Read our brochure on how Prodacapo's Patient Level Costing and Information System works in NHS Mental Health Trusts.
The system is currently delivering successful results to eight NHS Mental Health Trusts.
bhopal Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Patient Level Costing in a NHS Mental Health Trust
1. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
Prodacapo PLICS
in Mental Health
Better informed decisions
In its recent publication ‘NHS Improving the costing
of NHS services: Proposals for 2015-2021’, Monitor has
recognised the importance of costing at the patient
level as a basis for informing clinical and management
decision-making as well as influencing how tariffs are set
and how performance is compared between Trusts.
However, since the introduction of Patient Level Information and
Costing Systems (PLICS) in 2007, much has changed and Monitor has
recognised that the original approach is no longer sufficient.
Responsibility for a Mental Health Payment System (MHPS) has
moved to Monitor, which in turn has recognised the need for more
clearly defined costing standards and for a greater consistency and
“Collaboration has been essential
to the success of the Patient Level
Costing project and Bellis-Jones Hill
have been very helpful, supportive
and patient.”
Ada Foreman, Deputy Director of Finance,
Kent and Medway NHS and Social Care
Partnership Trust
2. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
compliance with them. The economic environment has become
much more demanding and the availability of funding more limited,
driving the need for more efficient and effective service delivery.
High profile failures in patient safety as catalogued by the Francis
Report and the Keogh Report has pushed patient safety to centre-
stage and regulators now demand greater transparency of clinical
and managerial performance and accountability, as well as the need
for a more balanced view of Trust performance. The Department of
Health has placed quality, innovation and productivity at the heart of
its strategy to deliver better patient outcomes and experience, and
greater efficiency.
Commissioning of services is being fundamentally restructured
to increase the responsibility of GPs for their patient’s treatment
and to focus on the delivery of integrated care pathways often
involving a range of healthcare providers in different organisations.
The recognition of Any Qualified Provider (AQP) as able to tender
for these services is forcing a fundamental re-think of the roles
and responsibilities of those participating, especially in how they
understand performance and profitability.
These demand that managers and clinicians work together to develop
a deeper understanding of what is really driving both the cost of
service delivery and patient outcomes. Patient Level Information
and Costing Systems (PLICS) are now seen by Monitor as essential
in helping Mental Health Trusts to deliver such management
information. By integrating patient activity data with the
corresponding costs and income at the patient episode level, PLICS
allows clinicians to see the financial effects of treatment provided,
compare performance with their peers and reduce unnecessary
clinical variation.
To provide the level of PLICS detail that clinicians require, the ability
to integrate and match all patient-relevant data at the patient
encounter level from numerous source systems accurately and easily
is essential. At Bellis-Jones Hill we have deep understanding of costing
methodology, large-scale data integration, management information
visualisation skills and clinical engagement techniques that are all
becoming an increasingly critical part of healthcare delivery in the NHS.
2
“The Bellis-Jones-Hill expertise
stems from a complete
understanding of their product
along with patience and
encouragement throughout the
implementation and beyond. The
consultancy time is put to great
use and consideration of our needs
at CNWL. We have never felt the
‘client/customer’ relationship with
the consultants, because they have
worked together with us, as a
team, throughout the process.
There is a definite feel for success
and further business development
during and post implementation.
Prodacapo, along with ADaPPT, is
undoubtedly excellent value for
money. It allows for ease of model
management and validation
which, in turn, ensures that the
Finance Department have become
a sophisticated supplier of financial
reporting, allowing provision of
the essential financial analysis
required for the ever changing
Trusts’ needs.”
Kara Evans
Senior Costing and PBR Lead
Central and North West London NHS
Foundation Trust
3. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
Dispelling the myths of why not to undertake PLICS now
While many Mental Health Trusts have embraced PLICS with relative ease, others have been
discouraged by a number of misconceptions which our experience indicates are misplaced and need
to be challenged. The most frequently mentioned myths include the following:
“We can only cost service lines as our patient data is not accurate or complete”
• Not true. Several of our many Mental Health clients have started with reservations regarding the quality of
their information. However, once they appreciated the tools available to assist with the validation, matching
and communication of their data (through the use of our ADaPPT system) they were confident that these initial
reservations were unfounded.
• Where data quality is an issue, one of the key benefits of investing in a PLICS system is to identify these areas
and expose them. We see this as a genuine short term success factor as these data gaps have previously lacked
transparency and been allowed to create an ‘excuse’ for the inadequate provision of information.
