Has data quality reduced in England?

A look back over the last 5 years when tariffs were suspended.

NHS England suspended its National Tariff Payment System (NTPS) early in 2020/21 following the Covid-19 pandemic.  Instead, trusts were paid by simpler block contract payments.  A few months later, NTPS was partially restored so that block payments would ‘flex meaningfully’ based on NTPS. 

From April 2023 the NTPS was replaced by the NHS Payment Scheme (NHSPS) involving four different payment mechanisms.  Under the new system most trusts will be reimbursed by a system of fixed and variable elements for non-elective care, with purely activity-based payments re-introduced for elective care only.

With the removal of the direct link between activity and payment for non-elective care, did data quality reduce in England?  We look at the evidence over the last 5 years to see if there was a pattern of declining data quality. 

What did we look at? 

CHKS hold 5 years of HES data and work extensively with our clients to continuously develop our data quality indicators. We looked at a series of data quality indicators from CHKS benchmarking system in iCompare. These include:

·       The CHKS data quality index;
·       The average number of diagnoses per finished consultant episode (FCE);
·       The percentage of non-specific primary diagnoses; and
·       The percentage of primary diagnoses that are a sign or symptom.

In each case, we compared the performance of English acute trusts which are subject to the tariff payment system with a control group comprising Welsh and Northern Ireland health boards where there is no such system in place.

We excluded elective activity from our analysis to focus on the area where policy on payment has changed the most i.e. non-elective care.

Conclusion
We found that England has fared no worse than the control group of Wales and Northern Ireland where the payment scheme has never operated.  To date, we tentatively conclude that data quality has not deteriorated as a response to the relaxation of the payment rules in England. This indicates that despite the change in focus of the payment system the quality of clinical coding has been maintained. However, without the addition of clinical coding audits to give further assurance it is not possible to definitely state that data quality is good.

The latest of the changes in the payment system in England only came into effect from April 2023, since the end of our analysis period, so we will need monitor the position and revisit the analysis in due course.
NHS England suspended its National Tariff Payment System (NTPS) early in 2020/21 following the Covid-19 pandemic.  Instead, trusts were paid by simpler block contract payments.  A few months later, NTPS was partially restored so that block payments would ‘flex meaningfully’ based on NTPS.