Using Patient level costing to understand supply and demand pressures in our emergency departments & Support services to GPs

York and Scarborough Teaching Hospitals NHS Foundation Trust, North East and Yorkshire, Acute

The problem

The costing team needs to re-implement the trust’s patient level costing system because otherwise it is unable to deliver the National Cost Collection return, unable to support the internal efficiency programme and unable to deliver quarterly reporting which will help with financial recovery.


The challenge

How can we redesign our patient level costing system to not only fulfil our regulatory costing obligations but also provide a patient level costing solution that delivers substantial value and supports our efficiency program?

Additionally, how can we leverage additional patient level activity data from various systems to gain deeper insights into patient pathways across our integrated care system (ICS)? This would empower clinical teams to make more informed decisions regarding resource allocation, ensuring optimal use of limited resources without compromising quality or patient safety.


The outputs

  • Implementation of a new and updated costing model incorporating patient activity and costing information for the financial year 2022/23.
  • Development of a new reporting suite offering multiple views and datasets of patient pathways into the trust.
  • Detailed analyses providing insights into patient demand within our emergency department (ED) departments on a daily/hourly basis, alongside the corresponding supply of nursing hours into ED. This analysis revealed a nursing resource utilisation rate of 72%, highlighting an efficiency opportunity exceeding £3 million annually.
  • Patient-level analysis of direct access requests (total cost of service £8 million, delivering 600,000 tests per year) into laboratory medicine. This analysis identified efficiency opportunities through enhanced vetting and control of GP access requests, with an estimated efficiency saving of approximately £80,000 per year.


The outcomes

  • Enhanced engagement with clinicians through the utilisation of patient-level data and care pathway analyses, facilitating informed discussions and encouraging service redesign from various perspectives.
  • Improved accuracy in understanding patient activity levels and associated income from hospital services, particularly outpatient services, ensuring accurate cost recovery.
  • Utilisation of a richer dataset to analyse services such as GP direct access (cost £8 million per year), identifying key GP practices driving costs into the trust and enabling informed discussions with the local ICS and targeted behaviour change within GP practices.

The Innovation

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What the peer-reviewers said

“There is now a data rich system in place which has been used to identify opportunities for improvement both within the trust and in the ICS, the momentum behind this will be key for future success.”

“Cost drivers implemented to see trends across GP practices and provides a newly updated model.”

“This tool clearly addressed a specific challenge that the organisation had and will deliver better value to the trust and ICS.”

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