“PLICS can be resource intensive to administer and to use”
• Costing a Mental Health Trust, or indeed any large organisation, requires the right resources. We believe that in order
for the Trust to exploit the opportunities that a good PLICS system will offer them, they need to make sound decisions
in the resourcing of their implementation. This is not to suggest that a large number of staff resources are required
but simply the right resources with relevant experience. As established costing specialists, we have this experience.
Through working with many Mental Health Trusts we can bring an unrivalled wealth of knowledge which will ensure
that the delivery of a PLICS system is achieved on time and on budget.
“We are not paid through Payment by Results so we do not need to understand patient level costs”
The evidence indicates that there are many reasons why PLICS would benefit your organisation above and beyond the
development of a tariff driven payment system. For example:
• Devolved autonomy – by creating an integrated patient-centred view of clinical activity, resources, costs and income,
Trust management can have access to reporting information that allows responsibility to be devolved to service line,
cluster and team levels and beyond to individual consultants with confidence, so that they can see what is really
happening..
• Accuracy and clinical engagement – by capturing costs of each individual resource, such as each healthcare
professional or cluster, we are able to avoid the averaging that is inevitably associated when cost pools alone are used.
This makes the related PLICS information much more relevant and credible to clinicians.
• Understanding clinical variation – by capturing all relevant financial and non-financial data at the patient encounter
level, each individual user is better able to understand variation at the level at which work is done and facilitate
reductions in clinical variation, service delivery redesign and improvement in patient outcomes.
• Planning and capacity management –by recognising the capacity constraints of the resources available to a Trust and
understanding how resourcing levels might respond to changes in demand, it is possible to anticipate the resource,
cost and profitability implications of future plans and “what if?” scenarios as a part of the annual planning process.
• Managing demand – by understanding the referral patterns by which patients attend a Trust for treatment, it is
possible to focus in on those areas where communications may need to be improved with GP surgeries and CCGs in
order to attract more patients.
• Performance improvement – the transparency that PLICS creates by linking drivers such as acuity, length of stay and
high cost drugs to patients, facilitates the development of robust Cost Improvement Programmes.
3
4. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
• Commissioning arrangements – by providing access to granular financial and non-financial information at the patient
level, Trusts can develop more evidence-based plans with their commissioners. The need for fact-based commissioning
has never been greater, particularly with the development of Accountable Lead Providers (ALPs) that will act as
aggregators of the different elements of service provision which make up a particular care pathway that a CCG may
wish to commission.
• Benchmarking – by capturing the individual resources consumed by each aspect of a patient’s treatment within a
cluster we have created the opportunity to understand the costs of the treatment provided, giving greater insight to
clinical decision-makers when comparing performance across time and by healthcare professional. This facilitates:
• Individual utilisation reporting and identification of time spent on patient facing activities
• Internal benchmarking of comparable staff and their performance
• Improved data quality at the point of entry, highlighting those staff where little or no activity is recorded
• Improved data quality – our Advanced Data and Patient Profiling Tool (ADaPPT) is a data warehouse designed to meet
the specific data matching and automation needs of PLICS. Together with Prodacapo PLICS, the level of detail used
readily highlights to clinicians and managers the financial implications of poor data quality so that they can prioritise
remedial action.
• The development of personal budgets for mental health service users – Standard outputs from our PLICS system
allow the Trust to develop and report expenditure on personal budgets for service users. This is achieved through the
detailed understanding of the services provided to the patient at each stage of their care and their related costs.
• Tendering for service delivery opportunities – Trusts are under tremendous pressure to ensure that they offer services
at a commercial rate. However gathering information to feed into service tenders has proved to be a challenge for
some. PLICS offers Trusts transparency of the direct, indirect and overhead cost of their services and creates the
opportunity to challenge Service Level Agreements against recognised internal and external benchmarks in order to
ensure the Trust can operate within an increasingly competitive market.
An integrated approach to Service Line Reporting (SLR) and Patient Level Information
and Costing Systems (PLICS)
Clinicians are, quite rightly, a demanding audience for PLICS information; it has to feel right if it is to
engage their interest and be open to the closest scrutiny. Along with the detail, managers also want
the bigger SLR picture to understand service delivery and performance management.
Our integrated approach to SLR and PLICS brings clinicians and managers together with data they can trust in one place.
SLR was developed by Monitor in 2006 and PLICS were first promoted by the Department of Health in 2007.
For some, bringing the two together was seen as simply too difficult, but at Bellis-Jones Hill we have always seen SLR and
PLICS as two parts of the same solution where SLR is primarily the aggregation of activity, costs and income from the
patient-episode level. This means that managers and clinicians can always drill down to understand cost and profitability
from Trust-level to the patient episode-level in a matter of clicks and - at any chosen level - analyse that data by the
resources, costs consumed and income generated.
