A

Accident and emergency (A&E) unit: A consultant-led 24-hour service unit (national code 01) with full resuscitation facilities in acute hospitals. In costing this term is used for a subset of ‘emergency department’ which also includes minor injury units, urgent treatment centres and walk-in centres.

Activity: A measurable amount of work performed using resources to deliver services to patients to achieve desired outcomes; for example, a procedure in theatre, pathology test or therapy contact.

Activity count: The number or duration of activities in the National Cost Collection, for example number of tests or time spent in theatre in minutes.

Actual duration: The time in minutes the patient care actually takes. It is used in conjunction with (non-admitted patient care) NAPC and (admitted patient care) APC to allocate costs as a superior costing method (SCM). It is recommended that mental health services use actual duration because of the variability of time spent with each patient. (Acute services are less variable by clinic and the CDS does not require ‘actual duration’ to be recorded; so acute trusts can use booked duration [in the CDS this is ‘expected duration’] to provide a reasonable and material allocation of cost).

Actual whole time equivalent (WTE): The real whole time equivalent (WTE) numbers of staff, as shown in the general ledger, and represents the actual cost of staff (in a particular service area) during the period. For example: one full-time staff member is one WTE. One part-time staff member doing 12 hours per week in a 40-hour week is 0.32 WTE. This is now used in the allocation method for designated support costs.

Acuity: The measurement of intensity of care. For example, nursing acuity is the measurement of the intensity of nursing care required by a patient. An acuity-based staffing system regulates the number or grade of nurses on a shift according to patients’ needs.

Admitted patient care (APC): An overarching term covering patients who have been admitted to a hospital; for example, ordinary elective admissions; ordinary non-elective admissions; day cases; regular day admissions; regular night admissions.

Adult: An adult is someone aged 19 years and over. See also ‘child’ and the National Service Framework for Children, Young People and Maternity Services

Aggregated costs: In the local general ledger, some costs distributed from a central function to a clinical service cost centre for service line management purposes may be reported separately. If these costs were not allocated to services using the prescribed method, for patient-level costing these costs need to be aggregated back to a central point, before allocating using the prescribed method to when creating the cost ledger. Standard CP2: Clearly identifying costs contains more detail on where this is appropriate.

Aligned payment and incentive: A type of blended payment, aligned payment and incentive (API) is a payment approach in which providers and commissioners agree a fixed element to cover all activity included in a system plan. A variable element then adjusts payments to reflect actual elective activity and quality of care (measured through best practice tariff and CQUIN achievement). See also NHS payment scheme.

Allocation to mobile: The time from the moment a response unit is allocated to an incident until it moves to travel to the scene. This includes preparing the crew and vehicle to move once assigned to the incident.

Alternative consolidated contingency option (ACCO): This is a submission option for trusts that do not have patient level data for a PLICS submission but the value is material to their cost quantum.

Anonymised record: Where a patient record is brought into the costing system without any patient identifiable information; for example, where there is sensitive/legally restricted data. This is not a proxy record; it is a real record without patient identifiable detail.

Approved Costing Guidance: The overarching term for the costing standards and the National Cost Collection guidance. Tells providers how to comply with the relevant costing conditions in the NHS provider licence.

Associate: Two companies are ‘associated’ if one company is a subsidiary of the other or both are subsidiaries of the same corporate body.

Assurance tools: Tools to help develop and maintain an assurance process that will promote continued improvement of costing in trusts; for example, the costing assessment tool (CAT) and the integrated costing assurance log (ICAL).

Attendance: A patient event where the patient is not admitted to hospital. This term is used in emergency care and outpatient services.

Audit trail: A record of where data comes from and the decisions that have been made to generate reports, data feeds and ledgers. This makes costing outputs transparent.

Automapper application (general ledger to cost ledger): An application to help map general ledger expense codes to the standardised cost ledger expense codes, reducing the burden of this exercise.

Auxiliary data feeds: The patient-level activity feeds that will be matched to the master feeds; for example, the pharmacy feed.

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B

Balance sheet: A section of the general ledger for the value of assets and liabilities of the organisation. Balance sheet items are not necessarily required in the costing process.

BDO report: The BDO report is the blueprint for the Costing Transformation Programme.

Blended payment: A payment framework comprising a fixed element, based on a forward-looking assessment of costs, plus at least one of: variable element, risk-sharing element and quality- or outcomes-based element. Aligned payment and incentive is a type of blended payment, used in the 2021/22 and 2022/23 National Tariff payment system and and the 2023/25 NHS Payment Scheme.

Booked duration: The time in minutes the patient care is booked to take in the appointment system (in the patient administration system). The Commissioning Data Set item name is ‘expected duration’. It is used in conjunction with non-admitted patient care and admitted patient care to allocate costs as the prescribed method. It is recommended that MH services use ‘actual duration’ because of the variability of time spent with each patient. Acute services are less variable by clinic and therefore can use ‘booked duration’ to provide a reasonable and material allocation of cost.

Budgeted headcount: The planned number of staff to run a department, service or ward. Often included in financial reports or produced by financial management staff for their annual ‘start point’ budgeting report. Budgeted headcount has been replaced by actual whole time equivalent as an allocation for designated support costs.

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C

Care cluster or cluster: National currencies that group patients of mental health services according to common characteristics, such as level of need and resources required.

Care professional: An individual formally trained or employed to care for patients; for example, nurses, therapists, support workers and social workers.

Casemix: A way of describing and classifying healthcare activity. Patients are grouped according to their diagnoses and the interventions carried out.

Casemix Office (NHS Digital): Designs and refines classifications used to describe NHS healthcare activity in England; the groupings of data known as healthcare resource groups (HRGs) for healthcare analysis. These classifications underpin the national reimbursement system from costing through to payment, and support local commissioning and performance management.

Child: National Service Framework for Children, Young People and Maternity Services defines children and young people as ’under 19 years’, with the caveat that ‘the age ranges for service provision will vary according to the different agencies’ statutory obligations’. These age ranges are generally applied in Healthcare Resource Group (HRG) version 4+. We therefore use these age definitions in the Approved Costing Guidance except where specified; for example, for cystic fibrosis children are categorised as 16 years and under.

Clinic attendance: General term for when patients attend a healthcare professional in a clinical setting whether booked or informal/unplanned. One patient may visit the healthcare professional(s) holding the clinic or a succession of patients during a clinic session. Includes clinics held by community care professionals in clinical settings (see also Community clinic attendance) and hospital clinics (see Outpatient attendance).

Clinical engagement: Involving clinicians and healthcare professionals in developing costing methods and practices, and making use of the costed data. Clinicians and healthcare professionals are a trust’s public face. They may remain in the same post for many years and have considerable NHS experience, which gives them a wealth of knowledge about the system’s strengths and weaknesses. Their decisions and actions bear directly on the use of the organisation’s resources. For more information on clinical engagement, see the Department of Health and Social Care’s guide to effective clinical and financial engagement.

