underlying data at national, provider and NHS region levels
• A metadata file describing the construction of each breakdown

Data on total reported cost and total recorded activity is reported by age, gender, deprivation and diagnosis in order to explore the relationship between patient characteristics and cost.

Users should understand that this analysis includes only activity and cost within the scope of the PLICS 2020-21 collection and is not a complete view of costs of care in the NHS.

This report does not seek to replace or reproduce analysis in the National Cost Collection (NCC) publication produced by NHS England and NHS Improvement.

Statistics published in this report are classified as Experimental Statistics, these are new official statistics undergoing evaluation.  They are published to involve users and stakeholders in their development and to build in quality at an early stage.  More information about experimental statistics can be found on the UK Statistics Authority website.

This dimension covers, with respect to the statistics, the proximity between an estimate and the unknown true value.

PLICS data is extracted from costing systems by providers and validated prior to submission to NHS Digital using a purpose-built tool provided by NHS England and NHS Improvement.

The NHS England and NHS Improvement tool provides immediate record-level error and warning notifications.  Missing or invalid values for mandatory data items are notified as errors.  The tool will only generate the files in the required format for submission once all errors have been resolved.  (Remaining warnings will not prevent files for submission being generated.)

NHS England and NHS Improvement reviewed summary data from the PLICS collection during the collection window.

Where data quality concerns were identified, NHS England and NHS Improvement asked the relevant providers to resubmit.  Providers could also request permission to resubmit.

These data quality checks reviewed the data at aggregate levels such as Healthcare Resource Group (HRG) for each provider, so may not detect data quality issues at record level.

The mandatory request from NHS England and NHS Improvement to NHS Digital for the PLICS Acute 2020-21 collection listed the providers expected to submit data.

As previously stated in How the data was collected, the University Hospitals of Leicester NHS Trust (RWE) has been excluded from the National Cost Collection publication.  The PLICS data submitted by this provider has similarly been excluded from this report.

This report includes data submissions from all other providers listed in the mandatory request.

To note, trusts with codes R0D, RDZ and RD3 have merged prior to the collection window opening.  The new merged trust will make two full year submissions of data using their legacy codes (RD3 and RDZ) as both the OrgID and the OrgSubmittingID data fields.  This means the data can no longer be matched to HES, but this option does ensure a full year of PLICS data for the merged trusts.  This affects APC, OP, EC, SI and SWC for these trusts.

A small amount of Mental Health data cannot be included in the publication as it was submitted with incorrect currency codes.  Where this was identified during the submission process, it was raised with the relevant trust, but there were some who were unable to resolve the issues prior to the closure of the collection window.  The total amount of excluded cost data is £11,645,978 – 0.01% of the 2020-21 national cost quantum.

The NCC guidance listed the activities and costs which were in scope for the PLICS 2020-21 collection.

The count of activities reported in PLICS for EC, APC, OP, SWC and SI may be compared with the count of activities submitted to SUS for the relevant Commissioning Data Set and reported in HES as a broad indication of the coverage of PLICS data.  However, the exclusions from the scope of PLICS 2020-21 mean we would expect the count of PLICS activities to be lower than the count of HES activities for each of these activity types.

Local knowledge, or other comparative data sources, may be required to assess the completeness of PLICS data for a specific provider.

Please ensure care is taken when comparing PLICS total cost for MH and IAPT data to their respective datasets as the rate of linkage is relatively low in comparison to the Acute data.  The latest datasets for MH and IAPT can be found here Psychological Therapies, Reports on the use of IAPT services - NHS Digital and here Mental Health Bulletin 2020-21 Annual report - NHS Digital

All mandatory PLICS data items are confirmed to be complete and valid at the point of submission.

Linkage of PLICS data to existing activity datasets is an area under review and development.  Areas where such approaches are more established are included and reported within this report such as with HES.  A full review of data linkage methodologies between PLICS data and other related datasets is planned, and this may be reflected in the content of future reports.  Where linkage has been possible however, this is described below.  Please also see the section Linkage To HES in relation to Acute data specifically.

Acute

The data items used to link PLICS data for EC, APC and OP activity to HES are not mandatory fields, so may be missing.  The linkage process has been designed to minimise the impact of missing data by attempting to find a match on various subsets of the linkage data items.

Where missing linkage data items mean that a PLICS activity record cannot be linked to HES, this will affect the analysis in this report which uses HES linked values such as age, gender, and diagnosis.

Using HES linked values in this report means that the analysis may be affected by HES data quality which will itself vary according to the fields being used for a particular purpose.

Mental Health

The percentages of PLICS Mental Health activity records that could be matched to an MHSDS record uniquely on both relevant identifiers for each activity type were:

The proportion of linked hospital provider spell records would not be meaningful due to the structure of the PLICS Mental Health activity data for hospital spells.  Details are included in the Coherence section below.

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates.

Following the financial year end on 31 March, there are a number of activities that take time to complete before PLICS data is available for analysis.

Each NHS provider prepares statutory accounts for the financial year, and these are audited.  As a submission of PLICS data must be reconciled to the provider’s statutory accounts, time is allowed following finalisation of the audited accounts for providers to prepare their PLICS submissions.

