Glossary of Terms
Casemix
The mix of types of patients, treatments and healthcare episodes.
Casemix adjusted payment
Casemix-adjusted payment means that providers are not just paid for the number of patients they treat in each specialty, but also for the complexity or severity of the mix of patients they treat. We propose to use the average Performance Managers for each HRG as a basis for adjusting payment to Trusts for the complexity of patients they treat.
Commissioning
An overarching term, embracing the strategic planning of services, the procurement and contracting of providers, and the monitoring of delivery, including patient outcomes.
Cost and volume agreements
Cost and volume commissioning agreements are specific about the volume and mix of services and price per case that the PCT pays for. Cost and volume agreements are not demand-driven or open-ended. Typically a cost and volume agreement will specify a cap on the volume of services based on plans and forecasts, together with provisions that clarify the respective responsibilities of the PCT and provider in the event that the volume of services differs from the planned level. Commissioning agreements should also cover other dimensions of service delivery and performance, including quality and access times.
FCE
Finished Consultant Episode. The period of time that one hospital inpatient spends under the care and responsibility of one consultant.
NHS Foundation Trust
Delivering the NHS Plan chapter 7 (LINK HERE) and NHS Foundation Trusts, eligibility and criteria (LINK HERE) set out plans for NHS Foundation Trusts.
HCHS
Hospital and Community Health Services. The main elements of HCHS funding are the provision of both hospital and community health services. HCHS provision also includes funding for those elements of Family Health Services that are discretionary.
HRG
Healthcare Resource Group ¿ groupings of treatment episodes which are similar in resource use and in clinical response.
Internal market
The system of competition among NHS hospital Trusts that operated from 1990-1997. During this period, purchasers (Health Authorities and GP Fundholders) were encouraged to use price competition as a basis for determining where to refer patients.
Market Forces Factor
An index used in resource allocation to adjust for unavoidable variation in input costs. It consists of components to take account of staff costs, London weighting, land, buildings and equipment.
NatPaCT
National Primary and Care Trust development programme.
OPCS
In the context of this document used to refer to OPCS4 codes, which are used to classify procedures in the NHS.
Pathways of care
This refers to the sequence of steps or encounters a patient has with the health service for a given condition. The components making up a complete pathway may include primary prevention, advice and reassurance, diagnosis, treatment, rehabilitation, continuing care, secondary prevention, and palliative care. It may also involve coordination with social services as well as family and community support. Streamlining the patient care pathway, and increasing coordination, communication along the pathway are critical elements of improving patient experience, as well as improving efficiency and outcomes.
Performance Managers
Performance Managers are the costs of NHS Services provided from NHS resources for NHS patients. They are derived using the detailed approach to costing health services (set out in the NHS Costing Manual). The aim is to achieve comparability by using a consistent approach to costing services.
SLA
Service Level Agreement.
Spells
A spell is a hospital stay from admission to discharge. A spell might cover more than one Finished Consultant Episode and where it does, the spell will be assigned to the key element of the care (unlike ïFirst FCEsÍ which are simply assigned to the first element of the patientÍs care).
Standard service classification tools
Groupings of healthcare episodes using standardised international and national data definitions, used to provide a manageable method for measuring the activity carried out by healthcare providers, measuring resource use, and relating this to the health need of patients and the outcomes of care.
Trimpoint
Trimpoints are set by NHSIA for HRG and define the length of stay beyond which a case is considered to be an outlier (significantly longer or shorter than the population average) in terms of length of stay. Performance Managers make use of trimpoints, with costs of care beyond the trimpoint costed separately as excess bed-days, to prevent distortion of the average cost of a HRG by outlier cases. In 2003/04 we will not use separate outlier payments and the national tariff and relative values will be increased to take account of the number of excess bed-days.
Relative Value Unit
An index number that shows the relative difference in cost/price between different HRGs. Relative values derived in this way are sometimes referred to as ‘cost weights’
Tolerance
Tolerances fix the amount fo funding to the planned level, provided activity remains within an agreed variance from plan. In 2004/5, tolerances can used in the cost and volume part of SLAs. They should not be used for the 48 designated HRGs, or be applied to in-year variation in patient choice activity.
ITC
Independent Treatment Centres, privately owned treatment centres used by Provider Trusts and Commissioners to treat NHS patients.
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