Clinical excellence awards (CEAs): Awarded to NHS consultants and academic GPs who perform ‘over and above’ the standard expected of their role.

Collection resource: A collection resource is an aggregation into groups with shared characteristics for reporting to us. They can be found in the extract specifications on our website.

Collection year: The cost collection year starts on 1 April and ends on 31 March. The cost collection year is the year it is collected in: so the 2022 cost collection will be for data from 1 April 2021 to 31 March 2022.

Commercial activities: Any activity a provider undertakes to generate a commercial return outside its directly commissioned healthcare contracts.

Commercial income: Income relating to non-patient care income. Historically this was referred to in the financial accounts as Category C income. This should be shown separately for costing and reported in the reconciliation statement. For the PLICS collection, this income should be netted off from the cost of providing the service that generated the income.

Commissioning Data Sets (CDS): National datasets collected by NHS Digital that allow providers and commissioners to view data on NHS funded or provided secondary care to improve patient care. They support the current Healthcare Resource Group (HRG) version 4 for calculation of payment to trusts and monitoring of other initiatives including the 18 weeks Referral to Treatment standard.

Community care contact: Where a healthcare professional visits a patient in their own residence (or place outside a clinical setting), whether booked or not booked. This data item should conform to the technical output specification for the Community Services Data Set (CSDS). Carer(s) may be present but multiple patients do not attend the location sequentially.

Community clinic attendance: A clinic attendance where a patient or patients visit a healthcare professional in a clinical setting – specifically as recorded on the Community Services Data Set (CSDS), whether booked or informal/unplanned. One patient may visit the healthcare professional(s) holding the clinic or a succession of patients during a clinic session. See Outpatient attendance for hospital clinics and those recorded on the Commissioning Data Sets.

Community first responder (CFR): CFRs respond to local emergency calls and provide first aid before an ambulance arrives.

Community mental health team (CMHT): Care professionals who assess and provide care to patients in a non-admitted care setting. They can also visit and review patients admitted to a ward or similar inpatient care setting.

Community Services Data Set (CSDS): A national dataset collected by NHS Digital which allows community service providers and commissioners to view local and national information from community services to improve patient care.

Community setting: May include the patient’s own residence, a health centre or a primary care facility. In the mental health sector, it may also include temporary accommodation, hostels or other locations.

Comparison against peers: he practice of comparing performance internally and externally based on key performance indicators of financial and/or care practice, with similar organisations to one’s own. This information for benchmarking is one of the main purposes of the National Cost Collection.

Complications and co-morbidities: Many Healthcare Resource Groups differentiate between care provided to patients with and without complications and co-morbidities. Complications may arise during a period of healthcare delivery and prolong the length of stay. Co-morbidities are pre-existing conditions that affect the treatment received and/or prolong the length of stay, for example diabetes or asthma.

Computer-aided dispatch (CAD): The system that helps dispatchers, crews and call handlers respond to an incident. It logs information from a response, including job-cycle timestamps.

Consultant episode: The time a patient spends in the continuous care of one consultant using the hospital site or care home bed(s) of one healthcare provider, or in the case of shared care, in the care of two or more consultants. Where care is provided by two or more consultants within the same episode, one will take overriding responsibility for the patient and only one consultant episode is recorded. Additional consultants contributing to a patient’s care are called shared-care consultants. A consultant episode includes episodes for which a GP is acting as a consultant.

Consumables: Items used in delivering patient care that are intended to be single use; for example, swabs after a theatre procedure or food in an occupational therapy session.

Core healthcare resource group (HRG): The unit that covers the primary diagnosis and procedure after removing any unbundled activity.

Cost allocation method: The process of distributing expenditure from a pool of similar costs to an appropriate destination, using resources and activities.

Cost categorisation: To ensure costs are categorised consistently, the standardised cost ledger in the technical document categorises costs according to whether they are patient-facing or support.

Cost centre: The code used in the general ledger (and cost ledger) to identify a department or service.

Cost classification: Costs are classified as fixed, semi-fixed or variable to ensure they are categorised consistently across all providers. This classification is not part of the costing process but shows how costs behave based on the level of activity. The definitions adopted for fixed, semi-fixed and variable costs are detailed in Standard CM15: Cost classification.

Cost driver: Any factor that causes activities and costs to vary, such as length of stay in hospital.

Cost ledger (standardised): Provides a complete record of financial expenditure and income incurred by an organisation. Information reported in the cost ledger will be based on entries made in the general ledger and ensures the costs are in the correct starting place to begin costing across all providers.

Cost model: A data structure or software product that contains the costing rules for importing, validating and allocating costs to activities, and then allocating these costed activities to patient events or incidents.

Cost object: The final destination for the costs originating in the general ledger after all the costing processes. For patient care, the cost object will be a patient event (for example episode) and for non-patient care the cost object may be an aggregate value assigned to a service, such as education and training.

Costing approaches: Standards that focus on high volume or high value procedures and procedures that can be difficult to cost. They should be implemented after the costing methods and prioritised by volume and value of the activity to your organisation.

Costing assessment tool (CAT): An improvement tool to allow costing practitioners to record and measure their progress against the costing standards. Scores from the CAT are included in the national PLICS portal for benchmarking, as well as identifying productivity opportunities and supporting the development of the national tariff. The CAT may also form the basis of provider assessment under the costing assurance programme.

Costing assurance programme: A review and tests of the costing process to provide evidence of the work done and the reasoning behind decisions.

Costing methods: These focus on high volume or high value services or departments and fall into three general categories: service-specific, resource-specific and other. They should be implemented after the information requirements and costing processes that form the core standards. The costing methods should be prioritised based on the value and volume of the service for your organisation.

Costing principles: Three costing principles – materiality, data & information and engagement – inform the standards and improve the accuracy, consistency, and relevance of costing. They are described in the costing principles section of the Approved Costing Guidance .

Costing processes: These standards describe the costing process to follow: the role of the general ledger; how to ensure costs are clearly identified and appropriately allocated to activities; how these activities should be accurately matched to patients; the process of reconciliation of both cost and activity data, and the assurance of the cost data.

Costing resource (also previously referred to as ‘implementation resource’): Components used to deliver activities, such as staff, equipment or consumables. The cost ledger includes a mapping of costing account codes to a prescriptive list of costing resources provided in the technical document.

Costing Transformation Programme (CTP): Our programme to move from reference costs collection to patient-level cost collection, improving the quality of costing information throughout the NHS and supporting providers to deliver more effective and efficient outcomes.

