2015-16 Programme Budgeting Guidance Issued 01.08.16 V1.0

Programme Budgeting Guidance for CCGs

Financial Year 2015-16

Version number: 1.0

Draft shared: 19th July 2016

First published: 1st August 2016

Prepared by: Programme Budgeting Team, NHS England Analytical Services

Contents Page

Chapter 17: 2015/16 Programme Budgeting Guidance for CCGs

17.1 2015/16 Programme Budgeting Guidance for CCGs

17.1.1 Introduction

17.1.2 Programme Budgeting Overview

17.2 What’s new for 2015/16?

17.2.1 The programme budgeting framework

17.2.2 Refined Care settings

17.2.3 Approach to allocating expenditure

17.2.4 Changes to submission template

17.2.5 Validations and checklist

17.3 2015/16 Data Collection Timetable

17.3.1 Timetable

17.3.1 Submission Document

17.4 Calculating Programme Budgeting Data

17.5 PB1 Analysis of Gross Expenditure

17.5.1 PC01: Primary Prescribing

17.5.2 UC01/SC01: Elective and Non-elective admissions

17.5.3 UC02: Unscheduled Care- A&E

17.5.4 UC03: Unscheduled Care- Emergency Transport

17.5.5 SC02/SC03/SC04: Outpatient Attendances, Procedures & Diagnostic Imaging

17.5.6 UN02: Critical Care

17.5.7 UN03: Unbundled/high cost Drugs & devices

17.5.8 OT01: Other Health Care Services

17.5.9 RC01: Running Costs

17.6 PB2: Analysis of Revenue

17.7 PB3: Adjustments

Chapter 17: 2015/16 Programme Budgeting Guidance for CCGs

17.1 2015/16 Programme Budgeting Guidance for CCGs

17.1.1 Introduction

1. The following chapter outlines the requirement and responsibilities of NHS staff involved in producing CCG level programme budgeting data for 2015/16.
2. Detailed guidance on the processes involved in calculating programme budgeting data isset out below, which is also supported by a mapping document.
3. This guidance will be relevant to Clinical Commissioning Groups (CCGs) and commissioning support organisations involved in producing programme budgeting data.

17.1.2 Programme Budgeting Overview

1. NHS England is committed to giving CCGs and NHS England in the regions practical support in gathering data, evidence and tools to help them transform the way care is delivered for their patients and populations. Programme budgeting now sits within the RightCare programme of work which provides a suite of materials to support effective ‘commissioning for value’.
2. The programme budgeting data return is an analysis of commissioning expenditure by healthcare condition for example, cancer and mental health and care settings across the care pathway. The data are used in the Spend & Outcomes Tool and will be included in the Commissioning for Value Tool this year.
3. These resources provide commissioners with vital information to support evidence based investment and prioritisation decisions. This allows healthcare commissioners to look at activity and outcomes that have been generated in healthcare programmes, to readjust the pattern of spending to get a better fit with needs of their local populations and to reduce health inequalities. This should lead to improvements in efficiency (value for money), effectiveness (better outcomes) and equity (fairer shares of resources and reduction in inequality of health outcomes).
4. The data also provide a source of financial information which is relatable to the wider public and have been successfully used to engage patients in PBMA (programme budgeting and marginal analysis) reviews of investment in services.
5. Programme budgeting data are also used to report to Parliament and Health Select Committees, and continue to be of interest to a wide range of stakeholders, including academics, public health observatories, and national clinical directors.
6. There are currently 23 programme budgeting categories, which are based on the World Health Organisation (WHO) International Classification of Disease (ICD10). Many of the programmes include additional sub-categories.

17.2 What’s new for 2015/16?

17.2.1 The programme budgeting framework

1. The main purpose of programme budgeting dataisto provide benchmarking information to NHS organisations, enabling evidence based investment & prioritisation decisions.
2. The guidance that follows aims to provide a framework for commissioners to analyse their expenditure. Encouraging a consistent application of this framework means that any variation, demonstrated through benchmarking, is due to actual differences in spending patterns rather than a slightly different approach to completing the return.
3. With this in mind, for 2015/16 there have been some changes to the programme budgeting methodology and collection templates. These changes are outlined below:

17.2.2 Refined Care settings

1. For 2015/16, the list of care settings has been refined. The changes include providing a further breakdown of outpatient activity. Previously, there was one care setting which covered Scheduled Care Outpatient (PBR) activity. In order to provide greater transparency, Outpatient PBR expenditure will now be analysed across 3 settings:

• SC02 Scheduled Care Outpatient Attendances
• SC03 Scheduled Care Outpatient Procedures
• SC04 Scheduled Care Outpatient Diagnostic Imaging

1. There will also be a new care setting, ‘OT01 Other Health care Services’. This setting will incorporate the following care settings from 2014/15:

• UC04 Unscheduled Care: Other Urgent Care
• UN04 Secondary Care: Other
• DA01 Direct Access Diagnostic Imaging
• CI01 Community and integrated care
• PL01 End of Life Care

17.2.3 Approach to allocating expenditure

1. In 2014/15, the programme budgeting team provided centrally derived apportionment data for inpatient, outpatient, A&E and emergency transport activity.
2. For 2015/16, the programme budgeting team will provide apportionment data for the following care settings:

• PC01:Primary Care Prescribing
• UC01:Inpatient: Non-elective admissions
• SC01:Inpatient: Elective
• SC02:Outpatient Attendances
• SC03:Outpatient Procedures
• SC04:Outpatient Diagnostic Imaging
• UN02:Critical Care

1. There will be a separate apportionment workbook for each of these settings. The workbooks will be in a different format to those used in 2014/15, and will include steps for calculating figures and reconciling to accounts values. These workbooks will guide CCGs through the calculation process and will provide a complete audit trail from apportionment data through to submission values, highlighting errors at the stage in which they occur, rather than at pre-submission sense-check stage.
2. Each workbook will include detailed guidance on how to use them. The source and extract specification will be included within the apportionment report files to help CCGs reconcile to their own locally held data.
3. A key change for 2015/16 is that we will not be providing apportionment data for the A&E and Emergency Transport care settings, this will need to be calculated using local information.
4. Please contact the programme budgeting team if you have concerns over using any of the centrally derived apportionment data and you feel that using locally derived apportionment data would be more appropriate.

17.2.4 Changes to submission template

1. The submission template now incorporates the main submission template and service level analysis (SLA) into one workbook.
2. The structure of the workbook has being simplified, removing the requirement to analyse revenue and adjustments by programme category & care setting.
3. The structure of the template and key changes are outlined below:

17.2.5 Validations and checklist

1. The programme budgeting returns will be subject to validations and checklists which will need to be signed off prior to submission. In previous years, a supporting ‘sense check’ workbook has been provided to CCGs. For completeness, these validations have now been incorporated into the workbook. This year the workbook includes a validations worksheet, which highlights where errors might have occurred in completing the form. This will enable you to verify the data prior to submission.
2. CCGs will be expected to ensure that data forms have been completed correctly and that all validations are correct prior to submission. Regional leads will also be expected to verify that all validations are passed before submitting returns in a single batch to the programme budgeting team.
3. The validations should be completed for the first submission deadline. The programme budgeting team will not accept any submissions that do not pass the validations. The programme budgeting team will only commence central validations on a region’s submission’s after all locally validated first submissions have been received for that region. Any delays in meeting the first deadline will result in a delay in receiving central validations feedback on submissions. This could mean that CCGs will not have the full resubmission window to make any amendments or changes for the final submission.

17.3 2015/16Data Collection Timetable

17.3.1 Timetable

1. In terms of timetable, the majority of the work must be done in August and September in order to meet the end September draft submission deadline.
2. Regional leads, CCGs and CSUs need to factor in the validations and checklist sign-off into their plans to ensure that this is completed in time for the 29th September deadline. This will ensure that minimal changes should be required in during the two week re-submission period at the end of October.

17.3.1 Submission Document

1. The total values in PB1_Gross Exp, PB2_Revenue must validate to gross expenditure and revenue as reported in the final accounts template for your CCG.
2. The total value in ‘PB1_Gross Exp’ should agree to Gross Employee Benefits plus Other Costs, for both programme expenditure and administrative costs, in the Statement of Comprehensive Net Expenditure.
3. The total value in PB2_Revenue should validate to Other Operating Revenue, both programme and administration.

17.4 Calculating Programme Budgeting Data

1. CCGs will need to use a combination of Integrated Single Financial Environment (ISFE) data, final accounts data, contracting data and business intelligence data to identify spend and to determine the appropriate programme category and care setting.
2. The specific methods for identifying spendor revenueand the method of allocation or apportionment are included within the guidance or the mapping documents. If you are unsure of the approach to use, or it is not covered within the guidance, please contact the programme budgeting team.
3. The following table provides an overview of the methodology to be used for expenditure in each care setting. More detailed information on how each care setting is defined is included within this guidance.

1. The NHS England programme budgeting team will provide programme budgeting apportionment data for the settings detailed above. There will be a separate apportionment workbook for each of these settings. The workbooks will include steps for calculating figures and reconciling to accounts values.
2. Each workbook will include detailed guidance on how to use them. The source and extract specification will be included within the apportionment workbooks to help CCGs reconcile to their own locally held data. The workbooks will be based on the correct tariff (ETO or DTR) used for each provider for 2015/16. They will include further details and examples on the expenditure to be included.
3. Please contact the programme budgeting team if you have concerns over using any of the centrally derived apportionment data and you feel that using locally derived apportionment data would be more appropriate.

