1. HRG4 Design and Clinical Engagement Dr. N.K.Griffin Consultant Paediatrician Northampton General Hospital Part time secondment to HSCIC

2. PbR’s requirements of HRGs  Encourage patient choice  Provide care in different settings  Recognise legitimate variations in costs  Improve performance  Capable of development in line with PbR expansion

3. How we Developed HRG4  Requirements from PbR and NHS  The Design Team  Design Rules & Framework  The intention…  The expectation…  The implementation

4. Key design rules  Consistent style and editorial approach across chapters  >600 cases or >£1.5m per annum  Limited variance  Setting independence  Unbundled elements form separate, additional HRG

5. Steering Group  Steering Group managed the process  Ensured compliance with the Design Framework  33 Expert working Groups, predominantly clinicians, with Casemix support

6. HRG4 Development process  Overall control by Steering Group  33 Expert Working Groups  4 Expert Reference Panels  Cancer  Children's Services  Specialised services  Chronic disabling disease

7. How we Developed HRG4  The Steering Group – task force  Pilot studies  Changing datasets  OPCS 4.3 [Effective April 2006]  25% increase in codes  Reflecting modern practise  Non-operative interventions

8. HRG4  Conform to Design Framework to ensure consistency across chapters  Improved statistical performance  Extend coverage of HRGs  Reflect current clinical practice

9. HRG4  Based on:  Routinely available data  Spells not FCEs  Resources not LoS  OPCS4.3 intervention codes  Complications/co-morbidities  Age splits  Unbundling  Increase from 19 to 29 Chapters

10. The results  Better reflection of cost  Greater clinical relevance  Unbundling to give better setting- independent costing  Age-specific costing  Greater complexity  Untried and untested

11. Children’s Services  Children are treated in practically every specialty  ICD/OPCS Codes may not reflect very different styles or cost of treatment  Recognise different child/adult costs  Attempt to separate child from adult HRGs  Need for a consistent age split  Similar issues for the elderly

12. Clinical Involvement  Clinician chaired Design Team and member of Steering Group  283 clinicians were members of EWGs  51 Colleges and Professional Associations represented  Practising doctors, nurses and AHPs released by their trusts

13. The Clinicians  Represented a Royal College or Professional Association  Relevant knowledge and experience  Understand the process and purpose  Supported but not paid  Travel and expenses  Administrative and secretarial

14. Why every trust needs their clinicians involved  To ensure accurate coding and optimise HRG classification  To help develop meaningful reference costs  They need ownership to accept and use the data  To help you interpret variations from the norm

15. How to get your clinicians involved: the simple answers  Threats of violence  Bribery  Coercion  Blackmail  Promises of fame and fortune

16. How to get your clinicians involved: the difficult answers  Make it interesting  Make it relevant  Make it easy  Make it useful  Provide the resources  Make time available

17. How to get your clinicians involved: the real answers  Respect their opinions  Recognise their different agenda  Accept that they have useful knowledge and experience  Identify the champions  Justify your views  Use the product honestly and wisely  Reward involvement with clinical benefits

18. ANY QUESTIONS?