COVID-19 patient: A patient clinically coded as either confirmed with the virus or suspected of having COVID-19. Once the coding no longer codes them as confirmed or suspected, they are no longer classified as COVID-19 for costing purposes.

COVID-19 outbreak: The period during which the COVID-19 virus impacted those in England and the healthcare services. Dates from March 2020, and at the time of writing was still ongoing.

Currency: A unit of healthcare activity such as healthcare resource group (HRG), spell, episode, or attendance.

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D

Data feeds: A set of data generated from a system of records held by an organisation, which is imported into the costing system.

Data quality: The degree of completeness, consistency, timeliness, and accuracy that makes data appropriate for a specific use.

Data validation tool (DVT) including DVT business rules: Tool: Assesses the data quality of the files produced by the costing software and then creates the files needed for submission. Business rules: A workbook giving the definitions the DVT uses to validate the files before submission. The reference tabs show the data permitted in a field, eg which HRGs are allowed to flow as part of the dataset.

Delivery of care for children with cystic fibrosis: The two models for delivery of care for children with cystic fibrosis:

• Full care delivered entirely by a specialist cystic fibrosis centre.
• Shared care delivered by a network cystic fibrosis clinic, which is part of an agreed designated network with a specialist cystic fibrosis centre. The network cystic fibrosis clinic is linked to and led by a specialist cystic fibrosis centre.

Depreciation: An accounting method to allocate the cost of a tangible or physical asset over its useful life or life expectancy. This helps companies earn revenue from a depreciating asset while realising a portion of its cost each year the asset is in use.

Direct costs: Costs that directly relate to the delivery of patient care, for example medical and nursing staff costs.

Disaggregated costs: Some costs may be reported in the general ledger at a level that is not detailed enough for patient-level costing, for example where multiple costs are combined. These costs need to be disaggregated when creating the cost ledger, using an appropriate method. Standard CP2: Clearly identifying costs, contains more information on disaggregating costs.

Duration: For costing purposes, duration is the time in minutes a care activity takes. Duration can be separated into ‘actual’ duration or ‘booked’/’expected’ duration (see above).

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E

Education and training (E&T) costs: Costs that relate directly to delivering education and training and are driven by E&T activity.

Education and training (E&T) programmes: A recognised part of the education and training curriculum and approved by the relevant higher educational institutes (such as the royal medical/dental colleges) and regulatory body. They provide clinical and mentoring support as defined by the relevant regulatory body.

Electronic staff records (ESR): A payroll database system commissioned by the Department of Health and Social Care and currently used by 99% of NHS trusts. It supports the delivery of the national workforce policy and strategy.

Emergency care: Emergency care as defined in the Emergency care dataset including both the services covered in emergency department (below) and some outpatient care including ambulatory care.

Emergency department (ED): Used for costing as the overarching term for accident & emergency units (24-hour service unit in acute hospitals), minor injury units, urgent treatment centres and walk-in centres.

Emergency operations centre (EOC): Where call takers, dispatchers and clinicians receive emergency calls and co-ordinate responses.

Episode: Short version of finished consultant episode (FCE). The costed unit for admitted patient care in the costing standards and the unit submitted to the National Cost Collection for acute and community services.  For mental health services submitted in the NCC, see spell.

Escort: A staff member who accompanies a patient from a healthcare setting for the patient’s and others’ safety.

Exceptional service/unit: A patient care or clinical service set up specifically for the COVID-19 outbreak not related to the organisation’s own patient care (even if these units were subsequently used for non-COVID-19 patients). The service is usually funded centrally outside normal commissioner or provider-to-provider contracts. The cost must have been included in the provider finance return (PFR) during the relevant costing period.

Excess bed days: Days that are beyond the trim point for a given HRG.

Expected duration: The time in minutes patient care is booked to take in patient administration system (PAS). The CDS data item name is ‘expected duration’ but for costing purposes we use the. It is used in conjunction with non-admitted patient care (NAPC) and admitted patient care (APC) to allocate costs as the prescribed method. It is recommended that mental health services use ‘actual duration’ because of the variability of time spent with each patient. Acute services are less variable by clinic and so therefore can use booked/expected duration to provide a reasonable and material allocation of cost.

Expenditure: Money spent on resources, including support resources, as reported in the general ledger output. Standard CP1: Ensuring the correct cost quantum and Standard CP2: Clearly identifying costs explain how expenditure should be extracted from the general ledger and prepared for the costing system.

Expense code: A code given to a cost to group entries in a general ledger. An expense code can be unique to one cost centre or appear in several cost centres in the ledger download.

External audit: A systematic and independent examination of an organisation’s accounts, statutory records, documents (including non-financial disclosures) by an independent body. This examination applies the accounting concept of ‘true and fair’, ensuring the financial statements are free from material misstatements and faithfully represent the organisation’s financial performance.

Extract specification: Defines the specification required for each extract to enable a trust to submit files to NHS Digital.

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F

False-positive matches: Cases where activity data has been matched incorrectly to a patient episode, attendance or contact.

Finance costs: Interest, income taxes and other such expenditure (NHS trusts).

Finance income: Amounts earned on money invested (foundation trusts).

Financial expenses: Interest, income taxes and other such expenditure (foundation trusts).

Finished consultant episode (FCE): The most detailed recorded level of admitted patient care in patient administration systems. All sectors with admission units should cost at this level. The NHS Data Model and Dictionary definition of an episode is a period of activity during which a named care professional is responsible for the patient. An episode starts when the patient is admitted or when their care is transferred, for example:

• when the responsibility for a patient transfers from one consultant (or general medical practitioner acting as a consultant) to another within a hospital provider spell. In this case, one consultant episode (hospital provider) will end and another one will begin
• when responsibility for a patient transfers from a consultant to the patient’s own general medical practitioner (not acting as consultant) with the patient still in a ward or care home to receive nursing care. In this case, the consultant episode (hospital provider) will end and a nursing episode will begin
• a consultant leaves the organisation and the patient is transferred to another care professional. A long-stay patient may have many such transfers:
  • the named care professional changes due to a change in the responsibility for the patient, for example, when a patient transfers from a paediatric to an adult service
  • the named care professional changes due to a change in the patient’s condition, a new episode may start under the newly responsible care professional.

Community care (and other settings) may record a named care professional who is not a consultant.

Fleet costs: Fleet costs cover the running and maintenance of vehicles, including cleaning and repairs.

FP10hp or FP10: A prescription that can be used by a GP, nurse, pharmacist prescriber, supplementary prescriber, or hospital doctor in England. When used in a secondary care setting, the medication can be issued from any pharmacy. The prescription information and cost are recorded separately and charged to the hospital provider. The form used to authorise the recharge is called FP10hp.