17.5 PB1 Analysis of Gross Expenditure

17.5.1 PC01: Primary Prescribing

1. The NHS England programme budgeting team will provide a workbook to support CCGs in allocating their primary care prescribing expenditure to programme categories, within PC01 Primary Prescribing.
2. CCGs will enter their prescribing expenditure values into the workbook. The workbook will be set up to apportion the expenditure to programme budgeting categories using data provided by the Business Services Authority. The workbook will also summarise the values ready for direct transfer into ‘PC01 Primary Prescribing’ of form PB1.
3. Expenditure in the setting should include all primary care prescribing and dispensing expenditure.
4. CCGs also need to identify whether they have any specific elements of prescribing expenditure which should not be apportioned using general CCG based programme budgeting splits. For example, if as a CCG you have lead commissioning expenditure relating to primary care prescribing for an element of specialised or public health care, then you will need to exclude this element of spend from the value to be apportioned and map this directly to a programme budgeting category using local knowledge.
5. The primary care prescribing workbook will include steps to support you in separating out this type of expenditure. If you are unsure of which category to map this to, please get in touch with the programme budgeting central team.

17.5.2 UC01/SC01: Electiveand Non-elective admissions

1. The following provides guidance for analysing elective & non-elective spend for the respective care settings SC01 and UC01.
2. The NHS England programme budgeting team will provide separate workbooks to support CCGs in calculating their elective and non-elective programme budgeting expenditure.
3. CCGs will enter their provider spend values into the workbook, which will be set up to apportion the expenditure to programme budgeting categories using CCG specific SUS data. The workbook will also summarise the values ready for direct transfer into form PB1.
4. CCGs will need to identify their actual expenditure on the prescribed set of elective or non-elective activity for each of their providers.
5. Expenditure to be included within Care SettingsSC01 elective and UC01non-elective is defined as follows:

• CCG commissioned spend on admissions for the following types of admissions codes:
• Elective – 11,12 and 13
• Non-Elective - 21, 22, 23, 24, 28, 31, 3281, 82, 832A, 2B, 2C and 2D.
• Expenditure within the scope of mandatory tariff, even if local tariffs have been used. Where local tariffs have been used, the workbooks will include functionality to allow for adjustments or direct allocations to programme categories.
• Expenditure with all providers of UC01 & SC01 activity, including non-contract and private providers
• Expenditure should be amount paid for activity rather than contract values
• Expenditure should include contract penalties or contract adjustments only if it affects this range of activity uniquely.This should be programme specific where possible. If there are contract penalties or adjustments which affect more than one care setting, include this in OT01, through form E1.
• Within your inpatient apportionment workbook, there may be some activity for programme category ’05x- Mental Health Disorders’. This is likely torelate to non-mental health spend within the scope of mandatory tariff, but where the patient has a secondary diagnosis of Dementia or similar.This expenditure should be included in the relevant UC01 or SC01 column.

1. Expenditure in SC01 and UC01 does not include:

• Maternity Pathway(including births)and year-of-care expenditure. Thisshould be excluded fromSC01 and UC01 expenditure values and reported separately in OT01, through form E1.
• Critical care episodes and high cost drug expenditure which are unbundled from an elective or non-elective admission. These should be reported separately under the relevant care setting (i.e UN02 or UN03).
• Expenditure on elective or non-elective admissions which are outside the scope of mandatory tariff, which should be reported separately in OT01, through form E1.
• Contract penalties or adjustments which affect a range of activity rather than just elective or non-elective PBR activity as defined above.
• Planned procedures not carried out should be included in form E1.
• CQUINs. This expenditure should be included in form E1, or the Mental Health analysis forms.
• Cross Border emergency treatment and charges for overseas visitors, this should be included in form E1.

1. Where you have expenditure for referral to treatment penalties (in SC01), or adjustments relating to NEL threshold (Marginal Rate) or NEL Readmissions (in UC01), this should be included in either the SCO1 or UC01 setting and analysed using the workbooks. Where material, these should ideally be apportioned or allocated using the diagnosis codes relevant to the penalty activity. This can be calculated using the manual allocation/apportionment column within the workbooks. Where immaterial, these values can be included in the value to be apportioned.
2. The apportionment workbook is based on SUS data and will include any system-based adjustments for best practice tariffs (BPTs). However, any locally managed top-ups or rebates for BPTs not accounted for within the SUS system will need to be adjusted for manually, in either the UC01 or SC01 apportionment workbook. The apportionment workbooks are designed to support this and will include examples of how to do so.
3. Examples of BPT top-ups and rebates applicable to inpatient activity are outlined below:

1. If your CCG has used any adjustments to nationally agreed prices for specific services within this elective or non-elective activity, please get in touch with programme budgeting team to discuss appropriate treatment.

17.5.3 UC02: Unscheduled Care- A&E