Attributing the costs of health & social care Research & Development Understanding AcoRD

Transcription

1 Attributing the costs of health & social care Research & Development Understanding AcoRD Trudi Simmons Senior Manager Research Finance & Programmes 1

2 Implementation Intoduction Basic principles behind the guidance The attribution process Common problems in attributing costs 2

3 Implementation AcoRD Published in May 2012 & adopted by England, Scotland, Wales & NI Published on the Gov at: 1. Working Group established to look at key issues around implementation 3

4 Principles of AcoRD Based on original principles set out in HSG(97)32 Uses the same three cost categories and definitions as HSG(97)32 Focuses on why an activity takes place rather than where or by whom Focuses on the Primary Purpose of an activity 4

5 Three sections Format of Guidance Main section that covers the background, principles and attribution process Annex A provides an Exemplar list of activities and where they should be attributed Annex B provides a set of Frequently Asked Questions (FAQs) updated regularly 5

6 Exemplar Lists Split into 3 sections Research, Support and Treatment Research Section has 2 parts Part A costs met by all grant funders Part B costs met by grant funders except where the funder is a member of the AMRC when DH will meet the cost. 6

7 The Categories of Costs Three types of costs: Research costs Treatment costs NHS Service Support Costs 7

8 Research Costs Costs of the R&D itself that end when the research ends. They relate to activities that are being undertaken to answer the research questions Met by grant funders through the award of a research grant except for PART B costs if funder is an AMRC member DH will meet PART B costs mainly via Research Capability funding (RCF) and Networks 8

9 Treatment Costs Patient care costs which would continue to be incurred if the patient care service in question continued to be provided after the R&D study had stopped 1. For the purposes of the attribution it should be assumed that an experimental intervention/ service being tested will continue after the end of the study Met through the normal commissioning process 9

10 Excess Treatment Costs (ETCs) ETCs are the difference between the cost of usual care and the cost of the treatment provided as part of the study Sometimes there are treatment savings rather than excess treatment costs 10

11 NHS Service Support Costs The additional patient care costs associated with the research, which would end once the R&D activity in question had stopped, even if the patient care involved continued to be provided Met from the R&D budget by the Health Departments of the United Kingdom 11

12 Attribution Process Concept of NHS patient care services and the premise that the NHS bears the cost of caring for its patients even when they are involved in a research study NHS patient care service is defined as a service provided by, or on behalf of, the NHS where that service treats, or contributes to, the care needs of a patient. 12

13 Two step approach step 1 Identify the core R&D activities the are being undertaken to answer the research question and which end when the research ends. These activities do not contribute to a NHS patient care service. These are Research Costs Examples of Research Costs are contained in Annex A 13

14 Step 2 NHS Patient Care Service Activities Activity that is part of NHS Services must be split between: NHS Treatment Costs NHS Support Costs 14

15 Treatment or Support Activity An activity is a NHS Treatment activity If it is integral to the provision of a treatment regime, whether this is standard or experimental An activity is a NHS Service Support activity if the patient care activity is primarily undertaken to facilitate research or is driven by the NHS duty of care to a patient, eg to ensure the safety of a patient participating in research 15

16 The attribution process Step 1 Step 2 In the context of this study is the activity a service provided by, or on behalf of, the NHS where that service treats or contributes to the care needs of a patient Yes No The activity is a patient care cost. Is the activity integral to the provision of a treatment (or diagnostic) regime? The activity is a Research Cost because it is not directly contributing to patient care Is the funder an AMRC member? Yes The activity is a Treatment Cost No The activity is a Service Support Cost Attribute Research activities between Part A and Part B 16

17 Treatment Costs As a rule of thumb most interventions that are being tested or compared as part of a study will be treatment costs even if they are experimental, unlicensed for the condition, not NICE approved, or there are no plans to continue with the intervention after the study has ended because the CCGs won t fund But placebo or sham treatments are research costs 17

18 Examples of NHS Support Activities The processing of the patient record to identify patients who may be suitable to approach to ask if they wish to participate in a research project; Obtaining informed consent; Additional investigations, assessments and tests where the results are required by the patient s care team to ensure patient safety and where arrangements are in place to feed the results back to the clinician 18

19 19 Common issues Attributing the costs of R&D is complex DH piloting an Activity Capture and Attribution Template (ACAT) to help No one size fits all Need to understand the detail of the study Why is the activity taking place? What usually happens to a patient? What would happen to the patient if they had the same treatment outside of a research study? Network support applies to research taking place in the NHS or in a NHS service provider Efficient study design can help to minimise cost Seek appropriate advice before grant submission

20 Common attribution mistakes Not referring back to the definitions of the 3 types of costs Attributing treatment costs as Support or Research costs Assuming because an activity takes place in the NHS it must be a NHS cost not true Assuming that funding for NHS Support and Treatment costs works in the same way as funding for research costs 20

21 21 NHS SSC Case Study Pam Gurney, University of Exeter Medical School

22 University of Exeter Medical School Case Study 1. Brief history of the School 2. Details on the funder 3. How we dealt with the difficult terms and conditions

23 Brief History of the University of Exeter Medical School 2002 took our first students as Peninsula Medical School (PMS) 2007 became the Peninsula College of Medicine and Dentistry (PCMD) 2013 split from Plymouth University and became the University of Exeter Medical School (UEMS)

24 Funder An AMRC Registered Charity As an AMRC registered charity, will not be required to pay (detailed in AcoRD Appendix A, Part B) are as follows: o Local study trial co-ordination and management. o Data collection needed to answer the questions that the research study is addressing (including collecting data for and completing the report). o Regulatory preparation and compliance including obtaining ethical approval and complying with the Medicine for Human Use (Clinical Trials) Regulations o The time taken by Chief and Principal Investigators (CI and PI) to explain the study to professional colleagues, and to understand, the research elements of a study. For example the time taken to explain the criteria for patient eligibility or to explain the randomisation protocol. o Sponsorship fees such as MHRA fees, and CTA annual renewal fees.

25 Our Solution United front with the academic / clinician One meeting the attendees being the academic, the HEI representative and the CRN representative Open discussion between all parties Contact with the CRN to make them aware of the cost commitment should the bid go ahead

26 Conclusion It is necessary, when dealing with SSC and ETCs that we work together with both the academic and the CRN to ensure that things are costed correctly. We understand the rules of each individual funder to ensure that we can attribute these costs appropriately.