Fully absorbed costs: Costs from a cost centre, specialty or other organisational unit that include not only the patient-facing element relating to the expenditure incurred but also the allocated support-cost element from support functions such as estates, human resources, and finance.

FutureNHS: A collaborative online platform used across the NHS on which we publish supporting guidance and the analysis of the cost data during the collection period.

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G

General ledger: Main accounting record for financial transactions by an organisation, including transactions for assets, liabilities, accounts payable, accounts receivable and other information used for preparing financial statements.

Group activity: In a group session, each patient contact counts as one activity and will receive a share of the resource used to provide the session.

Group session: An ‘appointment’ where more than one patient receives care from one or more care professionals at the same time. This can be while admitted, or in a non-admitted patient care setting.

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H

Handover to clear: The period during which the ambulance crew and vehicle are made ready to respond to another incident.

Hazardous area response team (HART): An ambulance team of paramedics and other emergency medicine practitioners trained and equipped to operate in hazardous areas such as disaster zones or those contaminated by hazardous chemicals or radiation.

Headcount: The total number of employees in an organisation (or defined section of an organisation) who have one or more employment contracts at the reporting date. If an employee holds two or more contracts in the same team/department, the headcount will be one. However, if they work for two separate teams/departments, the count will be two. We recognise that this may lead to counting one employee twice. An employee is someone recruited on a permanent or fixed-term contract. This excludes bank, agency, and locum staff. Note: reporting date refers to the date on which the relative weight values were created or updated.

Healthcare professional: An individual associated with either a specialty or a discipline who is qualified and allowed by regulatory bodies to provide a healthcare service to a patient.

Healthcare resource group (HRG): Groupings of clinically similar treatments that use similar levels of healthcare resource. Healthcare resource groups are used as the basis for many of the currencies. HRG4+ is the current version for the 2021/22 financial year costing process.

Hear and treat: Telephone advice callers who do not have serious or life-threatening conditions receive from an ambulance service after calling 999. Could be advice on how to care for themselves or where they can go for assistance.

Health promotion programmes: Programmes delivered to groups rather than individuals and directed towards particular functions (such as parenthood), conditions (such as obesity) and behaviour (such as drug misuse).

Hidden activity: Activity that takes place but is not recorded on any of an organisation’s main systems, such as the patient administration system. It must be identified for payments and clinical governance for the costed activity to be correct.

Hierarchical allocation method: A method of allocating support services costs to support services in one direction; for example, finance department costs can be allocated to IT, but IT department costs cannot be allocated to finance even if finance consumes IT resources. The standards specify that a reciprocal allocation method should be used instead because it more accurately represents the interactions between support services, so ultimately allows more accurate support costing at the patient level.

Home care: Where the patient is cared for in their own home as though they were in hospital: for example, a patient ‘transferred’ home for intravenous antibiotics rather than being ‘discharged’ home. The home care may be provided by the same provider or a contractor.

Home leave: Mental health term for a patient spending up to six days in their own residence while a bed at the inpatient unit is held open for them.

Home visit: A patient contact in the patient’s normal place of residence (excludes prison contacts).

Hospital ambulance liaison officers (HALO): Staff who liaise between hospitals and the ambulance service, especially during patient handover.

Hospital Episode Statistics (HES): A data warehouse containing details of all admissions, outpatient appointments and A&E attendances at NHS hospitals. This data is collected during a patient’s treatment at a hospital to enable hospitals to be paid for the care they deliver. HES data is designed to enable secondary use for non-clinical purposes. For more information see the HES section of the NHS Digital website.

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I

IAPT (Improving Access to Psychological Therapy): Improving Access to Psychological Therapy (IAPT) is an NHS service designed to offer short-term psychological therapies for treating people with depression or anxiety. Since January 2023 IAPT has been renamed Talking Therapies for Anxiety and Depression but for the 2023 Approved Costing Guidance we continue to refer to IAPT.

IAPT dataset: The IAPT programme is supported by a regular return of data generated by providers of IAPT services. The data is received by NHS Digital and released as statistical publications covering activity, waiting times and patient outcomes such as recovery.

Impairment: This financial term occurs when the fair market value depreciation of a business asset exceeds the book value of the asset on the company’s financial statements.

Incident: For costing purposes, an activity provided by the ambulance service relating to an event: clinical advice on the telephone or dispatching a physical response to treat one or more patients.

Income: centre A code used to hold the three types of income shown in column B of Spreadsheet CP2.1: Standardised cost ledger in the technical document.

Income feed: Records used for income billing.

Income group: A collection of income for a cohort of activities; for example, income for delivering patient care or non-patient care activities.

Income ledger: Holds all the income transactions in the same way the cost ledger holds all the costs.

Incomplete patient events: Any patient event where the patient has not been discharged at the end of the reporting period, and/or their care started in a previous reporting period, or diagnostics or other events took place before or after the end of the reporting period.

Indirect costs: Costs indirectly related to the delivery of patient care. They are not directly determined by the number of patients or patient mix but can be allocated on an activity basis to service costs. This term is commonly used in management accounting processes but is not used in the Approved Costing Guidance .

Information requirements: The standard describing how information should be collected and managed for the costing process IR1: collecting information for costing and is supported by self-help content.

In-month data loading: Extracting the most recent month’s data from the activity feeds and loading it into the costing system each month. The advantage over cumulative year-to-date data loading is that smaller volumes of data are involved, and less processing power and/or time are required. The disadvantage is that late entries or adjustments to the previous month’s figures are not picked up and included in the costing system.

Integrated care board (ICB): A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the integrated care system area. Replace clinical commissioning groups (CCGs).

Integrated care partnership (ICP): A statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within an integrated care system area. Responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the integrated care system area.

Integrated care systems (ICS): Organisational partnerships which plan and deliver joined up health and care services, established across England from 1 July 2022. Each ICS includes an integrated care board, integrated care partnerships and local authorities responsible for social care and public health functions as well as other vital services for local people and businesses. Within each ICS, place-based partnerships lead the detailed design and delivery of integrated services across their localities and neighbourhoods. Provider collaboratives bring providers together to achieve the benefits of working at scale across multiple places and one or more ICSs.

Integrated costing assurance log (ICAL): A standard format for the integrated costing assurance log required as part of the costing standards for all sectors. It is designed to work with a patient-level information and costing system (PLICS). Each worksheet includes a template to record how to set up and run the costing system, and record decisions that are essential to understanding the journey from the general ledger and activity feeds to the costing system output. The ICAL makes it easier to store and transmit costing knowledge. It can provide evidence for the assurance process and supports the costing principle of transparency. It makes it easier for us to compare costing practices to the standards. The template is downloadable from our website.

International Classification of Disease (ICD11): The ICD is a medical classification list produced by the World Health Organization (WHO). It provides codes for diseases, signs and symptoms, and is regularly updated.

