NHS Information Standards Board

NHS Information Standards Board DSC Notice: 06/2001* Date of Issue: March 2001 Subject: Data requirement for the production of casemix adjusted Reference Costs for Chemotherapy interventions. Implementation date: 01 April 2001 to commence preparation. 01 October 2001 for data collection/costing. DATA SET CHANGE CONTROL PROCEDURE This paper gives notification of changes to be included in the NHS Data Dictionary, the NHS Data Manual and the NHS CDS Manual in due course. Summary of change: Mandatory collection and data flow of Chemotherapy HRGs Summary of impact: Extension of data collection and expansion of dataflows. Change Proposal Reference No: 02/01 The NHS Information Standards Board (ISB), established by the NHS Information Authority, is responsible for approving information standards. The NHS ISB is supported by the Management Information Standards Board, Clinical Data Standards and Technical Standards sub-boards. *The DSCN Number Format has been changed to denote the new arrangements as follows: sequence number/year of issue (ccyy). The service identifier and service sequence number are redundant owing to changes in practice and have been removed. The packaging of standards documentation is under review. Any changes will be notified in due course. Please address enquiries about this DSCN to the Data Standards Team, NHS Information Authority, Aqueous II, Aston Cross, Rocky Lane, Birmingham, B6 5RQ Tel: 0121 333 0237 or to the nominated enquiry point. Data Set Change Notices are located on the Internet in the Electronic Library at http://www.standards.nhsia.nhs.uk/library/index.htm and on the NHSnet at http://nww.standards.nhsia.nhs.uk/library/index.htm

Reference: CP 02/01 version 1.2 DATA SET CHANGE NOTICE 06/2001 Subject: Type of Change: Data requirement for the production of casemix adjusted Reference Costs for chemotherapy interventions. i. Mandatory collection of a list of Chemotherapy HRGs, (see Appendix 1) ii. Introduction of an annual data flow of these aggregated data items from Providers to the NHS Executive Headquarters Reason for Change: To introduce Chemotherapy HRGs required to support casemix adjusted costs for the purposes of the National Schedule of Reference Costs (NSRC). Effective Date: Mandatory collection of Chemotherapy HRGs from 1 st October 2001 for the 2001/02 financial year. This six months data to be annualised for the reference cost submission to be submitted by the 30 th June 2002. The six months from the 1 st April to 30 th September 2001 to be used by the service as a lead-in / preparation period before commencing the mandatory collection of Chemotherapy HRGs on 1 st October 2001. Introduction: 1. The new NHS white paper made it clear that Trusts will be required to publish their costs on a consistent basis and the data will be published in a National Schedule of Reference Costs. This DSCN: i. mandates the collection of the list of Chemotherapy HRGs as given in Appendix 1; and ii. extends the current annual mandatory data flow of reference costs to include these aggregated Chemotherapy HRGs from NHS Trusts to the NHS Executive Headquarters. This will then meet MS (H) requirements in respect of the rollout of the NSRC and facilitate the benchmarking of services. In addition this information will be used in determining efficiency targets for the NHS, and supporting the monitoring of performance against National Service Frameworks. Page 2 of 9

Background: 2. Cost information on chemotherapy is incorporated in final accounts in global terms. This is not suitable for reference costs nor does it allow for the differing complexity of activity to be adjusted for in setting efficiency targets. To meet the timetable agreed with MS (H) a consistent dataset needs to be available to allow costed HRG information to be included in the reference cost information from June 2002. Chemotherapy services are one of the major areas of activity provided by acute NHS Trusts, hence the requirement to include meaningful activity costs in the National Schedule as soon as possible to meet ministerial commitments. 3. For the June 2001 NSRC returns Trusts are required to submit costed chemotherapy data on interim groupings based on the more common drug regimens and the site of the cancer itself. This supports the direction of travel taken by the work of clinicians on developing more substantive groupings. They assist the providers of these services to begin separately identifying the high costs of chemotherapy for reference costs purposes as an interim step to the introduction of more detailed groupings of Chemotherapy HRGs for the 2002 NSRC returns. 4. In pursuit of more sophisticated costing, an analytical base for developing Chemotherapy HRGs was established on a series of target chemotherapy protocols in a pilot study. The pilot study involved: 4 NHS Trusts - identifying individual treatment components for 30 patients per protocol - attributing costs to each component - identifying the relevant data items involved, casenote search, scrutiny of pharmacy and other departmental systems. 5. A report on the analysis of this first tranche of data recommended that further data be collected to extend and strengthen the analysis to cover all main protocols used to treat solid tumours. This pilot study involved a new series of pilot sites of an additional 4 NHS Trusts further validating the initial research. 6. It was agreed at the outset that the analysis should support a straightforward HRG structure of chemotherapy treatments, which were clinically meaningful. Comparative analysis of the data assisted in identifying an HRG structure, allocating an HRG to a programme of chemotherapy treatment, based on the named drug protocol and tumour site. 7. Given the complexities of leukaemia and myeloma treatments, it is intended that Chemotherapy interventions for this condition are covered under the auspices of a separate project. It is planned that these will be included in the National Schedule of Reference Costs to meet ministerial timescales and to support developments detailed in the recent NHS National Plan. Page 3 of 9

