Ambulance Patient Level Activity and Costing 2019-20

This is a publication on patient-level costing and activity in NHS ambulance services, using data submitted to the Patient Level Information and Costing System (PLICS) Ambulance data collection for 2019-20 by NHS trusts in England.

The PLICS Ambulance data collection has been developed to support NHS England and NHS Improvement’s Costing Transformation Programme and is used to:

• inform new methods of pricing NHS services
• inform new approaches and other changes to the design of the currencies used to price NHS services
• contribute to NHS England and NHS Improvement’s strategic objective of a single national cost collection
• inform the relationship between provider characteristics and cost
• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence
• identify the relationship between patient characteristics and cost
• support an approach to benchmarking for regulatory purposes

The patient-level data submissions to the PLICS Ambulance data collection replace the equivalent aggregate data submissions to the NHS reference costs collection (which was introduced in 1997-98).

During the phased transition to patient level collections, some data continues to be collected by NHS England and NHS Improvement at aggregate level.

For example, ambulance activity data for the Isle of Wight was collected at aggregate level.

This section aims to provide users with an evidence-based assessment of the quality of the statistical output of the Ambulance Patient Level Activity and Costing 2019-20 publication by reporting against those of the nine European Statistical System (ESS) quality dimensions and principles appropriate to this output. These dimensions and principles are also consistent with the UK Statistics Authority (UKSA) Code of Practice for Official Statistics.

For each dimension, this section describes how this applies to the publication.

This dimension covers the degree to which the statistical product meets user need in both coverage and content.

This publication contains analysis of PLICS Ambulance data submissions from NHS providers, including:

• a HTML summary report
• a CSV file containing the aggregate underlying data at national and provider levels
• a metadata file describing the construction of each breakdown

Data on total reported cost and total recorded activity is reported by incident type and response type.

Users should understand that this analysis includes only activity and cost within the scope of the PLICS Ambulance 2019-20 collection and is not a complete view of costs of ambulance care in the NHS.

This report does not seek to replace or reproduce analysis in the National Cost Collection (NCC) publication produced by NHS England and NHS Improvement.

Statistics published in this report are classified as Experimental Statistics, these are new official statistics undergoing evaluation. They are published to involve users and stakeholders in their development and to build in quality at an early stage. More information about experimental statistics can be found on the UK Statistics Authority website.

This dimension covers, with respect to the statistics, the proximity between an estimate and the unknown true value.

PLICS Ambulance data is extracted from costing systems by providers and validated prior to submission to NHS Digital using a purpose-built tool provided by NHS England and NHS Improvement.

The NHS England and NHS Improvement tool provides immediate record-level error and warning notifications. Missing or invalid values for mandatory data items are notified as errors. The tool will only generate the files in the required format for submission once all errors have been resolved. (Remaining warnings will not prevent files for submission being generated.)

NHS England and NHS Improvement reviewed summary data from the PLICS Ambulance collection during the collection window.

Where data quality concerns were identified, NHS England and NHS Improvement asked the relevant providers to resubmit. Providers could also request permission to resubmit.

For providers that made their submission close to the deadline, there will have been less opportunity to review data quality and arrange resubmission.

These data quality checks reviewed the data at aggregate levels for each provider, so may not detect data quality issues at record level.

The mandatory request from NHS England and NHS Improvement to NHS Digital for the PLICS Ambulance 2019-20 collection listed the providers expected to submit data. All providers listed in the mandatory request submitted.

The NCC guidance listed the activities and costs which were in scope for the PLICS Ambulance 2019-20 collection.

Local knowledge, or other comparative data sources, may be required to assess the completeness of PLICS Ambulance data for a specific provider.

All mandatory PLICS Ambulance data items are confirmed to be complete and valid at the point of submission.

Completeness of required fields varies between submitting providers.

As a new data collection, providers will be mapping data values from their local systems to the PLICS submission specification for the first time. Variation in measures between providers may reflect differences in local data extraction and mapping processes rather than true variation in activity.

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates.

Analysis from the PLICS Ambulance 2019-20 collection is published as early as possible after data processing and data quality checks have concluded.

This report will be published on the pre-announced publication date.

Coherence is the degree to which data that are derived from different sources or methods, but refer to the same topic, are similar. Comparability is the degree to which data can be compared over time and domain.

NHS Digital collects PLICS Ambulance data to comply with a mandatory request from NHS England and NHS Improvement. The submitted data is pseudonymised and released to NHS England and NHS Improvement.

NHS Digital and NHS England and NHS Improvement each use this data to create their respective PLICS Ambulance analytical assets. The analytical teams work together to promote coherence between their assets wherever possible. However, as data is being processed by each organisation independently, it is possible that differences exist between the analytical assets.

This report uses only data from the NHS Digital PLICS analytical asset.

The NCC publication produced by NHS England and NHS Improvement uses data from the NHS England and NHS Improvement PLICS analytical asset and aggregate NCC data submitted to NHS England and NHS Improvement. Results in the NCC analysis are therefore likely to differ from the results in this report.

The 2019-20 financial year was the first period of mandatory submission of PLICS Ambulance data by relevant providers.

Changes in data quality would be expected to occur over time as providers continue to develop their costing and reporting methods. The 2019-20 data may reflect some impacts of the Covid-19 pandemic for activity during the last few weeks of the financial year.

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

This report is accompanied by a data file in machine-readable format, and a metadata file explaining how the values in the report and data file have been calculated.

Re-use of our data is subject to conditions outlined here:

https://digital.nhs.uk/about-nhs-digital/terms-and-conditions

This dimension describes the extent to which different aspects of quality are balanced against each other.

To meet user needs for detailed costing information within a reasonable timescale, the volume of analysis presented in this report has been limited.

The amount of data quality feedback that can be provided and acted upon by providers is also limited to that which can be performed within the collection window. For any data quality issues identified following the submission deadline, it is no longer possible for providers to amend and resubmit their data.

This dimension covers the process for finding out about users and uses and their views on statistical products.

We welcome feedback on this report – please send all comments to [email protected] with ‘PLICS Ambulance analysis’ in the subject.

This dimension describes the effectiveness, efficiency and economy of the statistical output.

The PLICS Ambulance data collection has been designed to use data already held by providers within activity and costing recording systems.

The procedures and policy used to ensure sound confidentiality, security and transparent practices.

PLICS Ambulance data is stored by NHS Digital and access is strictly controlled. To read more about how we keep patient data safe, please visit https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe

Access to record level data for medical/health care research purposes would require application through a stringent process where the need for record level rather than aggregate data would have to be justified. NHS Digital publishes a monthly register of data releases that includes applications that have successfully completed this process.

The risk of disclosing an individual’s identity in this analysis has been assessed and statistical disclosure control has been applied to the data accordingly.

The disclosure control method used for this report is described in the HES Analysis Guide.

In summary:

• if a national count is between one and seven, no sub-national breakdown will be provided
• if a national count is eight or more:
  • sub-national counts between one and seven are replaced by a “*” symbol.
  • zeroes are unchanged
  • all other sub-national counts are rounded to the nearest five
• national totals are not suppressed or rounded

No disclosure control need be applied to total cost values, as these cannot be related to an individual.

Relevant NHS Digital policies include:

Statistical governance policy (see User documents section at the end of the page)

Freedom of information process

A guide to confidentiality in health and social care

Privacy and data protection