Investment revenue: Amounts earned on money invested (NHS trusts).

Internal audit: Takes place within an organisation and is reported to its audit committee and/or directors. Helps to design the organisation’s systems and develop specific risk management policies.

Intervention: An action or policy that will benefit the patient, whether it is physical, psychological or pharmaceutical.

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J

Job cycle: The ambulance job cycle comprises the series of activities when an emergency operations centre receives a call, decides on an action, and sends a response unit to treat one or more patients. It starts when a call is received, or a response is dispatched to (for example, a patient referred by NHS 111) and ends when the response unit is ready to be sent on another job.

Joint venture: Usually formed where two or more persons or companies come together to execute a particular business proposition or project in a contractual or corporate arrangement.

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L

Local Improvement Finance Trust (LIFT): LIFT is a public-private partnership (PPP). It delivers a wide range of property services to the NHS, including new build, master planning, land assembly and estate rationalisation. For more information visit the Community Health Partnerships website.

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M

Mandated transition path: Guide to which elements of which standards are mandatory by which year of implementation.

Mandation: The process of making implementation of the Approved Costing Guidance mandatory for all providers in a specific sector.

Market forces factor (MFF): An index used in patient care income calculations and commissioner allocations to estimate the unavoidable regional cost differences of providing healthcare. To obtain cost neutrality, the underlying market forces factor (MFF) used in the PLICS portal and data quality tools is scaled using the percentage difference between PLICS costs quantum before applying the MFF and after. That is, the total national value of PLICS costs submitted is the same whether it includes or excludes the MFF.

Master feeds: The core patient-level activity feeds to which auxiliary feeds will be matched: for example, admitted patient care (APC).

Matching (costing standards): The process to ensure the relevant auxiliary data feeds can be attached to the correct patient events in the master feeds.

Matching rules (costing standards): Govern how auxiliary patient-level feeds should be matched to the correct patient contact. The rules have a hierarchy, with some matching rules preferred to others to minimise false-positive matches.

Matching to national dataset: The patient events submitted as part of the National Cost Collection are matched to the underlying national dataset, to access more data items for that patient event in the PLICS portal and other national reporting data. For example, an admitted patient care episode is matched by NHS Digital to the Commissioning Data Set (CDS) to access all the diagnosis codes (ICD11).

Materiality: A value that is significant to the overall picture of cost or activity.

Maternity Services dataset (MSDS): National dataset collected by NHS Digital that allows maternity services providers to view data on maternity services relating to a mother and baby(s) from the point of the first booking appointment to discharge from maternity services.

Mental Health Minimum Data Set (MHSDS): National dataset collected by NHS Digital that allows mental health providers and their system suppliers to view data on secondary and specialist MH services, in England, or located outside England but where services are commissioned by NHS England to improve patient care.

Minor injury unit: NHS minor injury units (national code 03) are defined as doctor or nurse led service unit treating minor injuries and illnesses and can routinely be accessed without appointment. This term is used for costing as a subset of ‘Emergency Department’ which includes 24-hour A&E units, minor injury units, urgent treatment centres and walk-in centres.

Mobile to scene: The period from the moment an ambulance response unit starts its journey to arrival at the scene or being stood down.

Mono-specialty A&E departments: NHS mono-specialty A&E departments (national code 02) are defined as a consultant led specialty units; for example, ophthalmology and dental. This term is used for costing as a subset of emergency department which includes minor injury units, urgent treatment centres and walk-in centres.

Multidisciplinary team (MDT) meetings: Where care providers with varied expertise come together to review the care plan of one or more patients. The patient may or may not be present.

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National Cost Collection (NCC): The annual submission of patient level and average cost per unit data by NHS providers via NHS Digital.

National Cost Collection index (NCCI): A measure of the relative cost difference between NHS providers.

National Costing Grouper 2022/23 and documentation: Published by The National Casemix Office at NHS Digital, including the user manual, the code to group table, individual chapter summaries and a summary of changes from the previous costing grouper release.

National Tariff Payment System: The National Tariff Payment System was introduced in 2014 and comprised a set of rules, prices and guidance that governed the transactions between providers and commissioners of NHS-funded secondary healthcare to ensure services provide best value to their patients. The National Tariff replaced the previous Payment by Results payment system but was itself replaced by the NHS Payment Scheme in the 2022 Health and Care Act.

Negative costs: Where the balance of a cost or set of costs in the general ledger or balance of a resource, activity or cost object in the costing process appears to be less than zero. Can occur for reasons that include miscoding, the value of a journal exceeding the value in the cost centre, and inaccurate timings of accrual release in the general ledger. These are detailed in Standard CP2: Clearly identifying costs.

Netting off: Allocating income to reduce all or part of a cost in an expense code to ensure costs of activities are not inflated.

NHS Digital: NHS England and NHS Digital legally merged on 1 February 2023 and NHS Digital ceased to exist as a separate legal entity. This is the first step towards creating a new, single organisation to lead the NHS in England. While work continues in assimilating the two organisations into the new NHS England from an operational perspective, the 2023 Approved Costing Guidance and supporting information will continue to refer to NHS Digital. This will be kept under review and we will keep you informed as new processes evolve.

NHS Payment Scheme: The NHS Payment Scheme is a set of rules and guidance that governs the transactions between providers and commissioners of NHS healthcare. It was introduced by the 2022 Health and Care Act, replacing the National Tariff Payment System. The payment scheme has more flexibility than the tariff to allow payments to be calculated in ways other than using prices.

Non-current assets: Long-term investments whose full value will not be realised within the accounting year; for example, investments in other companies, intellectual property (for example patents), property, plant and equipment.

Non face-to-face contact: Time spent by healthcare providers reviewing and advising a patient on care without that patient being physically present; for example, having a phone conversation or a web chat with a patient while the patient is at home.

Non-responding time: The time frontline staff and vehicles are available to respond to a 999 call.

Nurse educator: Also known as a nurse tutor, a nurse who teaches and prepares registered nurses for entry into practice positions. They can also teach in patient care settings to provide continuing education to licensed nursing staff. Nurse educators teach in graduate programmes at master’s and doctoral level, to prepare future advanced practice nurses, nurse educators, nurse administrators, nurse researchers and leaders in healthcare and educational organisations.

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Observation: Carried out by healthcare professionals in a mental health care setting to ensure a patient is well and not harming either themselves or others.

OPCS codes (OPCS Classification of Interventions and Procedures (OPCS-4): A fundamental information standard created and managed by the NHS Digital Data Model and Dictionary. The codes are part of the ‘clinical coding’ applied to patient events by trained clinical coders. The OPCS codes show the procedures and interventions that took place and work in conjunction with the WHO International Classification of Disease (ICD11) codes for diagnosis.

