Placement Tariff Funding and Currency Development. Jenni Field, Head of Finance Strategy, Health Education England

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1 Placement Tariff Funding and Currency Development Jenni Field, Head of Finance Strategy, Health Education England

2 Tariffs and Currencies Currencies are the unit of education and training activity for which a payment is made (HEE responsibility) Tariffs are prices set for each currency (DH responsibility) At the moment there are 3 currencies and tariffs: Non-medical placements Undergraduate Medical Placements Postgraduate Medical Posts 2013/14 3,175 + mff * 34,623 + mff N/A 2014/15 3,175 + mff 34,623 + mff 2015/16 3,175 + mff 33,965 + mff 12,400 + mff and 50% basic salary costs 12,400 + mff and 50% basic salary costs * mff = market forces factor, to reflect local price variations

3 The Historic Funding Position - Funding based on local agreements - Inequities in funding across different organisations and within organisations (across different professions) - Rarely linked to outcomes or quality

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5 The case for tariffs The Government is committed to the principle of tariffs for education and training as the foundation to a transparent funding regime

6 The case for tariffs - Commissioning on quality, not cost - More certainty for trusts around income - Arrangements are more transparent - Fairer distribution of funding across the system - Easier and quicker to commission clinical placements

7 Transitional Tariffs The gains and losses phase in over time Annual Losses capped at 2m or 0.25% of turnover The transition model runs for 13 years Year /20 over 70% complete in financial terms and 16 Trusts remaining Year /22 over 99% complete in financial terms and only 2 Trust remaining

8 Gain over 1m Gain under 1m nil effet Loss under 1m Loss between 1m and 2m Loss over 2m Grand Total Summary of Funding Changes Postgrad change Undergrad change Gain over 2m Gain between 1m and 2m Gain under 1m nil effect Loss under 1m Loss between 1m and 2m Loss > 2m Grand Total

9 Future Tariff Design There is a need for robust and up to date costs Future Tariffs will be set based on the outcome of the Cost Collections from NHS Trusts The cost collections are a major undertaking for Trusts, the majority of whom have never submitted costs in this way.

10 Timeline January 2014 initial mid year cost collection Summer /14 full year cost collection Late Currency Development Summer /15 second full year cost collection Autumn 2015 integrated cost collection pilot

11 Scope of the collection Narrative outline of the scope: 2.1 The data to be collected for year end is for students and trainees who go on a clinical placement as part of their training programme that: is a recognised part of the education/training curriculum for the course and approved by the higher education institute and the relevant regulatory body, as appropriate; has the appropriate clinical and mentoring support as defined by the relevant regulatory body.

12 Cost Components 001: Pre-placement costs Proportion of staff time involved in pre-placement activities x staff cost 002: Direct teaching staff costs Proportion of staff time performing direct teaching x staff cost 003: Cost of teaching staff time spent on training courses - Proportion of staff time spent on training courses related to student/trainee teaching x staff cost + Cost of course fees 004: Cost of staff teaching while delivering patient care - Proportion of staff time teaching while delivering patient care x Staff cost

13 Cost Components 005: Facilities cost Proportion of facilities used for student/trainee-related activities x facility cost 006: Administration cost Proportion of administrators time on training and education activities x staff cost 007: Central education costs - Proportion of staff costs for Education Directorate activities x staff cost + travel and subsistence 008: Overheads

14 Cost Components Salaried only Additional reporting requirements related to salaried trainees only: 009: Cost of checking a trainees work Proportion of time spent checking a trainees work (in addition to that done by teaching staff) x staff cost 010: Course fees and expenses for courses and examinations Cost of trainees attending courses or examinations 011: Total trainee staff cost Number of trainees by grade x trainee cost by staff grade 012: Proportion of trainee time in training (%) Proportion of trainee time in training (%)

15 Data analysis: Education Cost Index compared with RCI 45% 13/14 ECIs vs 12/13 RCIs 40% 35% 30% 25% Full year 2012/13 RCI Half year 20% 15% 10% 5% 0% -5% 45 or less 55 or less 55 to to to to to to to to to to or more

16 Non-Salaried Programmes Pre-placement costs Overheads Direct Teaching Direct teaching staff costs Cost of teaching staff time spent on training courses Cost of staff teaching while delivering patient care Facilities cost Staff teaching while giving patient care Administration cost Central Education cost Placement exams/assessments Overheads

17 Salaried Programme Pre-placement costs Direct Teaching Direct teaching staff costs Cost of teaching staff time spent on training courses Trainee salary cost Staff teaching while giving patient care Cost of staff teaching while delivering patient care Facilities cost Administration cost Central Education cost Placement exams/assessments Overheads Cost of checking trainees' work Cost of trainees attending courses or examinations Total trainee salary cost

18 Frequency Data analysis: Distribution of derived salary costs Salary Range 000

19 Ongoing work to improve data quality Benchmark tool from for local use Improved guidance particularly removing ambiguities and inconsistencies Updated collection template Tighter validation at point of submission Running further workshops through our LETBs for joint finance and education audience

20 DISCUSSION BREAK: What involvement have you had with your local placement providers in their tariff submission? Provision of activity data? Reviewing results and benchmarking?

21 Currencies Balance between Enough currencies to fairly reward Trusts Manageable number to limit the admin burden

22 Development of Currencies The new currencies will be called Education Resource Groups (ERGs) The 13/14 data is informing the creation of currencies HEE / DH have carried out analysis of the data HEE established a multi-professional group to develop proposals Wider stakeholder consultation will follow

23 Currency Development Group membership Trusts representatives Representatives of the professional groups (from HEEAGs) The Department of Health and Health Education England

24 Currency Development Group The group s objectives: Set out the approach for creating ERGs Develop the principles for ERG design Receive and request further data analysis Propose draft groupings based on the principles and applying their educational and professional insight Advise on the wider consultation process and assist with responding to feedback

25 Currency Development: Principles Transparency Equity Stability Flexibility Quality Iso-Resource Educationally meaningful Minimum Coverage These will be considered but sometimes there is a tension or conflict between meeting all the principles and a balance has to be found

26 A flavour of early discussions to avoid perverse financial incentives commissioners and providers need to believe in the currencies the currencies need to support the wider workforce objectives as few as possible minimum number that meets the objectives

27 Data analysis Looking at various permutations: Groupings of similar professions / specialties Split by year of training Split by cost component Split by type of provider Analysis of mean / median / IQR Impact of outliers

28 ANY QUESTIONS?