Acute Patient Level Activity and Costing, 2018-19

This is a publication on patient-level costing and activity in acute NHS services, using data on accident and emergency, admitted patient care and outpatient activity submitted to the Patient Level Information and Costing System (PLICS) Acute data collection for 2018-19 by NHS trusts in England, and additional information obtained through linkage to Hospital Episode Statistics (HES). 

The PLICS Acute 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 by 2020’
• 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 Acute 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. For example, for the acute activity included in this report, some sectors have not yet been mandated to submit PLICS Acute data, and some elements of acute care such as critical care are not yet part of the PLICS Acute collection.

This section aims to provide users with an evidence-based assessment of the quality of the statistical output of the Acute Patient Level Activity and Costing 2018-19 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 Acute 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 Acute 2018-19 collection and is not a complete view of costs of acute 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 Acute 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.)

If providers identify any data quality issues during the collection window they can re-validate and re-submit data as many times as they wish before the submission deadline.

NHS England and NHS Improvement reviewed summary data (from the PLICS Acute collection and from other sources) during and immediately after the collection window, to identify potential data quality issues. Where data quality concerns were identified, providers were invited to make a resubmission of their PLICS Acute data in a further collection window.

Please note that these data quality checks reviewed the data at aggregate levels such as Healthcare Resource Group (HRG) for each provider. These checks 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 2018-19 collection listed the providers expected to submit data.

2 out of the 148 listed providers (Bolton NHS Foundation Trust and University Hospitals of Derby and Burton) made partial submissions including only part of their activity. These incomplete submissions have been excluded from this analysis.

All other listed providers submitted all expected data files.

The NCC guidance listed the activities and costs which were in scope for the PLICS Acute 2018-19 collection.

The count of activities reported in PLICS may be compared with the count of activities submitted to the Secondary Uses Service (SUS) for the relevant Commissioning Data Set and reported in Hospital Episode Statistics (HES) as a broad indication of the coverage of PLICS data. However, the exclusions from the scope of PLICS Acute 2018-19 mean we would expect the count of PLICS activities to be lower than the count of HES activities.

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

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

The data items used to link PLICS Acute to HES are required 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.

Users of the data must make their own assessment of the quality of the data for a particular purpose. 

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

Analysis from the PLICS Acute 2018-19 collection is published as early as possible after data processing and data quality checks.

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 Acute data to comply with a mandatory request from NHS England and NHS Improvement. The submitted data is linked to HES, 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 Acute analytical assets. The analytical teams work together to promote coherence between their assets wherever possible, but 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.

For 2016-17 and 2017-18, analysis of PLICS Acute data collected from a subset of providers who submitted data on a voluntary basis was published as management information.

The 2018-19 data in this report should not be compared with the 2016-17 or 2017-18 data, nor should comparisons be made between the data from the voluntary collections. Differences over time could be due to the changes in the cohort of submitting providers, or changes in data quality as providers 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 within the collection window is limited. This means that data quality issues may only be identified following the submission deadline, when it is no longer possible for providers to amend and resubmit their data.

There is also no opportunity for late submissions should a provider miss the submission deadline for the initial collection window.

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

This is a new experimental statistics publication. We welcome feedback on this report – please send all comments to [email protected] with ‘PLICS Acute analysis’ in the subject.

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

The PLICS Acute 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 data to minimise the number of data items collected, and hence reduce the burden of submissions for providers.

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

PLICS Acute data is stored by NHS Digital and access is strictly controlled. Read more about how we keep 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