The Impact of Costing and Funding Regimes in the UK NHS

The Impact of Costing and Funding Regimes in the UK NHS

Background

In the United Kingdom, the knowledge of care providers at NHS is improving continually, especially regarding how to spend the income and the impact of such spending on service provision and the patients. Still, the process of costing is considerably variable according to the care provider. Inconsistency is common in the classification of physical and human resources and other activities conducted within the hospital setting. Particularly, datasets and costing allocations used for quality management and cost are inconsistent.  In addition, it is a common knowledge that detailed information on patient care cost cannot necessarily be provided by all provider’s costing systems (Blunt and Bardsley, 2012). Therefore, a research on the impact of costing and funding regimes in the NHS is necessary to add on the existing knowledge regarding the transparency of the practices, improvement of clinical ownership, and to inform on the funding policies implemented in the NHS system.

I am motivated to conduct this research because of the inadequacy of the information on the scrutinized data about the outcomes and cost of care. Many hospitals in the United Kingdom are introducing computerized information systems to track and analyze the cost of health care to the patients. Thus, this calls for a research to assess the effectiveness of such introductions, given that little information is currently available to the public.

Statement of Purpose

            The main purpose of this research is to analyze the history of costing and funding regimes at NHS. Additionally, it assesses distinct types of costing employed by varied medical facilities and their importance. Besides, the research should highlight the usefulness of PLICS (Patient-Level Information and Costing System) if it is properly integrated and implemented (Blunt and Bardsley, 2012). Moreover, the study establishes an evidence base for testing the need for an improved national costing strategy and cost collection strategy. In fact, the study outcome ought to inform the decision if the government should mandate both.

Transforming from one form of costing to the other is not easy. Thus, the research eases the process by supporting the decision makers in the sector to transform successfully. It highlights the significance of undertaking assurance processes, developing national costing community and costing capability, and development of mechanisms to make the best utilization of cost information while engaging non-finance healthcare staff in the United Kingdom. My main audience for the study include patients, healthcare professional, and the government officials. The targets set for this study are realistic because all the study respondents and subjects are within reach. As an experienced researcher, I intend to team up with other professionals in the field for advice and guidance. The timeframe allocated for this research is 5 months. Therefore, the allocated timeframe, if properly managed will be enough to gather and analyze field data.

Literature Review

In the UK, the costing methods applied provide outputs at the patient level because the medical facilities put the patient at the heart of cost management. Considering this, it is possible to combine the information on the patient with the necessary healthcare quality measures. Blunt and Bardsley (2012) argue that since the introduction of funding regimes and costing in the UK’s NHS, the cost of healthcare provision from one patient to the other can be tracked across the settings, providers, and related outcomes. In essence, it provides a larger picture of the efficiency and quality of healthcare, though it is subjected to government regulations. The combination of quality information and cost guarantees focused efficiency on the basis of quality care.

According to Adil (2012), NHS recently introduced PLICS (Patient-Level Information and Costing System) that represents a transformation in the costing methodology. Initially, the costing and funding methodology predominantly applied ‘top-down’ allocation approach according to appointments and averages. Contrastingly, the latest approach is sophisticated and more direct because it is based on the actual events and interactions related to the associated costs and the patients. In this case, cost calculations occur by tracing actual resources used by a patient and the resultant associated costs. For instance, if imaging services are provided, each patient that receives them must be ascertained to allow for the attribution of the associated cost. Eventually, it will be possible to allocate income to individual patients to allow for the mapping of their profitability.

            Ellwood et al. (2015) observe that PLICS improves resource use and clinical ownership dramatically. It is easier to initiate dialogues regarding resources consumed by particular patients for comparisons with teams, peer groups, and healthcare officials. Further, it provides crucial but necessary information demonstrating the insufficiency of tariff granularity for improved recognition of specialist activities. In fact, according to Kallala et al. (2015), the regulatory bodies can monitor and ascertain the contributions made by business units.

The existent costing method reflects accurately how the funding is spent. As patient receive healthcare services, the management of the medical facility carries out activities to deliver these services, thus mandating the need to spend resources on such. Baker and Gilbert (2013) argue that even though proper costing methods are in use by some facilities in the UK, simplified versions are of costing strategies are applicable to the majority of healthcare service providers. However, it is notable that simplified costing techniques hardly reflect how the providers are spending financial resources accurately. Hence, the adoption of the latest technology in costing results in better and informed decision making.

            Costing methods in NHS considers the existing general ledger of the provider, which is viewed as fundamental to the entire process of cost management. According to Chapman and Kern (2011), the current costing method utilizes decision support structures and available information to manage provider’s operations. The structures include physical resources as defined by stock and procurement management, human resources that form part of the existent organization structure, and the activities conducted daily by operational and service managers. If the cost is directly linked to the care of individual patients, clinicians can easily recognize the yielded cost information. In this way, it is probable that the information will be utilized, as the assessment and improvement of information accuracy are made much easier.