8. HRG development is well supported by the clinical professions and their appropriate professional organisations. 9. Further details on Chemotherapy HRG assignment/costing requirements will be found in the Chemotherapy Definitions Manual (A Chemotherapy Definitions Manual will be posted to the NHS Information Authority, Casemix Programme website nww.casemix.nhsia.nhs.uk during May 2001 for downloading as a pdf file) and the 2001 Costing Guidance. New Arrangements: 10. This DSCN mandates the collection of the prospective directly assigned data items listed at Appendix 1 and their submission on an annual basis to the NHS Executive. This builds upon the interim groupings detailed in the 2001 Costing Guidance. Argument: 11. In implementing this aspect of the White Paper, the National Costing Strategy Group (NCSG) has been given lead responsibility for the development of reference costs including the National Schedule of Reference Costs (NSRC) and associated information including the National Reference Cost Index (NRCI). This is used as the basis of setting efficiency targets on an annual basis. 12. This change builds on the national costing initiative that falls within the remit of this Costing Group. Efficiency and performance colleagues have therefore supported the roll out of casemix adjusted reference costs across all parts of the acute sector as quickly as possible. 13. Approval was given by ROCR in November 1997 to develop an HRG database for acute services in line with a timetable agreed by MS (H). This included approval of an annual collection exercise (undertaken in June each year) by electronic medium. The June 2001 collection will cover all surgical and medical inpatient and day case activity, Accident & Emergency, Radiotherapy, consultant-led and nurse-led outpatient activity for Ophthalmology, Dermatology, Gynaecology, General Surgery (Surgical Gastroenterology, Vascular Surgery, Breast & Endocrine Surgery), Rheumatology, Trauma & Orthpaedics, Urology, Medical Gastroenterology and Cardiology. Where HRGs are currently not available, other activity measures have been used e.g. bed/cot days for critical care services, clients for community nursing services and new and follow-up costs for outpatient specialties not already mandated. The interim chemotherapy groupings identified in the 2000 Costing Guidance and collected as part of the 2001 Reference Cost Collection will be replaced in the NSRC by casemix-adjusted HRG costs from June 2002. 14. The use of chemotherapy has increased markedly during the 1990s with a concomitant rise in expenditure related both to the use of cytotoxic drugs per se and to the supportive services needed by patients undergoing chemotherapy (e.g. inpatient and outpatient care; investigations; treatments for side-effects and complications). Page 4 of 9

15. The increase in chemotherapy usage and expenditure can be attributed to a number of factors: Wider usage of chemotherapy in patient groups where treatment was already established before 1990 (e.g. breast cancer; colorectal cancer). Extension of the use of chemotherapy to a wider range of tumour types. Introduction of expensive new anticancer agents (e.g. paclitaxel, docetaxel). Introduction of new supportive care treatments (e.g. 5HT 3 antiemetics; colony stimulating factors). 16. There is currently no standardised method for recording chemotherapy activity across the UK. Cancer Registries normally only collect information on anticancer treatments delivered within six months of diagnosis, thus missing many patients who receive chemotherapy late in the course of the disease. Information on chemotherapy recorded by Cancer Registries is usually limited to a simple Yes/No item, without (for example) recording the type of chemotherapy used or its duration. Information held on hospital patient administration systems is frequently based on contracting currencies, which vary across the country. Detailed data are collected within some oncology departments, but are unlikely to yield comparable data due to a lack of agreed definitions. 17. Agreed Chemotherapy HRG definitions and dataset to support them will have several benefits, including: promoting more robust recording of information Casemix specific information for use in performance management, service planning and national, regional and local benchmarking initiatives. more clinically meaningful activity base for cost comparison. Clearance: 18. The NSRC principles and acute services roll out time-scales have been approved by MS (H) following recommendations by the former Financial Issues Group (multidisciplinary) who were responsible for the co-ordination of the implementation of the financial aspects of the White Paper. This responsibility has now been passed to various constituent Groups such as the National Costing Strategy Group. As part of the process for reference costs a consultation exercise was undertaken with the NHS following ministerial approval. 1500 copies of the consultation document were issued and 150 (10% rate) responses were received. 19. The responses were supportive of the principles and processes being adopted; 74.5% of NHS Trusts and 85.7% of Health Authorities who responded were supportive. In addition, letters of support were received from the BMA, Unison, National Consumer Council and several Community Health Councils. Since this time, representations have continued to be received for widening the scope of reference costs, developing measures Page 5 of 9

that reflect changes in clinical practice and technological developments and support the NHS business agenda generally. 20. Discussions with representatives of ROCR confirmed that the original approval given in November 1997 covers the acute services included within this and previous notices. 21. Development of HRGs are supported by those needing to monitor performance against National Service Frameworks as this will start to allow performance to be monitored across a wider range of care which constitute a more rounded view of health care delivery. In addition, the NHS members of the National Costing Strategy Group, HFMA and Teaching Hospitals Trusts Finance Group have given support. 22. The NHS Information Authority (Population Health and Service Management Information Area of Work) also supports this development. 6. Conclusion: 23. This change mandates the collection of the list of Chemotherapy HRGs listed in Appendix 1. 24. This will allow casemix adjusted activity and cost data to be included in the NSRC, National Reference Cost Index and will be used to support the development of more sensitive efficiency measures. 25. Work will be undertaken to complete the development of chemotherapy treatments for leukaemia and myeloma HRGs and those will be the subject of a future change proposal. Page 6 of 9

