Patient Level Activity and Costing, 2020-21

The distribution of total cost and count of EC attendances shown in this chart excludes attendances where the diagnosis is either Unknown or the record is unable to be linked to a HES record which made up 17% and 8% respectively of the total cost of the attendances linked to HES EC data.

The most frequent diagnosis group was ‘Nothing abnormal detected’.  Attendances with the diagnosis group ‘Gastrointestinal conditions’ had the highest proportion of total cost recorded.

Total cost and count of APC activities can be analysed by ICD-10 chapter of primary diagnosis for the linked HES finished consultant episode.

The variation between total cost of episodes per diagnosis chapter is influenced by both the frequency of episodes in each diagnosis chapter and the diagnosis chapter.  The most frequent diagnosis group was ‘Diseases of the digestive system’.  The diagnosis group 'Diseases of the circulatory system’ had the highest proportion of total cost recorded.

OP data has not been analysed by diagnosis due to known incompleteness of diagnosis recording in HES outpatient records.

For costing purposes some activity is ‘unbundled’ and the costs are identified separately from the costs for the ‘core’ activity.  Details of submitted ‘unbundled’ PLICS activity is reported in the sections below.

The total cost of mental health data can be explored using the cluster code assigned to each patient, which indicates the type of mental health they are receiving treatment for.

A total of £3.8 billion was reported for admitted patient mental health provider spells (MHPS), of which 52% (£2 billion) was assigned to a cluster.

The cluster with highest associated costs for MHPS was 'Ongoing or Recurrent Psychosis (High Symptoms and Disability)' at £269 million.

To note both MHCC and MHPS charts below show distribution of cost and care contacts where patients have been assigned a specific cluster code.  This is a subset of the full list of categories found in the Adult Mental Health Care Cluster Code list (see the data model and dictionary).

IAPT data can provide mental health related cost and activity breakdowns similar to the MH datasets using patients’ cluster codes.  There were £543 million recorded costs across 4 million appointments, of which 71% were assigned a care cluster.

The cluster which made up the greatest proportion of both IAPT costs and appointments was ‘Non-Psychotic (Moderate Severity)’.  Across the year in this cluster 1.3 million appointments were attended, with a total cost of £179 million.

To note the IAPT chart below shows the distribution of costs and care contacts where patients have been assigned a specific cluster code.  Furthermore, clusters with relatively small numbers have been omitted to aid clearer visualisation but are contained within the full dataset available for download with this report.  This is a subset of the full list of categories found in the Adult Mental Health Care Cluster Code list (see the data model and dictionary)

The Patient Level Information and Costing System (PLICS) Ambulance data collection includes mandatory and required data items.

For a PLICS Ambulance data submission to be accepted, all mandatory data items must be completed with valid values.  Mandatory data items are therefore 100% complete for all providers, although other data quality issues may be found when analysing such data.

Required data items may be left blank in a submission, either because the provider does not hold the relevant data in their information systems, or the data item does not apply to an incident.  Completeness of each required data item may vary significantly between submitting providers.

This analysis of PLICS Ambulance data reports on:

• Incident outcome - a mandatory data item
• Response type - a mandatory data item
• Number of response units arriving at a healthcare provider – a required data item which had high data completeness for all providers

For each of these breakdowns, variation between providers should be interpreted with caution as it may reflect differences in how data has been extracted from local systems for submission to the PLICS Ambulance collection rather than true variation in services provided.

The response type or types arriving on scene are reported for each ambulance See and Treat incident.

The response type reported was not consistent with other submitted information about the incident for 14.4% of See and Treat incidents and 18.7% of total See and Treat costs.  (For example, more or fewer response types were listed than the reported total number of response units arriving on scene.)

The number of response units arriving at a healthcare provider is reported for each See and Convey incident.

The number of response units was missing or zero (which is not consistent with a See and Convey incident) for 4.5% of See and Convey incidents and 3.8% of total See and Convey costs.

Where the number of response units was submitted and was consistent with a See and Convey incident, almost all (79.7%) of the total reported cost related to incidents for which a single response unit arrived at a healthcare provider: