Patient Level Activity and Costing, 2021-22

This is an integrated publication on patient-level costing and activity in Acute, Mental Health, IAPT, CSCC and Ambulance NHS services.  Specifically for Acute this uses data on Emergency care (EC), Admitted patient care (APC), Outpatients (OP), Specialised ward care (SWC) submitted to the Patient Level Information and Costing System (PLICS) data collection for 2021-22 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 Key Definitions and Key Facts section.

The PLICS data collection has been developed to support NHS England’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’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 at aggregate level.

This section aims to provide users with an evidence-based assessment of the quality of the statistical output of the PLICS 2021-22 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, ICB 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 submitted values from PLICS and from the linked HES collection, in order that the relationship between patient characteristics and cost can be explored.

Users should understand that this analysis includes only activity and cost within the scope of the PLICS 2021-22 collection and is not a complete view of costs of care in the NHS.

Breakdowns at the Integrated Care Board (ICB) and NHS region level are based on the ICB and region of the provider.

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

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.

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

Where data quality concerns were identified, NHS England 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 to NHS Digital for the PLICS Acute 2021-22 collection listed the providers expected to submit data. Providers may be required to submit to one or multiple PLICS feeds depending on the care services they provide.

The following providers submitted data to the 2021-22 PLICS collection but are excluded from both this report and the NCC publication:

• University Hospitals of Leicester NHS Trust (RWE)
• Surrey and Sussex Healthcare NHS Trust (RTP)
• Wirral Community Health and Care NHS Foundation Trust (RY7)
• Cambridgeshire Community Services NHS Trust (RYV)
• Northumbria Healthcare NHS Foundation Trust (RTF)

The following providers submitted SWC data to the 2021-22 PLICS collection which has been excluded from this report and the NCC publication:

• Croydon Health Services NHS Trust (RJ6)

Submissions to the 2021-22 PLICS collection from the following providers have not been excluded from this report or the NCC however are known to have issues and should be treated with caution:

• West Midlands Ambulance Service (RYA)
• South Central Ambulance Service (RYE)

The following providers merged prior to the collection window opening and submitted data to the 2021-22 PLICS collection under their merged code and their legacy code:

• University Hospitals Bristol NHS Foundation Trust (RA7) has data submitted under both RA7 and RA3 as the OrgSubmittingID with RA7 as the OrgID
• Guy's and St Thomas' NHS Foundation Trust (RJ1) has data submitted under both RJ1 and RT3 as the OrgSubmittingID with RJ1 as the OrgID

The NCC guidance listed the activities and costs which were in scope for the PLICS 2021-22 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 2021-22 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 IAPT and CSCC data to their respective datasets as the rate of linkage is relatively low in comparison to the Acute data.  The latest datasets for MH can be found here Mental Health Bulletin 2021-22 Annual report - NHS Digital. The latest dataset for CSCC can be found here Community Services Statistics - NHS Digital. The latest datasets for IAPT can be found here Psychological Therapies, Reports on the use of IAPT services - NHS Digital.

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

As a new mandated data item in the 2021-22 PLICS collection, wheelchair equipment activity submitted in SI may suffer from data quality and completeness issues. This means reported figures should be used with caution.

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, sex, 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.

For the 2021-22 linkage processing there was an issue which impacted the use of the AEAttendNo data field which is utilised as part of the linkage hierarchy. This has resulted in a slight reduction of possible linkage matches between the PLICS EC feed and HES A&E data and therefore contributes to a reduced linkage rate for PLICS EC.

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.

IAPT

The percentages of PLICS activity records that could be matched to a single IAPT record on a unique Care Contact ID:

CSCC

The percentages of PLICS activity records that could be matched to a single CSDS record on a unique Care Contact ID:

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 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, 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.

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

The analysis from the 2021-22 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.  The submitted Acute data is linked to HES (EC, APC, OP), whilst all other data is pseudonymised and released to NHS England.

NHS Digital and NHS England 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.  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 uses data from the NHS England PLICS analytical asset and aggregate NCC data submitted to NHS England.  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.  From 2020-21 onward these are now 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.

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 2021-22 data collection, data quality checks by NHS England after the collection window identified a small number of submissions that have been excluded from the analysis in this report for data quality reasons. Details of these exclusions can be found in the above section ‘Coverage - providers’.

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].

In addition to this publication we have developed a PLICS management information webpage which can be found here. This page provides analyses which are designed to raise awareness and improve the quality of data submitted as part of the PLICS collection by making this information available in an open and accessible format.

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, IAPT and CSDS 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 England 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 England 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 England 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