Operating expenses: The ongoing cost for running a product, business, or system.

Orthotic appliance: A support worn by a patient outside their body. See also prosthetic limb.

Other activities: Activities performed by a provider that do not relate to the care of its own patients. These include care provided to direct access patients and commercial activities. See Standard CM8: Clinical and commercial services supplied or received.

Other operating income: Includes revenue from all operating activities that do not relate to the principal activities of the company, such as gains/losses from disposals, interest income, dividend income, etc.

Outpatient attendance: A clinic attendance where a patient or patients visit a healthcare professional in a clinical setting (usually but not exclusively a hospital setting), specifically as recorded on the Commissioning Data Set (CDS). These can be booked or informal/unplanned. One patient may visit the care professional(s) holding the clinic or a succession of patients during a clinic session (see community clinic attendance for community service clinics).

Outpatient care: Non-admitted patient care contacts in a formal or non-formal ‘clinic’ setting.

Outreach activity (acute): Where the staff who deliver services in critical care wards in acute hospitals see patients outside their main settings to provide continuity of care; for example, a critical care outreach nurse visiting a patient on an orthopaedic ward.

Outreach activity (mental health): Non-admitted patient care contacts that require the care professional to look for the patient before the contact can take place.

Outsourced services: Services a provider is contracted to provide which are provided by an external provider, often a private provider, on their behalf. See also services supplied.

Overheads: Such as finance and HR. They are allocated to all the services that used them, using a prescribed allocation method such as actual usage or headcount. These costs do not use resources and activities in the costing process.

Overstated: Reported with a value greater than the real value.

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Patient administration system (PAS): A central repository that stores patient-related information such as demographic data and details of how inpatients and outpatients came into contact with the hospital.

Patient care pathway: The patient’s journey from initial contact to the end of treatment or to a condition management programme. A pathway may continue alongside the latter once it has begun. There are standardised pathways for various health conditions, although an individual patient’s pathway is likely to vary from the standard. Some patients will be on multiple pathways at the same time. For more detail, see the National Institute for Health and Care Excellence (NICE) website.

Patient event: The record of a patient that is costed. Can include any point of delivery, including episode, attendance, care contact, telephone call or bed day (community and critical care providers only).

Patient-facing costs: Costs that relate directly to delivering patient care and are driven by patient events; they should have a clear activity-based allocation method and will be both pay and non-pay.

Patient-level activity (acute, mental health and community): Calculated by matching activity to a patient episode, attendance or contact. Some types of activity are not directly matched to a patient but still reported at the patient level using weightings based on headcount and/or acuity and time used.

Patient-level activity (ambulance): Calculated by distributing activity from incidents across the patients involved. Some types of activity are not directly matched to a patient but are still reported at the patient level using weightings based on headcount and/or time used.

Patient-level costing: The practice of allocating costs to individual patients by recording and/or calculating the support resources and patient-facing resources consumed in delivering activities related to patient care.

Patient-level costs: Calculated by tracing individual patients’ actual resource use. The output of the patient-level information and costing system (PLICS).

Patient-level feeds: Data sources specified in Standard IR1: Collecting information for costing.

Patient-level information costing system (PLICS): Both the whole process of patient-level costing and costing software that combines activity, financial and operational data to cost individual episodes of patient care.

Patient report form (PRF): Completed by ambulance crew members and containing information about each patient treated.

Patient transport service (PTS): Provides NHS-funded transport for eligible people unable to travel to their healthcare appointments or between healthcare sites by other means due to their medical condition.

Patient unit costs: Costs of single episodes, attendances, contacts or spells of care delivered to individual patients. Reference costs are calculated from the average unit costs for different currencies across all relevant patient episodes, attendances, contacts, or spells. Unit costs are defined in the National Cost Collection guidance.

Payment by results (PbR): The term previously used for the payment system in England, within which there was a national tariff that referred to the nationally set prices paid for each currency. PbR was replaced by the National Tariff Payment System, which has itself been replaced by the NHS Payment Scheme.

Place-based partnerships: In each integrated care system, place-based partnerships will lead the detailed design and delivery of integrated services across their localities and neighbourhoods. They will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners with a role in supporting the health and wellbeing of the population.

Placement: The time students and trainees spend at a healthcare provider. A placement must last longer than one week (five working days) and be linked to defined learning outcomes. This duration may total one week but be spread over several months; for example, one day a week for six weeks.

PLEMI (PLICS extract matching identifier): PLICS extract matching identifier enables data linking across all the activity feeds from one organisation. PLICS data quality tool (DQT) Gives an NHS provider an interactive view of the PLICS data it submitted. Improves data quality and helps ensure outliers are identified and addressed. The tool extracts nationally collected PLICS data and combines it with the relevant national published dataset (for example HES). It gives users access to a range of reports. Accessed via the PLICS portal.

PLICS portal: Allows users to analyse patient-level costing information. The portal connects nationally collected PLICS data with the relevant national published dataset (HES data for acute services) to enable in-depth benchmarking of costs, patient outcome reporting, patient-level activity analysis for example, patient pathway analysis and more.

Private finance initiative (PFI): A way in which the private sector finances a public sector project. The project is leased to the public and the government authority makes payments to the private company.

Private patients: Those responsible for paying fees for their care, either directly (self-pay) or through private medical insurance. Since the source of income is different from that for other types of patient, private patients need to be identified and flagged.

Prosthetic implants and devices (internal): Artificial substitutes for body parts intentionally left behind for functional or cosmetic reasons after surgery; for example, a titanium hip which remains in the patient after an operation.

Prosthetic limb or appliance (external): Worn by the patient on the outside of the body to replace or support part or all of a body part.

Provider collaborative: Partnership arrangements involving at least two trusts working at scale across several locations, with a shared purpose and effective decision-making arrangements.

Provider finance return (PFR): The monthly finance return submitted by trusts and foundation trusts to the NHS England finance department.

Providers of NHS services: Legal entities, or subsets of legal entities, that provide healthcare under NHS service agreements, operating on one or more sites within and outside hospitals. They include NHS trusts and NHS foundation trusts providing acute, ambulance, community and mental health services to treat patients and service users. They also include GP practices, local authorities with social care responsibilities, and non-NHS providers, although these are outside the scope of the Approved Costing Guidance.

Proxy records: For areas with no patient-level activity, it may be possible to create new records for costing to cost a patient not the patient; for example, care provided outside the organisation. However, proxy records should not be created because of poor data quality. Note: for services with sensitive/legally restricted data, an existing patient record is anonymised or pseudonymised at patient level for costing and the cost collection -this is not a proxy record but a real record without patient identifiable detail.

