Yorkshire Humber Neonatal Operational Delivery Network Helen Brown

Yorkshire & Humber Neonatal Operational Delivery Network Helen Brown – Network Director Charlotte Bradford – Senior Information Manager

Agenda �Background �Why reference costs are important �Sharing Yorkshire & Humber data �Highlight challenges �Suggest actions �Any further questions

Region Map & Unit type/level? NICUs (Neonatal Intensive Care Unit) • Bradford Royal Infirmary • Hull Royal Infirmary • Leeds General Infirmary • Sheffield, Jessop Wing Many other hospitals provide High Dependency care LNUs (Local Neonatal Unit) • Airedale General Hospital, Keighley • Barnsley Hospital • Calderdale Royal Infirmary, Halifax • Chesterfield Royal Infirmary • Doncaster Royal Infirmary • Grimsby, Diana Princess of Wales Hospital • Pinderfields Hospital, Wakefield • Rotherham Hospital • Scunthorpe General Hospital • York Hospital A small number of hospitals focus on Special Care SCUs (Special Care Units) • Bassetlaw Hospital, Worksop • Harrogate District Hospital • Scarborough Hospital • St James's Hospital, Leeds One unit solely provides neonatal surgical care • Sheffield Children's Hospital

Background “We are moving towards the development of national prices for Neonatal Critical Care (NCC) and the quality and accuracy of the costing information submitted by your trusts will dictate the robustness of those prices. We strongly urge you to review the data attached with this letter using the checklist below, and work with your local Trust internal Costing Teams to ensure that this year’s costing returns are as accurate as possible. ”

Requested Trust Clinical Lead Actions �Please review the data provided for your unit against the Clinicians Checklist below. You can find more information about National Cost Collection (Reference Cost) submissions in the NCC briefing paper attached if needed �Please find out who does the National Cost Collection (Reference Cost) in your organisation (Costing Team) and make contact with them now. The National Cost Collection will be submitted 7 th September - 6 th November 2020. Costing Teams will currently be preparing for the submission. Please support them to provide the best collection possible this year.

Understanding the Basics • Grouper: The daily update data input into Badger. Net is run through a grouper (set of algorithms) and is then allocated a HRG care level code based on the output. • This grouper was changed in 2016 to match updated BAPM standards and altered some elements particularly of XA 02 Z, XA 03 Z & XA 04 Z • HRG codes: • XA 01 Z = Intensive Care • XA 02 Z = High Dependency • 2016 grouper removed NAS and barrier nursing from this category • XA 03 Z = Special Care • 2016 grouper removed monitoring at regular intervals, special monitoring, continuous monitoring and recurrent apnoea from this category into XA 05 Z • XA 04 Z = Special Care with mother/carer resident • This category could occur away from the neonatal unit and be classified as Transitional Care • XA 05 Z = Normal Care/Neonatology supported care • This code will only be generated when an infant is on a neonatal unit but meets no other category of care or is on the PNW/TC with phototherapy • All providers must ensure they are utilising the 2016 Grouper for correct data collection for Reference Costs.

Understanding the Basics • Location of care: • There are 3 locations of care associated with neonatal reference costs • 13 – Neonatal Unit • 14 – Transitional Care • 15 – Post Natal Ward • Only care appropriate to the setting should be allocated – for example XA 01 Z cannot take place in any location other than 13 • National data from reference costs identifies care days are being allocated to inappropriate care locations in some places • Reference Costs • Submissions by each provider to the National Casemix Office annually as a summary of the cost of a service • For neonatal care these are a summary of activity days within each HRG, at each location of care for each hospital Trust • The national neonatal tariff is based on activity from reference cost submissions nationally, averaged out within the total quantum of resource allocated to neonatal care • All units have been issued with spreadsheets giving details of your provider reference cost submissions for each HRG and the Badger. Net activity for the same period for comparison • Ideally activity captured via Badger. Net should mirror that input via Reference Costs

Overview of National Pricing Work �National Expert Working Group set up to establish a national tariff for Neonatal Critical Care �Chair – Dr Eleri Adams, Consultant Neonatologist Oxford University Hospitals NHS Foundation Trust �Group representation from Clinical, ODN, National Pricing Team, Finance & Information �Charlotte Bradford, Yorkshire & Humber Neonatal ODN, sits on this group representing the National Neonatal Data Managers Group 8

Overview of National Pricing Work �Neonatal Critical Care Non Mandatory Prices published in 2020 -21 Tariff Consultation documents (Jan 2020) Neonatal Critical Care HRG code New for 2020 HRG name Surgical Neonatal Intensive Care Unit Non-surgical Neonatal Intensive Care Unit Local Neonatal Unit Special Care Unit XA 01 Z Neonatal Critical Care, Intensive Care 1, 517 1, 391 1, 493 XA 02 Z Neonatal Critical Care, High Dependency 925 841 Neonatal Critical Care, Special Care, without External Carer 573 525 558 XA 04 Z Neonatal Critical Care, Special Care, with External Carer 458 420 447 482 XA 05 Z Neonatal Critical Care, Neonatology Supportive Care 289 289 XA 03 Z 821 602 9

