Measuring Cost and Impact Nick Hex Project Director 28 March 2012

Understanding the economics – why is it important? Importance of cost effectiveness in decision-making; Changing commissioning landscape; Funding restrictions – QIPP; NHS Outcomes Framework.

Increasing survivorship

Economic costing February – October 2011: Models of the costs of different approaches to survivorship; Based on activity and costs at 4 pilot sites; Proxy costs and assumptions used.

Economic costing Key findings: The costs of LTFU care costs in secondary care have been reduced by risk stratification of patients New models of care increase capacity to provide care for more survivors; But good practice models of care may require additional costs.

Economic modelling

Objectives Our remit: Identify additional variables that will influence the cost of the new pathways and describe the effects of these; Produce a more detailed model of costs for a LTFU service; Develop the costing methodology into a model which can be easily used by commissioners and care providers to understand the costs of survivorship.

Additional cost factors Implementation and start-up costs; Quality improvements, eg, care coordinators, transition clinics etc; Services outside the acute sector.

Literature review Very little data or published studies; Costs, but no activity, for primary care; Services outside the acute sector do not have negative impacts on patient care.

Economic modelling: inputs Staffing activity Clinical staff NursesSupport Outpatient clinics Nurse-led clinics Telephone follow-ups Virtual review

Economic modelling: inputs Investigation costs; Quality additions; Additional primary care visits: GP time; Investigations. Tariff income.

Costing scenarios 1.Costs of treating 900 survivors with and without risk stratification; 2.The effect on the commissioning body and the hospital provider of changing service provision, ie. the impact of changing tariff income

Scenario 1: hospital costs Non risk-stratified service Numbers£ All patients900340,000 Risk-stratified service Numbers£ Level 17516,000 Level ,000 Level ,000 TOTAL302,000

Scenario 2: tariff impact Non-risk stratified serviceRisk-stratified service Hospital cost£340,000£302,000 Additional primary care cost -£32,000 Total£340,000£334,000 Tariff payment£315,000£228,000 Shortfall to provider£25,000£74,000

In summary Costing model indicates that hospitals may reduce costs through risk stratification but tariff income may also be reduced; Commissioners likely to incur additional primary care costs; More research needed around outcomes and the provision of services outside of secondary care;

Next steps Finalise model and issue for consultation, along with a user guide; Develop further scenarios; Draft report for NHS Improvement/NCSI.

Thank you Nick Hex