Equity and Cost Growth in Specialised Services

Equity and Cost Growth in Specialised Services
The Strategy Unit January 2021

• NHS specialised services provide care for people with complex or rare medical conditions. Treatments for these conditions are often expensive: While specialised services support a small proportion of the population, approximately one-sixth of the total NHS budget - over £19 billon - was allocated to this area in 2019/20.
• The reports published here, address two important and enduring questions about specialised services:

1. To what extent do specialised services follow patterns of need?
2. What factors are driving the rapid increase in spend on specialised services?

Publicly funded hospital care: expenditure growth and its determinants

Publicly funded hospital care: expenditure growth and its determinants
Centre for Health Economics 19 January 2021

• Understanding the drivers of growth in health care expenditure is crucial for forecasting future health care requirements and for the efficient use of resources. This paper considers total hospital admitted care expenditure in England between 2009/10 and 2016/17.
• Decomposition techniques are used to separate changes in expenditure into elements due to changes in the distribution of characteristics, of both individuals and the services they receive, and due to changes in the impact of characteristics on expenditures. Growth in aggregate expenditure was due to increases in total patient admissions together with a substantial shift towards episodes of non-elective care, particularly the use of long-stay care. Decomposition of patient level expenditure suggests efficiency gains in treatment across the full distribution of expenditures, but that these were outweighed by structural changes towards a greater proportion of patients presenting with high-dimensional comorbidities. This is particularly relevant at the top end of the expenditure distribution and accounts for a large proportion of the total expenditure growth.

Costs of joint replacement in osteoarthritis

Costs of joint replacement in osteoarthritis: a study using the National Joint Registry and Clinical Practice Research Datalink datasets
Arthritis Care Re. 2020 Oct 1. doi: 10.1002/acr.24470.

• Analysis of National Joint Registry linked with Hospital Episode Statistics data to estimate of the costs of primary hip and knee replacement in individuals with osteoarthritis. The mean censor-adjusted 1-year hospitalisation costs for hip and knee replacement were £7,827 (95% CI £7,813 to £7,842) and £7,805 (95% CI £7,790 to £7,818), respectively. Complications and revisions were associated with up to a three-fold increase in 1-year hospitalisation costs. Adding primary and outpatient care, the mean total hip and knee replacement 2-year costs were £11,987 and £12,578, respectively.

How to cost the implementation of major system change: case study using reconfigurations of specialist cancer surgery in part of London, UK

How to cost the implementation of major system change: case study using reconfigurations of specialist cancer surgery in part of London, UK [Presentation]
HSRUK 2020

• Abstract of a presentation given at HSR UK 2020 illustrating a framework and principles for costing major system change implementation. The case study uses the RESPECT-21 mixed-methods evaluation of specialist surgery services reconfiguration for prostate, bladder, renal and oesophago-gastric cancers, and focuses on a London region [UCL] where services for eight cancer pathways were centralised to fewer high-volume units.
• Presentation available here. [YouTube]

Abstract

How can we best incentivise world class cancer services in England?

How can we best incentivise world class cancer services in England?
Incisive Health for Cancer Research UK, September 2019

• This paper explores how to best use financial levers and incentives to support the delivery of the NHS Long Term Plan (LTP) cancer ambitions, summarising findings and recommendations developed through consultation with experts. 
• The report explores how funding and commissioning of services currently operates in the NHS in England and assesses what opportunities exist to deliver the ambitions of the NHS LTP. The conclusion reflects on the opportunity that exists, with the NHS LTP and accompanying funding settlement, to ensure funding for cancer services is optimally delivered to improve outcomes 
• Box 1 - Principles that should guide decisions on cancer funding:
• Funding should take into account predicted increases in incidence, survival and comorbidity, ensuring that resources keep pace with need and are sufficient to deliver the ambitions of the Long Term Plan.
• Funding should be prioritised for the areas of cancer services where evidence shows it can deliver the biggest improvement in outcomes.
• Financial incentives should be used to support improvements in quality and service transformation, and to incentivise innovation, not just as a measure to stabilise current performance.
• Funding should also be used to encourage all those involved in cancer services to come together to design, test and implement radical new approaches to improved cancer outcomes.
• Funding should be allocated in a way which enables the NHS, at both a national and a local level, to track how money is used and to account for the progress delivered.

NHS efficiency map updates

NHS efficiency map updated
HFMA, NHS Improvement and NHS England, updated 12 April 2019

• The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) schemes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency. 
• Updated case studies on Theatres reporting and utilisation  and Aligned incentive contract.

NHS financial sustainability
National Audit Office 18 January 2019

• This report 
• summarises the financial position of NHS England, CCGs and trusts 2017/18
• examines the financial flows and incentives in the NHS and whether these encourage long-term financial sustainability
• examines how local partnerships of health and care organisations are progressing, and what the Department of Health & Social Care, NHS England and NHS Improvement are doing to support them
• Figure 17 - National initiatives to help bodies to reduce demand, manage costs and improve efficiency

Mental health specialised commissioning will be devolved to provider collaboratives

Mental health specialised commissioning will be devolved to providers
HSJ 3 January 2019

• Mental health specialised commissioning will be fully devolved to provider collaboratives within the next three years, according to Birmingham and Solihull Mental Health Foundation Trust chief executive John Short.
• An NHS England spokesperson said: “Following the success of the new care model programme the intention is for specialised mental health services to eventually be planned and delivered by partnerships of providers and NHS England, as well as local commissioners, in all parts of the country.
• This is in line with a wider drive to join up care – and the timing of implementation will vary according to the maturity of services and local health systems.”

See Preparing for 2019/20 Operational Planning and Contracting Annex E: Integration of specialised services with local health and care systems

NHS England 21 December 2018

Supporting Research in the NHS: response to consultation on ETCs and commercial research

NHS England’s response to the public consultation: “Supporting Research in the NHS: A consultation covering changes to simplify arrangements for research in the NHS and associated changes to the terms of the NHS Standard Contract”
NHS England 4 May 2018

• A summary of responses received to the consultation on simplifying arrangements relating to Excess Treatment Costs (ETCs) in non-commercial research and commercial contract research. accompanied by details of 12 agreed actions to support and apply research in the NHS. 
• Specialised Commissioning will be developing a new process to be unified with the new ETC management process. The intention is to publish a planned specialised commissioning process by end of June 2018 which will be tested with stakeholders. 

Economic analysis of service and delivery interventions in health care

Economic analysis of service and delivery interventions in health care
Health Serv Deliv Res 2018;6(5)

• Evaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
• "Broadly speaking, there are two approaches to producing summative assessments of the costs and benefits of entire programmes. The first involves direct estimation of the summative impacts through exploitation of some experiment or other source of variation in implementation. The second involves modelling the causal chain through component processes to derive an aggregate measure where direct estimation is not feasible." see Recent developments