PLICS data is then submitted by each provider during a submission window agreed by NHS England and NHS Improvement following engagement with trusts, costing software provider, NHS Digital and users of PLICS data.  During the submission window, the data quality of submissions is reviewed by NHS England and NHS Improvement, with resubmission of data requested where required.

Following the closure of the submission window, NHS Digital completes additional data processing including linkage to relevant activity data sets and provides processed data to NHS England and NHS Improvement.

The analytical teams at NHS Digital and NHS England and NHS Improvement work together to reconcile their respective analytical assets and conduct data quality checks.

The analysis from the 2020-21 collection is published as early as possible after completion of all data processing, reconciliation and data quality review activities.

This report will be published on the pre-announced publication date.

Coherence is the degree to which data that are derived from different sources or methods, but refer to the same topic, are similar. Comparability is the degree to which data can be compared over time and domain.

NHS Digital collects PLICS data to comply with a Mandatory Request from NHS England and NHS Improvement.  The submitted acute data is linked to HES (EC, APC, OP), whilst all other data is pseudonymised and released to NHS England and NHS Improvement.

NHS Digital and NHS England and NHS Improvement each use this data to create their respective PLICS analytical assets.  The analytical teams work together to promote coherence between their assets wherever possible, including consistent exclusion of data from a small number of providers following data quality checks by NHS England and NHS Improvement.  However, as data is being processed by each organisation independently, it is possible that differences exist between the analytical assets.

This report uses only data from the NHS Digital PLICS analytical asset.

The NCC publication produced by NHS England and NHS Improvement uses data from the NHS England and NHS Improvement PLICS analytical asset and aggregate NCC data submitted to NHS England and NHS Improvement.  Results in the NCC analysis are therefore likely to differ from the results in this report.

The table below summarises the key characteristics of PLICS data collection since it began on 2016-17.

Prior to the 2019-20 period, all PLICS data was specifically related to Acute settings only with Mental Health, IAPT and Ambulance only being introduced at this time as separate reports.  For 2020-21 these will now be published as a single integrated report.

As illustrated by the summary table above whilst the content and scope of the data collection has been expanding and developing it is not recommended that comparisons between different years of data occur and if they do they should be done with caution.

In addition to the change in the list and number of providers included in the analysis, differences over time could be present due to changes in the data set and submission guidance between the two periods (for example the reporting of high cost drugs or diagnostic imaging), and changes in data quality as providers continue to develop their costing and reporting methods.

In order to respond to the challenges posed by the coronavirus pandemic the NHS in England were instructed to suspend all non-urgent activity for patients for parts of the 2020-21 reporting period.  The timing and implementation of certain measures may also have varied geographically across England and will have impacted upon how and the extent to which these types of care activities were provided during this time which may need to be considered when interpreting the data.

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

This report is accompanied by a data file in machine-readable format, and a metadata file explaining how the values in the report and data file have been calculated.

Re-use of our data is subject to conditions outlined here:

https://digital.nhs.uk/about-nhs-digital/terms-and-conditions

This dimension describes the extent to which different aspects of quality are balanced against each other.

To meet user needs for detailed costing information within a reasonable timescale, the amount of data quality feedback that can be provided and acted upon by providers is limited to that which can be performed within the collection window.  For any data quality issues identified following the submission deadline, it is no longer possible for providers to amend and resubmit their data.  Submissions may therefore need to be excluded from analysis and reporting to prevent the data quality issues causing outputs to be misleading.  For the 2020-21 data collection, data quality checks by NHS England and NHS Improvement after the collection window identified a small number of submissions that have been excluded from the analysis in this report for data quality reasons.  Please see the Differences between this analysis and NCC published tables section for Mental Health, and the Diagnosis section for Ambulance.

This dimension covers the process for finding out about users and uses and their views on statistical products.

As in previous years, we have sought and welcome feedback on our PLICS reports – please send all comments to [email protected] with ‘PLICS analysis’ in the subject.

This dimension describes the effectiveness, efficiency and economy of the statistical output.

The PLICS data collection has been designed to use data already held by providers within activity and costing recording systems.  It is also designed to link to HES, MHSDS and IAPT data to minimise the number of data items collected, and hence reduce the burden of submissions for providers.  However, please see the Data Completeness – Linkage section for details on what is currently possible.

The procedures and policy used to ensure sound confidentiality, security, and transparent practices

PLICS data is stored by NHS Digital and access is strictly controlled.  To read more about how we keep patient data safe, please visit https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe

Access to record level data for medical/health care research purposes would require application through a stringent process where the need for record level rather than aggregate data would have to be justified.  NHS Digital publishes a monthly register of data releases that includes applications that have successfully completed this process.

The risk of disclosing an individual’s identity in this analysis has been assessed and statistical disclosure control has been applied to the data accordingly.

The disclosure control method used for this report is described in the HES Analysis guide.

In summary:

• If a national count is between one and seven, no sub-national breakdown will be provided
• If a national count is eight or more:
  • sub-national counts between one and seven are replaced by a “*” symbol
  • zeroes are unchanged
  • all other sub-national counts are rounded to the nearest five
• National totals are not suppressed or rounded

No disclosure control need be applied to total cost values, as these cannot be related to an individual.

Relevant NHS Digital policies include:

Statistical governance policy (see User documents section at the end of the page)

Freedom of information process

A guide to confidentiality in health and social care

Privacy and data protection