Additional Information: For additional information on technical and developmental aspects of these HRGs please contact: Virginia Jordan Project Manager NHS Information Authority Population Health & Service Management Highcroft Romsey Road Winchester SO22 5DH Tel: 01962 810738 Fax: 01962 844711 Website: nww.casemix.nhsia.nhs.uk Or For additional information on costing and data collection aspects of these HRGs please contact: Anne Arnold or Paula Monteith FD-CSD Department of Health Quarry House Quarry Hill Leeds LS2 7UE Fax: 0113 254 5526 or 0113 254 4591 Tel: 0113 254 5491 Page 7 of 9

Appendix 1 Chemotherapy: HRG Labels (Version 3.1) HRG X01 X02 X03 X04 X05 X06 X07 X08 X09 X10 X11 X12 X13 X14 X15 X16 X17 X18 X19 X20 X21 X22 X23 X24 X25 X26 X27 X28 X29 X30 Description Breast Cancer Chemotherapy CMFs Breast Cancer Chemotherapy Anthracycline Breast Cancer Chemotherapy Vinorelbine Breast Cancer Chemotherapy Taxane Breast Cancer Chemotherapy Trastuzumab Breast Cancer Chemotherapy Other Colorectal Cancer Chemotherapy Fluorouracil Bolus Colorectal Cancer Chemotherapy Fluorouracil (48hr infusion) Colorectal Cancer Chemotherapy Fluorouracil continuous infusion Colorectal Cancer Chemotherapy Irinotecan Colorectal Cancer Chemotherapy Oxaliplatin Colorectal Cancer Chemotherapy Other Lung Small Cell Cancer Chemotherapy CAV Lung Small Cell Cancer Chemotherapy CAE Lung Small Cell Cancer Chemotherapy Platin based regimens Lung Small Cell Cancer Chemotherapy VICE Lung Small Cell Cancer Chemotherapy Other Lung Non Small Cell Cancer Chemotherapy MIC or MVP Lung Non Small Cell Cancer Chemotherapy Single Agent Vinorelbine Lung Non Small Cell Cancer Chemotherapy Single Agent Gemcitabine Lung Non Small Cell Cancer Chemotherapy Vinorelbine, Gemcitabine in combination Lung Non Small Cell Cancer Chemotherapy Docetaxel Lung Non Small Cell Cancer Chemotherapy Other Ovarian Cancer Chemotherapy Single Agent Carboplatin Ovarian Cancer Chemotherapy Paclitaxel Ovarian Cancer Chemotherapy Other Stomach Cancer Chemotherapy ECF Stomach Cancer Chemotherapy Other Oesophageal Cancer Chemotherapy Cisplatin and Fluorouracil Oesophageal Cancer Chemotherapy Other Page 8 of 9

X31 X32 X33 X34 X35 X36 X37 X38 X39 X40 X41 X42 Bladder Cancer Chemotherapy Platin based regimens Bladder Cancer Chemotherapy Other Testicular Cancer Chemotherapy BEP Testicular Cancer Chemotherapy POMBACE Testicular Cancer Chemotherapy Other Cervical Cancer Chemotherapy Platin based regimens Cervical Cancer Chemotherapy Other Non Hodgkins Lymphoma Cancer Chemotherapy CHOP Non Hodgkins Lymphoma Cancer Chemotherapy Other Hodgkins Disease Cancer Chemotherapy ABVD Hodgkins Disease Cancer Chemotherapy Other Other Solid Tumour Cancer Chemotherapy Special Notes 1. The Chemotherapy HRGs are identified by tumour site and will be assigned to each programme of chemotherapy. The HRG assigned will be based on the regimen prescribed for that programme. A programme can be made up of many cycles, the cycle being the pattern of drug administered for a single regimen. The HRGs will be assigned prospectively to that programme of treatment at cycle1,day1. 2. The Chemotherapy HRGs have received the endorsement of the National Costing Strategy Group, the Information Standards Board, the Management Information Standards Board, the Chemotherapy Clinical Working Group, and the Joint Collegiate Committee for Oncology. 3. Further details on Chemotherapy HRG assignment/costing requirements will be found in the Chemotherapy Definitions Manual (A Chemotherapy Definitions Manual will be posted to the NHS Information Authority, Casemix Programme website nww.casemix.nhsia.nhs.uk during May 2001 for downloading as a pdf file) and the 2001 Costing Guidance. Page 9 of 9