Diseases of Childhood Expert Working Group 1 st March 2012

Overview Introduction Stakeholder engagement Changes made in reference cost 2011/12 design Where we are – HRG4 The Catalyst for Change Where we are going –HRG4+ What does this mean for us? Summary

PROVIDER PATIENT TREATMENT NOTES CODING PAS COSTING REFERENCE COSTS TARIFF DH PbR SUS HES SUS PbR £ NATIONAL SYSTEM COMMISSIONER PAYMENT £ The (Simplified) Operating Environment CDS

HRG4 Groupers & Design Change Freeze Dates OPCS-4.5 TOCE HRG4 Reference Costs 2006/07 Grouper Rel’d Apr 2007 HRG4 Road Test 2009/10 Grouper Rel’d Jun 2008 HRG4 Payment 2009/10 Grouper Rel’d Apr 2009 HRG4 Reference Costs 2007/08 Grouper Rel’d Jan 2008 HRG4 Road Test 2010/11 Grouper Rel’d Oct 2009 HRG4 Payment 2010/11 Grouper Rel’d Apr 2010 HRG4 Reference Costs 2008/09 Grouper Rel’d Jan 2009 HRG4 Road Test 2011/12 Grouper Rel’d Oct 2010 HRG4 Payment 2011/12 Grouper Rel’d Apr 2011 HRG4 Reference Costs 2009/10 Grouper Rel’d Jan 2010 HRG4 Road Test 2012/13 Grouper Rel’d Oct 2011 HRG4 Payment 2012/13 Grouper Rel’d April 2012 Design Change Freeze Dates Aug 2006Aug 2007Aug 2008Aug 2009 Changes implemented in next RC Grouper may be amended in current RT Changes made in previous Payment Grouper may be amended in future RT OPCS-4.5 request closing date = 3rd March 2008 OPCS-4.5 released = 1 April 2009 OPCS-4.5 TOCE OPCS-4.5 OPCS-4.5 TOCE

Stakeholder Engagement Paediatric representatives on 12 EWGs Assistance with redesign of hepatobiliary HRGs Regular attendance at UK Children’s Health Alliance (UKCHA) meetings Regular attendance at Children’s PbR sub-group meetings (DH)

HRG Design Changes for Chapter P Some codes added/removed from CC list Creation of 2 new HRGs: –PA71Z Hepatobiliary and pancreatic disorders –PA72Z Metabolic disorders –The activity for these new HRGs was split out from PA25* Major Gastrointestinal Disorders Remapping of some other diagnosis codes to more appropriate HRGs; For example I46.- Cardiac Arrest diagnosis codes were mapping to PA14 Lower Respiratory Tract Disorders without Acute Bronchiolitis – now maps to PA23 Cardiac Conditions

Where we are: HRG4 Reference Costs have been collected since 2006/07 Payment by Results Tariff has been funding mechanism since 2009/10 Anatomical or disease specific chapters, underpinned by 4 national standard datasets for : Inpatient Care and Day Case Care (zero length of stay) Critical Care (Intensive Care for Adults, Children, Neonates) Outpatient Care (not admitted, hospital-based, includes interventions) Emergency Medicine (not admitted, hospital-based, investigations)

The Catalyst for Change Proposed Health and Social Care Bill 2011 Clearer demarcation of specialist service provision and increased need to identify “specialist” patient journeys at local / national levels Increasing number of groups responsible for commissioning of non-specialist NHS services National organisations other than the Department of Heath taking responsibility for establishing the scope, structure, and levels of national tariff payment NHS Commissioning Board Monitor

Where we are going: HRG4+ Increased scope - extending to Community Care, see Community Information Data Set (April 2012) Procedure-precedence in grouping, with discrete care events “unbundled”, with improved recognition of diagnosis in APC (multiply comorbid / multiple interventions) and extending the use of proxies for severity of diagnosis (previously trialled) Extended acknowledgement of truly “specialised” services, especially for infants Introduction of diagnosis in Outpatients and Emergency Medicine and development of classifications using available Community data

What does this mean for us? Multiple procedures are captured using escalation logic currently; this may be refined or replaced with other methods CCs exist currently; these may be amended to a ‘summative CC’ system Child splits; Recognition of children is sporadic within H, a systematic review will take place Increased use of diagnosis in other settings will refine HRG generation and support accurate reference costs and understanding of service provision. For instance, EM currently only records an x-ray and a cast, not what bone was actually broken!

Summary The Casemix Vision: To enrich the current HRG4 classification and respond to the changing needs of the healthcare infrastructure, especially for providers of increasingly specialist care To prove the concept that PPGs are capable of recognising appropriate and effective commissioning, in a standard and formalised manner for local and national health populations To continue to develop a Casemix Product Suite that supports innovative clinical practice and policy development and enhances understanding of care at the patient level