Pseudonymised record: Where a patient record is brought into the costing system without any patient identifiable information, but with an identifier that can be mapped back to the patient if required. This may be used for legally sensitive information but where the tracking to the patient is deemed essential for local use. This is not a proxy record; it is a real record without patient identifiable detail.

Psychiatric intensive care unit (PICU): Provides care to mental health patients who require immediate or more than usual care due to high risk of self-harm or harm to others. PICUs usually have higher staffing levels and may have an array of specialised care providers. Not to be confused with ‘paediatric intensive care unit’, which may also use PICU as an abbreviation.

Publication: This term is used for both the Approved costing guidance (ACG) and the National cost collection publication. The ACG publication consists of the collection guidance, costing standards and collection tools provided by NHS England to support trusts to accurately cost and submit their data in the NCC. The NCC publication consists of the schedules and the dashboards made available to trusts to view their National cost collection index (NCCI).

Public dividends capital (PDC): A form of long-term government finance provided to NHS trusts when they formed to enable them to purchase their assets and pay a dividend to the Department of Health and Social Care.

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Quantum of cost: The total expenditure measured and allocated for the costing exercise. It should be reconcilable to the audited accounts using the Approved Costing Guidance.

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Reciprocal allocation method: The prescribed method of allocating costs that takes account of how corporate support services provide services to one another : for example, part of the cost of the finance department is allocated to IT and part of the cost of the IT department is allocated to finance. Note: the hierarchical allocation method is not prescribed.

Reciprocal charging arrangements: Agreements with foreign states allowing the NHS to charge their governments for care provided to overseas patients.

Reconcile: Matching output from the costing system with its data sources as well as with totals from other financial statements. This takes account of adjustments and exclusions made during the costing process.

Reconciliation: The process of making sure that two or more sets of records agree. Costing involves a cost reconciliation (to ensure all cost is used in the costing process) and an activity reconciliation (to ensure all relevant patient events are used in the costing process).

Refresh: The practice of replacing data loaded into the costing system month-on-month with a fresh extract from the patient-level feeds. This may add new records, amend existing records and remove erroneous records from PLICS. For example, an activity in June, which is entered in the patient-level feed in August due to an administrative error, would be missed by an in-month data load at the end of June. A refresh after August would pick it up and add it to the list of activities in June within the costing system.

Regular day or night admission: An admission in a series of regular day/night admissions for a course of treatment.

Relative weight value (RWV): Developed to assign costs at the patient level where a patient-level feed is not available to identify the precise cost or number of activities performed. RWVs can also be used where supporting allocation information is required for the patient-level feeds. They can be used to allocate both patient-facing, overheads (type 1 support costs) and type 2 support costs.

Resource group: See Collection resource.

Resources: Components used to deliver activities, such as staff, equipment or consumable. The cost ledger includes a mapping of costing account codes to a prescriptive list of costing resources provided in the technical document. Also called costing resource (or, previously, implementation resource).

Response unit: One staffed vehicle or other unit (for example community first responder) that can be physically dispatched to an incident.

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Searching: Mental health term for the clinician proactively tracking down their patient to ensure reviews are performed, medications taken, etc.

Secondary Uses Service (SUS):  SUS is The single, comprehensive NHS Digital repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.

Secure Electronic File Transfer (SEFT): SEFT is The web portal NHS providers use to transfer PLICS XML files created by the data validation tool (DVT) to NHS Digital electronically and securely.

See and treat: Incidents where frontline staff provide focused clinical assessment at the patient’s location, followed by appropriate immediate treatment, discharge and/or referral. Often a patient will be referred to other more appropriate services or services which can provide further support at home or in a community setting, in liaison with the patient’s GP.

See, treat and convey: Incidents that result in a patient being conveyed because of an emergency call from a member of the public or organisation, or because of being categorised as needing an emergency response following a referral by a healthcare professional or electronically transferred to the CAD system from another CAD system

Service-level agreement (SLA): Agreement between two organisations to identify the expected level of service one provides to the other.

Service-line management (SLM): A method that identifies discrete service areas and manages them as distinct operational units. It enables NHS trusts to understand their performance and organise their services in a way which benefits patients and delivers efficiencies for the trust.

Service-line reporting (SLR): A method for reporting cost and income by service lines (discrete business units) to improve understanding of each line’s contribution to performance. SLR measures a provider’s profitability by each of its service lines, rather than at an aggregated level for the whole provider.

Services received: Care provided to one organisation’s patients by another organisation.

Services supplied: All activities a provider performs for another organisation that do not relate to the care of its own patients.

Service team session (NAPC): A defined period of time where one or more care professionals see a sequential list of patients. It could be a day in the community, or a 4-hour session, or defined as a formal clinic, depending on the sector and the available information.

Small numbers suppression: Information about an individual that is not public must not be identifiable, or able to be deduced from the data, from the PLICS data quality tool or public portal. Figures that may identify individuals when subtracted from totals, subtotals or other published figures must be suppressed.

SNOMED CT: A structured clinical vocabulary for use in an electronic care record. Represents care information in a clear, consistent and comprehensive manner. The move to a single common clinical terminology will reduce the risk of misinterpretation of the care record in different care settings. NHS provider organisations should have adopted SNOMED by April 2020 (although this will have been impacted by COVID-19. Further information on the NHS Digital website.

Specialing: Monitoring patients who require continuous one-on-one nursing care; for example, specialist palliative medicine.

Spell: The period from date of admission to date of discharge for one patient in one trust. A spell may consist of one or more than one finished consultant episodes. For the mental health sector, spell is the costed patient event that is submitted for admitted patient care in the National Cost Collection. (For acute and community admitted patient care, the costed patient event in the NCC is the episode.) For commissioning purposes spell is a currency in the acute and community sectors.

The period from date of admission to date of discharge for one patient in one hospital. A spell may consist of more than one finished consultant episode.

Stakeholder: All individuals and groups likely to be affected by a proposed change.

Standalone feeds: Patient-level activity feeds not matched to any episode of care but reported at service-line level in the organisation’s reporting process; for example, the cancer multidisciplinary team meeting (MDT) feed.

Standards: The Approved Costing Guidance describes the costing approach to adopt to comply with the Costing Transformation Programme. There are sector-specific standards for acute, ambulance, mental health, and community providers but some areas of these standards have been integrated to reduce the burden on integrated providers; for example, costing processes. This single, common integrated document set can apply to all sectors.

Statement of comprehensive income (SOCI): A financial report detailing the change in a company’s net assets during a specific period. It differs from a typical income statement that details profits and losses.

Statistic allocation table: A place to store relative weight values used to allocate costs.

Students: Those receiving education and training from a healthcare service provider who are not paid a salary (see also trainees for those who do receive a salary).

