Acute Patient Level Activity and Costing, 2019-20

The Patient Level Information and Costing System (PLICS) Acute data collection has been designed to link to Hospital Episode Statistics (HES) data at record level to permit analysis such as costing by primary diagnosis. This limits the burden on submitting providers by minimising the number of PLICS Acute data items collected and ensures that a single version of activity information is used.

Further information on the HES data linked to in this analysis is available from the HES publication pages:

Accident and emergency

Admitted patient care

Outpatients

All A&E attendances, APC finished episodes and OP appointments included in PLICS Acute submissions would be expected to have been submitted to the Secondary Uses Service (SUS) within Commissioning Data Set submissions, which form the basis of HES data.

For each attendance, episode or appointment, a match is sought among the 2019-20 HES activity records for the same provider. The primary matching field is CDS Unique Identifier. For PLICS Acute activity records where CDS Unique Identifier is not submitted or the CDS Unique Identifier does not match to any HES record, a secondary matching method is used to link records based on fields such as NHS number and date of birth, and dates of activity.

Some HES records are anonymised because they contain diagnosis or procedure codes which are subject to legal restrictions.  The processing which matches PLICS Acute records to HES data does not link any PLICS Acute activity to these anonymised HES records.

The matching process found a small number of matches between PLICS Acute records for incomplete APC episodes and HES completed APC episodes (0.02% of PLICS Acute APC episodes). These may reflect data quality errors in either the PLICS Acute or SUS submissions. Such matches are excluded from the table below and in the APC analysis in this report.

The percentages of PLICS Acute activity for which a unique matching HES record was found were:

HES data for 2019-20 includes acute activity submitted by providers that were not required to submit PLICS Acute data for this period, such as non-NHS providers and NHS providers in other sectors.

When comparing HES and PLICS Acute activity counts for 2019-20 for a specific provider, please note that some activity recorded in HES was not in scope for the PLICS Acute collection for 2019-20.

Full details of the activities in and out of scope were published in the National Cost Collection guidance.

Examples of activity included in HES and excluded from PLICS Acute for 2019-20 (both activity and cost) are:

• private patients, overseas visitors, patients from the devolved administrations and patients funded by the Ministry of Defence
• all activity in HIV and sexual and reproductive health clinic specialties, and activity in other specialties with related Healthcare Resource Group (HRG) codes

Examples of activity included in HES and excluded from PLICS Acute for 2019-20 (associated costs reported as part of the cost of other PLICS activity records) are:

• birth episodes for healthy or well babies – costs reported in PLICS as part of the costs of the maternity delivery episode
• outpatient appointments where the patient did not attend – costs in PLICS allocated only to the patients who attended

Providers were also offered the option of excluding from their PLICS Acute submissions any activity records where zero or minimal cost was to be allocated against the core activity HRG as a result of unbundling costs (such as rehabilitation or specialist palliative care). The approach to including or excluding such activity records may vary between providers.

Linking HES data to PLICS Acute data allows us to analyse the PLICS Acute data by data items recorded in HES, such as diagnosis and procedure codes.

We cannot use the linked data to report the costs of all HES activity, as not all elements of cost are currently recorded in the PLICS Acute dataset. For example, a HES APC episode for a child may include a period of paediatric critical care. The PLICS Acute data for this episode will only include the core costs of the APC episode, as the paediatric critical care costs are ‘unbundled’ and remained within the aggregate part of the National Cost Collection for 2019-20.

As more of the unbundled costs move from the aggregate collection to the PLICS Acute collection in future years, more complete analysis of the total cost of an activity reported in HES should be possible.