Data Discrepancies and Impact on National pricing �National EWG have reviewed 18 -19 reference cost submissions for Neonatal care provision �Queries raised over activity reported by HRG compared to the previous submissions in 17 -18 �EWG asked National ODN to co-ordinate an exercise comparing Badger. Net data �Individual files sent to providers �YH approach to help support Trusts to improve cost collection submissions, initially, by organising a series of workshops 10

Data Discrepancies and Impact on National Pricing Org Name Trust A Trust B Trust C Trust D Trust E Trust F XA 01 Z RC 1819 BA 1819 Trust I Trust J Trust K Trust L Trust M Trust N Trust O XA 03 Z RC 1819 BA 1819 2351 2052 631 1987 680 4664 273 188 558 706 4843 3749 88 22 19 65 1185 1041 82 93 262 294 1931 1774 275 340 1392 1736 1744 1177 268 187 414 487 2878 2639 508 2481 2616 Trust G Trust H XA 02 Z RC 1819 BA 1819 176 XA 04 Z RC 1819 BA 1819 336 XA 05 Z RC 1819 BA 1819 Total NNU Activity RC 1819 BA 1819 Difference 239 1639 222 5637 9164 -3527 384 225 790 5899 5817 82 277 123 215 1692 1520 172 183 229 529 331 2987 2721 266 18 15 164 3426 3435 -9 242 79 512 4028 4067 -39 29 1333 3814 3662 152 389 208 187 394 504 2319 2172 813 116 17 241 3751 3220 531 3893 3388 2171 2679 5946 5761 223 198 12 364 12245 12390 -145 2987 274 1186 838 2360 3269 3370 944 27 413 9930 5738 4192 386 395 1024 983 4113 3547 451 352 774 557 6748 5834 914 4154 4268 4284 4256 6591 5482 4512 253 35 771 19576 15030 4546 1386 1640 1968 2139 4089 3855 1896 324 666 194 10005 8152 1853 461 498 607 576 3534 3481 118 254 667 5387 5376 11 494 500 1049 1066 3854 3886 285 305 293 5988 6030 -42 11

Data Discrepancies and Impact on National Pricing XA 01 Z Activity Org Name CCU 13 CCU 14 CCU 15 Total Cost Total CCU 13 CCU 14 CCU 15 Unit Cost Total CCU 13 Trust A N 2351 £ 4, 757, 249 Trust B L 273 £ 448, 809 £ 1, 644 Trust C S 88 88 £ 88, 297 £ 1, 003 Trust D L 82 82 £ 202, 695 £ 2, 472 Trust E N 275 £ 388, 762 £ 1, 414 Trust F L 268 £ 263, 082 £ 982 Trust G L Trust H L 208 £ 274, 853 £ 1, 321 Trust I N 3893 £ 3, 467, 145 £ 3, 468, 926 £ 891 Trust J L 2987 £ 1, 913, 024 £ 640 Trust K L 386 £ 904, 560 £ 2, 343 Trust L N 4154 £ 9, 314, 016 £ 2, 242 Trust M N 1386 £ 1, 981, 065 £ 1, 429 Trust N L 461 £ 814, 375 £ 1, 767 Trust O L 494 £ 718, 044 £ 1, 454 * CCU 14 £ 4, 757, 249 £ 2, 024 £ 1, 781 * CCU 15

Data Discrepancies and Impact on National Pricing XA 04 Z CCU 13 Org Name Activity CCU 14 CCU 15 Total Cost CCU 14 CCU 15 Total Unit Cost CCU 13 CCU 14 CCU 15 Total CCU 13 336 £ 238, 227 £ 709 Trust A N Trust B L Trust C S 277 £ 155, 358 £ 561 Trust D L 183 £ 138, 985 £ 759 Trust E N Trust F L 389 £ 196, 040 £ 504 Trust G L Trust H L 813 £ 330, 525 £ 407 Trust I N 223 4617 £ 109, 232 Trust J L 3370 Trust K L 451 Trust L N Trust M 1620 £ 793, 525 £ 1, 358, 788 £ 2, 261, 545 £ 490 £ 1, 529, 272 £ 454 451 £ 345, 728 £ 767 4512 £ 2, 090, 229 £ 463 N 1896 £ 663, 941 £ 350 Trust N L 118 £ 30, 492 £ 258 Trust O L 286 2046 £ 127, 101 £ 909, 263 £ 444 878 2774 882 £ 390, 192 £ 391, 970 £ 490 £ 444

Summary of Changes in Activity, Unit Cost & Total Cost for XA

Summary of Changes in Activity, Unit Cost & Total Cost for XA

Suggested Actions �Take the time to review the data locally �Clinical discussion and review as well as finance/cost collection �REMINDER - Dates for submission – National Cost Collection will be submitted 7 th September 6 th November 2020 �ODN here to help �Any questions?