Background
Migrating to and developing a patient level costing solution (PLICS) programme has been a prominent topic of conversation for the costing community in Health and Social for years now, especially following its successful adoption within other jurisdictions. Trusts and the Strategic Planning and Performance Group (SPPG) alike have recognised the value of integrating a PLICS programme to enhance analytical capabilities and the quality and granularity of Health and Social Care (HSC) financial information. By integrating a PLICS programme, providers and commissioners would be able to better understand how resources are used to identify opportunities for cost reduction, improved efficiencies and achieving clinical level ownership.
As an increasing number of Northern Ireland Trusts began reaching the end of their original costing systems’ lifetimes and a drive to deliver PLICS data as quickly as possible, a decision to initiate a tender process was made.
Although the tender process– managed by colleagues in the Business Services Organisation Procurement and Logistics Service (BSO PaLS)– was lengthy, CACI’s patient level costing solution, Synergy, came out on top thanks to its costs and exceptional quality, along with CACI’s project team’s demonstrated understanding of the Northern Ireland landscape through their previous experiences.
Customer lead
Eilis Calvert is a head accountant in financial performance within the Strategic Planning and Performance Group of the Department of Health, responsible for producing guidance, returns submissions, data quality assurance and usage in the most effective capacities possible.
Project mapping & planning
According to Eilis, Synergy’s ability to deliver high-quality PLICS product and data insight with ease and flexibility would address each of the Northern Ireland Trusts’ needs, especially gaining a better understanding of their population. Previous systems costed in aggregate, resulting in a lack of visibility or granularity that Synergy could rectify. In addition, some Trusts previously needed to take additional steps to populate the necessary NI costing template following the completion of the costing process, which Synergy 4 would output directly and significantly reduce time for Trusts.
“Prior to [Synergy], we used higher-level costing data, but the devil is in the details, so getting that level of granularity [was critical] to help us to really understand the whole patient journey, especially as our healthcare system covers social care,” Eilis explained.
Action
The scope of Northern Ireland Trusts differs from NHS in other UK jurisdictions. While the Northern Ireland Trusts lean heavily on the work of NHS England and NHS Wales in developing patient level methodology, Eilis recalls the significant work that had to go into developing methodology and guidance for other elements specific to Northern Ireland, such as social care and adapting datasets to fit the electronic patient data collected in Northern Ireland. Reporting requirements also differed for these Trusts, such as the inclusion of Programmes of Care.
CACI helped the Trusts overcome these differentiation challenges by developing additional guidance aspects and modifying software to process data and report in the necessary capacity that would meet HSCNI’s unique needs. CACI’s project lead provided continuous support and advice through to the final cost submission being made. A constant flow of communication was maintained between CACI and the Trusts, ranging from ad-hoc calls to the creation and delivery of formal reports. CACI’s communicative approach ensured that a collective understanding was met across the Trusts, with Eilis sharing that CACI was “very supportive of everyone’s individual needs while ensuring that the department received the consistency that they required”.
Overcoming challenges
Working with such large data volumes and patient level data was unfamiliar territory for the costing teams, leading to teams having to upskill in these areas. Patient level cost allocation only began (and through a new system) in 2023, changing the pre-existing costing methodology from what the teams had been using for several years prior. With a plethora of data to review and a new system to work with, the cost review challenge was substantially heightened.
The implementation of Synergy began in January 2023, with Trusts trained up on the new system within the year, including working on a pilot model and completing a cost submission. Despite Eilis recalling this time as one of intensity, she is proud of what the HSC costing community have achieved.
“The project team at CACI was great at bringing people along this very challenging journey on a very tight deadline and keeping us all right, so that we were able to achieve what we needed to in that first year,” Eilis shared.
Success
Working with CACI on the PLICS data was helpful, although not without its challenges. The Northern Ireland Trusts are continuing to work with CACI this year to further develop and implement individualised validation and cost review dashboards to ensure Trusts will be equipped to meet their needs and deadlines as they arise.
