Mandating patient level costing to NHS community services

Key points

• We broadly agree with the proposals outlined in the consultation document, which are in line with the wider set of reforms taking place as part of NHS England and Improvement’s (NHSE/I) five-year costing transformation programme.
• Moving away from reference costs, and towards patient-level costing, has the potential to bring several benefits to the community sector, including enhanced standardisation across service provision and more accurate data collection – two issues which have historically been a barrier to national investment in, and prioritisation of, the community sector. However, as acknowledged in the consultation, there are some outstanding challenges and risks that must be addressed before moving forward with the proposals as outlined. In particular, the current pressures created by the COVID-19 pandemic, and the ongoing demand increases that community providers will face, mean that NHSE/I must take every possible step to avoid creating any additional burden for providers of community health services.
• Before moving to mandate patient-level costing, NHSE/I should seek to understand the reasons behind the variation in the group of providers already submitting patient-level costing data consistently and support providers to meet the new standards (including the 2 per cent of community trusts who do not have a patient-level information and costing system).
• Additionally, NHSE/I should seek to engage with Community Interest Companies (CICs), who provide a significant proportion of NHS community health services, but are currently excluded from these proposals. We support the extension of patient-level costing to CICs, subject to them being properly resourced and supported to do so.