The Audit Commission has criticised existing NHS datasets for failing to reflect what is happening to patients.
In its annual review of the Payment by Results data assurance programme, the financial watchdog says that data definitions are becoming increasingly problematical in the NHS.
It says routine, short-stay treatments in particular may be recorded as “inpatient at one hospital and outpatient at another.”
This not only leads to poor data quality, but to disputes between trusts and commissioners over payments using the PbR tariff, and to increased management costs.
“The total cost of this activity is £6.8 billion,” the report says. “One director of finance we interviewed estimated that his organisation spent at least one full time equivalent post across the staff grades working on this.
“If replicated across the country, this would equate to £16.4m of management time spent on this single issue.”
The Audit Commission says the NHS puts these problems down to “poor national guidance” from the Department of Health and NHS Connecting for Health, but the real issues lie deeper.
It says that contract disputes often arise when trusts seek to maintain historical levels of income “whether their approach to recording admissions correct.”
It says this encourages both trusts and commissioners to make ‘bottom-line’ adjustments to contracts, rather than to tackle data quality issues or to try and understand what the data really means.
At a national level, it says this is problematic, because the NHS tariff is supposed to make sure that competition takes place on quality not price, but trusts are charging different prices for the same services, because of the way they account for them.
At a more fundamental level, the Audit Commission says these problems arise because PbR was developed when hospitals delivered most episodes of care.
As treatment and observation has shifted into specialist centres and community settings, the datasets have not shifted with them, and therefore no longer reflect how the NHS delivers care.
“The problems with data definitions are symptomatic of a wider problem; that the current NHS national data sets do not properly reflect what is happening to patients,” the ‘By Definition’ report says.
“Valuable data that describes a patient’s diagnoses and treatment is significantly reduced when it moves from an inpatient to an outpatient setting, and is lost entirely when it moves into the community.
“This means clinicians do not recognise their service from the data, local organisations lack the information to plan and fund care, and national data on NHS productivity becomes increasingly unreliable.
“This is a significant problem that needs to be dealt with alongside other known problems with the datasets, such as the lack of information quality and outcomes.”
The Audit Commission says the NHS Commissioning Board and Monitor, as the new economic regulator of trusts, should make sure that patients are recorded consistently.
Over time, it says they should also develop datasets that capture all interventions, wherever they take place, and include quality measures.
It wants the NHS Information Centre to support this work, to provide better guidance, and to act as a single point of contact for data and PbR queries.
And it wants commissioners to work with local clinicians to find out how care is actually delivered, to agree reporting requirements before setting up new pathways, to make sure local and national returns tally with each other, and to benchmark their performance.
“Developing [new] datasets is necessary. But it will be a long and difficult task. In the meantime, there are still practical steps for national organisations to improve data definitions and their use by the NHS,” the report concludes.