Acute Patient Level Activity and Costing, 2019-20

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 2019-20 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 neonatal and paediatric 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 2019-20 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 2019-20 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.

A separate summary of PLICS Acute data for unbundled adult critical care, high-cost drugs, blood products and devices, and outpatient diagnostic imaging is published alongside this publication as management information.

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.

The summary of PLICS Acute data for adult critical care, high-cost drugs, blood products and devices, and outpatient diagnostic imaging is classified as management information. This term describes information collated and used in the normal course of business to inform operational delivery, policy development or the management of organisational performance. The data may be incomplete in places and is not quality assured to the same extent as other official statistics.

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.)

NHS England and NHS Improvement reviewed summary data from the PLICS Acute collection during the collection window. Submitting providers also received a summary report soon after making their submission.

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

For providers that made their submission close to the deadline, there will have been less opportunity to review data quality and arrange resubmission.

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 2019-20 collection listed the providers expected to submit data. 

Since the mandatory request was issued, NHS England and NHS Improvement agreed that Great Ormond Street Hospital for Children NHS Foundation Trust would not submit PLICS Acute data for 2019-20. 

Following the collection window, NHS England and NHS Improvement carried out further data quality checks and identified a small number of providers to be excluded from the National Cost Collection publication for data quality reasons. The PLICS Acute data submitted by these providers has similarly been excluded from this report.  

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

A small amount of APC and OP data from one provider has been excluded due to a data quality issue affecting data linkage. 

The NCC guidance listed the activities and costs which were in scope for the PLICS Acute 2019-20 collection.

The count of activities reported in PLICS for accident and emergency (A&E), admitted patient care (APC) and outpatients (OP) 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 Acute 2019-20 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 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 data for A&E, 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.

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 2019-20 collection is published as early as possible after data processing and data quality checks have concluded.

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, 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.

For 2016-17, PLICS Acute data was collected from 61 providers who submitted on a voluntary basis. Similarly, for 2017-18, PLICS Acute data was collected from 80 providers. Data for 2016-17 and 2017-18 was published as management information.

The 2018-19 financial year was the first period of mandatory submission of PLICS Acute data by relevant providers. Analysis of the 2018-19 data submitted by 146 providers was published as experimental statistics. 

Comparisons between the 2019-20 data from 137 providers included in this report and the 2018-19 data should be made with caution. In addition to the change in the list of providers included in the analysis, differences over time could be 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. The 2019-20 data may reflect some impacts of the Covid-19 pandemic for activity during the last few weeks of the financial year. 

Comparisons should not be made with the 2016-17 or 2017-18 data as differences over time could also be due to the differences in the cohort of submitting providers from year to year.

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 2019-20 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. 

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

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. 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