Methods

The following are the objectives of the study.

i.                    To assess the level of improvement in technical efficiency brought by costing and funding regimes in the UK NHS.

ii.                  To analyze how the resources are utilized within healthcare economies in the United Kingdom.

iii.                To establish a link between quality of health care and cost management and resource use.

iv.                To determine how information system and clinical ownership results in a greater clinical engagement.

v.                  To show how PLICS, as a new method of costing in the United Kingdom, is better than the previous methods applied at NHS.

Data Collection Methods

Questionnaire

To meet the objectives of this study, I intend to use several data collection methods as per the nature of respondents. My main focus is to distribute questionnaires to study subjects it is the cheapest method to use in this study (Robinson and McCartan, 2016). Given the limited timeframe for the study, most of the questions to be availed will be close-ended and direct. While some of the questionnaires will be handed out to the respondents, others will be sent via mail and later returned via the provided address in an envelope. The move will ensure the utmost level of confidentiality to enable the respondent to disseminate full information. Additionally, this method is adaptable for the entire sampled sectors such as patients, officials of the medical facility and the management (Singleton et al., 2013).

Furthermore, questionnaires are appropriate for the collection of infrequent or regular routine data on costing and funding regimes in the NHS. The respondents will fill out the required information themselves, thus minimizing instances of the provision of skewed and inappropriate data. It should be noted that the selected respondent have first-hand information on how the methods of costing such as PLICS impact the healthcare environment. In fact, most of them (especially the patients) are direct beneficiaries of the efficiency of services brought by technological methods of costing that include Patient-level information and costing system.

Interviews

Besides filling in questionnaires, interviewing the respondent is crucial because it allows for face to face interactions with the respondent (Gill et al., 2014). As a data collection method, it is ideal for extra inquiry to capture information not gathered by use of close-ended questionnaires. Given that this is a qualitative research, taking notes while talking with the study subjects is important. Later, the notes will be interpreted for further analysis. Specifically, conducting an interview ensures the establishment of a link between quality of health care, cost management and resource use in NHS (Robinson and McCartan, 2016). To access the organizational premises, a request will be made earlier to the concerned authorities and the respondents. The data gathered will be analyzed using computer software such as Microsoft excel and Mysql (Ott and Longnecker, 2015). Lastly, the plausibility of the conclusion will be checked by comparing the research outcome with other relevant studies formerly conducted in a similar field.

Ethical Issues

To conduct the research ethically, I will focus on protecting the research subjects by maintaining confidentiality. Under all circumstances, I will not disclose personal information about the respondents because of the sensitivity of the information gathered. The majority of study subjects are staff at distinct healthcare facilities in the UK. Therefore, any disclosure of their participation may cost them their jobs. In addition, I am obliged to ensure high quality of research and to refrain from falsified information to alter purposely alter the research outcome (Behi and Nohan, 2012). In fact, the ethical principles bind me to maintain factual data to validate the outcome of the study. Furthermore, I ought to comply with the legislation and laid down rules of the organization that I draw the respondents from. It is also important for me to foster a strong relationship with the respondents for them to provide factual and useful information.

 Project Plan

The following is a research project plan to be conducted within a span of 5 months.

Activity	Time
Formulating research topic	2 Weeks
Research background	2Weeks
Review of literature	2 Months
Actual field study	1 Month weeks
Data analysis	3Weeks
Research conclusion	1 Week

References

Adil, M., 2012. Use Of Patient Level Costing Data (Doctoral dissertation).  Manchester Business School.

Baker, J. and Gilbert, D., 2013. Clinical Effectiveness and the Pace of Change. British Journal of Nursing, 6(15), pp.845-845.

Behi, R. and Nolan, M., 2012. Ethical Issues In Research. British Journal of Nursing (Mark Allen Publishing), 4(12), pp.712-716.

Blunt, I. and Bardsley, M., 2012. Patient-Level Costing: Can it Yield Efficiency Savings?. Report, Nuffield Trust, London.

Blunt, I. and Bardsley, M., 2012. Use of Patient-Level Costing to Increase Efficiency in NHS Trusts. Nuffield Trust, London.

Chapman, C. and Kern, A., 2011. Designing Cost Systems in Healthcare. British Journal of Nursing, 14(1). Pp. 2-54.

Ellwood, S., Chambers, N., Llewellyn, S., Begkos, C. and Wood, C., 2015. Debate: Achieving the Benefits of Patient-Level Costing—Open Book Or Can't Look?. Public Money & Management, 35(1), pp.69-70.

Gill, P., Stewart, K., Treasure, E. and Chadwick, B., 2014. Methods of Data Collection in Qualitative Research: Interviews and Focus Groups. British Dental Journal, 204(6), pp.291-295.

Kallala, R.F., Vanhegan, I.S., Ibrahim, M.S., Sarmah, S. and Haddad, F.S., 2015. Financial Analysis of Revision Knee Surgery Based on NHS Tariffs and Hospital Costs. Does It Pay to Provide a Revision Service?. Bone & Joint Journal, 97(2), pp.197-201.

Ott, R.L. and Longnecker, M., 2015. An Introduction to Statistical Methods and Data Analysis. New York: Nelson Education.

Robson, C. and McCartan, K., 2016. Real World Research. London: Wiley.

Singleton Jr, R.A., Straits, B.C. and Straits, M.M., 2013. Approaches to Social Research. London: Oxford University Press.