Subsidiary: A company is a ‘subsidiary’ of another company (its ‘holding company’) if that other company:
(a) holds a majority of the voting rights in it, or (b) is a member of it and has the right to appoint or remove a majority of its board of directors, or (c) is a member of it and controls alone, pursuant to an agreement with other members, a majority of the voting rights in it.

Superior costing method (SCM): A more advanced costing method than the prescribed method. For example, ward care costs are allocated by duration in minutes. Superior costing method code SCM2 Acuity, Specialing and Observations uses duration and extra patient-specific information to allocate the costs in a more detailed way. Superior costing methods need to be authorised by our costing team before they are used. The integrated technical document includes a list of authorised SCMS on spreadsheet CP3.5 (Superior and Alternatives).

Supplementary feed: Ambulance information feed that contains no information about patient-facing activities. It is an information source to help to allocate resources more accurately; for example, fleet information feed.

Supplier: The two main categories of supplier for costing are the PLICS suppliers and suppliers of goods and services.

Supporting contact: Contact from anyone other than the principal healthcare professional recorded on the PAS. A patient often receives multiprofessional services during their episode; for example, physiotherapists working with burns patients on a ward. This contact can take place during any type of patient event (including APC, NAPC and ED), where the contact adds additional specialist knowledge or treatment to the care given.

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Talking Therapies for Anxiety and Depression: Talking Therapies for Anxiety and Depression is the new name for IAPT, the NHS service designed to offer short-term psychological therapies for treating people with depression or anxiety. For the 2023 Approved Costing Guidance we are continuing to refer to IAPT.

Technical document: A series of Excel spreadsheets available to download from our website to support implementation of the costing standards. It is sector-specific, but some spreadsheets have been integrated to include all items for acute, mental health and community services; for example, Spreadsheet CP2.1: Standardised cost ledger to reduce the burden on integrated providers. The standards cross-refer to spreadsheets in the technical document, including column and row number where applicable. The technical document also contains the information needed for cost collection.

Technology Reference data Update Distribution (TRUD) datasets: The Terminology Reference data Update Distribution (TRUD) service supplies datasets to support consistent coding of activity, including:

• the chemotherapy regimens list, including adult and paediatric regimens, with mapping to OPCS-4 codes that have one-to-one relationships with unbundled chemotherapy HRGs
• the National Interim Clinical Imaging Procedure (NICIP) code set of clinical imaging procedures, with mapping to OPCS-4 codes that relate to unbundled diagnostic imaging HRGs
• the national laboratory medicines catalogue, a national catalogue of pathology tests.

Tele medicine: Non face-to-face contact with a patient using telephone or web-based applications; for example, ambulance hear-and-treat service. Only non face-to-face contacts that directly support diagnosis and care planning and replace a face-to-face contact should be included in the costing process.

Third-party frontline resource: Costs of patient-facing services provided by third-party organisations, such as activity performed by third-party ambulance crews.

Traceable costs: Where actual costs are used from an information feed to inform a relative weight value.

Trainees: Those receiving education and training from a healthcare provider who are paid a salary (see also students who do not receive a salary).

Travel time (ambulance): Time spent travelling. It can apply to travel to scene, scene to treatment location, treatment location back to base, or anywhere.

Travel time (non-ambulance): Time taken by a healthcare professional to make a journey from their workplace to meet a patient or patients.

Treatment function code (TFC): Code recorded to report the specialised service in which the patient is treated. For more detail see NHS Data Dictionary entry.

Triage: The process of determining the priority of patients for treatment, based on the severity of their condition; for example, paramedics will triage patients before transporting them to hospital and an A&E nurse will triage patients when they arrive at the hospital.

Trim point: For each HRG, the trim point is calculated as the upper quartile length of stay for that HRG plus 1.5 times the inter-quartile range of length of stay. After the spell of treatment exceeds this number of days, a provider will receive payment for each additional day the patient remains in hospital. This is referred to as an excess bed day payment or a long stay payment.

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Unbundled healthcare resource group (HRG): An unbundled HRG represents an additional element of care. It will always be associated with a core HRG that represents the care event and will always be produced in addition to that core HRG.

Understated: Reported with a value smaller than the real value.

Unit cost: The cost incurred by a provider to produce, store and sell one unit of a product or service. Unit costs include all fixed costs and all variable costs associated with the production of a product or delivery of a service.

Unlikely match: A rule that voids any match made between data feeds when trying to associate resource use or activity with a patient episode. Care providers can list scenarios that will never occur in a clinical context; for example, a specialty prescribing a drug that is never involved in a patient’s care pathway within that specialty. Knowing these unlikely scenarios will avoid unlikely matches.

Unmatched activities: Activities not allocated to the patient episode, attendance or contact for which they occurred.

Unwinding of discount: A term used in accounting and finance to describe, where future liability is fixed/certain, the undoing (unwinding) of the process to find out the discount in the said fixed future liability as against its relative current value (or interest to its relative present value). For example, when you apply discounting to a future cash payment to arrive at a present value, it is necessary to unwind that discount for each successive year until you arrive at the date of payment.

Urgent treatment centre (UTC): NHS urgent treatment centre is a term used by providers for either walk-in centres (emergency care department type 04, also called ‘national code 04) or minor injury units (emergency care department type 03, also called national code 03). We do not use this as a separate costing term.

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Value-based healthcare: A metric that combines cost and outcome of patient care to provide improved information on the ‘value’ the expenditure has provided for the patient. The concept is based on the research of Porter and Teiseberg (2006) (Redefining health care. Harvard Business Review) and is a framework for restructuring healthcare systems with the overarching goal of value for patients. It can be used when rolling out PLICS information, to contribute to the decision-making toolkit by giving a more effective comparator metric than cost alone.

Virtual ward: Allow patients to be treated at home rather than in hospital supported by technology.

Volume of service: The number of patients treated and activities performed by the department or service.

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Walk-in centre: NHS walk-in centres (national code 04) are predominantly nurse-led primary care facilities dealing with illnesses and injuries including infections and rashes, fractures and lacerations, emergency contraception and advice, stomach upsets, cuts and bruises, or minor burns and strains without patients needing to register or make an appointment. They are not designed for treating chronic conditions or immediately life-threatening problems. This term is used for costing as a subset of ‘emergency department’ which includes 24-hour A&E units, minor injury units, urgent treatment centres and walk-in centres.

Ward attender: A non-admitted patient care event where the patient is seen on a ward rather than an outpatient clinic or setting. The costs will be the cost of the ward plus any additional clinical professional, but it remains an outpatient patient event.

Weighted activity: Calculation to weight activity by a relative value unit to add acuity to the count of activity.

Whole-time equivalent (WTE): Measurement of the staffing resource involved in providing a service, taking account of full and part-time working.

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