This integrated approach creates the link for clinicians between patient outcomes and the resources used to treat those
patients. In short, Prodacapo PLICS provides a solid foundation for all aspects of Service Line Management within a
Mental Health Trust, supporting both clinicians and managers with a common language.
4
5. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
Prodacapo PLICS
Mental Health Trusts are large and complex organisations and the data they generate reflects this.
For PLICS to produce information that is credible to clinicians, the data used must reflect reality as
they understand it. This demands an approach to costing that makes a clear connection at the most
granular level between clinical activity and the resources consumed in delivering it, and not just
relying on the simplistic apportionment of cost pool data.
Our approach
Our approach is to cost each Service User active day of care in order to give a complete view of the
pathway of care.
By costing at this fine level of detail, one single version of the truth can be created that can then be analysed and
reported by:
• Cluster, Cluster Group and Super Cluster
• Service, Team and individual Healthcare profession
• Commissioner and contract
An overview of our Prodacapo PLICS solution
Prodacapo PLICS has been developed as a solution to the specific needs of Acute, Mental Health and Community Care
Trusts so that they can cost and then understand industrial volumes of data from multiple and diverse data sources.
Our solution can carry out complex calculations on massive amounts of data and yet still allow users to understand and
engage with their PLICS results in an easy and intuitive way.
Inbound data hub - ADaPPT
For PLICS to reflect the reality of what is really happening in a Trust, the data volumes can be vast. Especially in the larger
Trusts and particularly when a high degree of data granularity is required. To be useful, data for PLICS has to be matched
against each unique patient episode and then formatted to populate the structured templates of data that are required
by Prodacapo. Undertaking such data manipulation and data matching can be very labour intensive task if undertaken
manually. For this reason Bellis-Jones Hill has developed the Advanced Data and Patient Profiling Tool (ADaPPT) which,
using our bespoke data Extract-Transform-Load capability, fully automates these laborious processes.
5
6. ADaPPT ensures a higher degree of data completeness and accuracy than is available through a typical data warehouse
and speeds up the routine refresh of PLICS data to facilitate monthly reporting. It also reduces the need for SQL scripting
skills in the Trust, skills that are often in short supply, and can thereby free up valuable internal IT resources.
Costing engine
We believe that for PLICS to be truly valuable for cost management, rather than just costing purposes, it is essential that
true Activity Based Costing principles - as have now been embraced by Monitor - are applied. This means costs can be tied
back to individual resources used in departmental cost centres, not just aggregated into cost pools where the granularity
of individuals, such as each clinician, is lost in averages. To cope with such data volumes reliably and at speed, the
Prodacapo PLICS Solution runs in a SQL database environment which provides “industrial strength”, with calculating times
of less than one hour for a typical acute trust.
On-demand web-based reporting
If PLICS results are to inform operational and strategic decision-making, it must be readily
accessible on an on-demand, self-service basis to clinicians and managers in a way that engages
their interest and allows them to inform themselves of management and decision-making
information relevant to their needs.
Bellis-Jones Hill was the first to recognise the natural synergy between what QlikView could offer
and how clinicians and managers like to see Trust information. This fit is confirmed by the fact
that all of our NHS clients have now picked QlikView as their web based reporting tool of choice.
QlikView makes the complex seem simple: it has a powerful search capability, allows data from
many sources to be integrated and has superb visualisation capability that makes it easy for users
to draw insights from their PLICS results.
P R O DAC A P O P L I C S I N M E N TA L H E A LT H
6
7. P R O DAC A P O P L I C S I N M E N TA L H E A LT H
7
Prodacapo PLICS – the
complete package
In short, the Prodacapo PLICS
solution is the most advanced, best
proven, most flexible solution to
delivering a true PLICS capability on
time and on budget.
Implementation and support
Our Prodacapo PLICS solution can be implemented and operated by Trust staff with training and
support from our specialist staff at Bellis-Jones Hill, or can be provided as a Managed Service on your
own IT infrastructure.
About Bellis-Jones Hill
Founded in the UK in 1999, Bellis-Jones Hill Group is a performance management solutions provider supporting a wide
range of blue chip organisations in their development of costing, planning, performance management, analytics and
Business Intelligence systems. Clients include Thomson Reuters, Barclays, Environment Agency, Skandia Life, RSA and over
40 NHS trusts including Acute, Mental Health and Community Care Services.
