Standard Costing Model pilot - Report on the findings of the ... - DOC by 7m4ysl36


									                                                Standard Cost Model - HPV

  NHS Information Centre for Health and Social Care
    Standard Cost Model - Data Collection Review

                    Review of:
  HPV Immunisation programme- Vaccine monitoring

                                June 2009

Information Standards team
NHS Health and Social Care Information Centre
Page 1
                                                         Standard Cost Model - HPV

   1. Standard Cost Model

In response to a request from the Cabinet Office Better Regulation Executive, the
Information Centre for health and social care (IC) has adopted the Standard Cost
Model (SCM) methodology as a way of measuring the burden imposed on the
NHS through the collection of centrally required data by the public sector.

   2. Introduction – Extract from the ROCR licence application

   2.1 – Extract from the ROCR licence application 208/008;

The collection of aggregated vaccine uptake data and vaccine usage by Primary
Care Trust (PCT) will allow The Department of Health (DH) and Health Protection
Agency (HPA) to:

1. Monitor vaccine uptake from an implementation perspective.
2. Evaluate the effectiveness of HPV vaccination against disease. A decline in
cervical cancers and pre-cancers is not expected to be seen for at least 10 years
after the start of the HPV vaccination programme for girls, because cervical
cancer cases do not peak until a woman’s late thirties. In the first years of the
programme therefore, national vaccine coverage will be compared alongside
HPV infection rates, incidence of the precursors of cervical cancer, and, if
appropriate, the incidence of warts.
3. Monitor vaccine supply, wastage and predicted usage.

The aggregated uptake data collected will also be of benefit to PCTs to help with
their local management and implementation of the programme.

The monthly collections will be used to monitor the number of girls vaccinated
and remaining vaccine supply to gauge vaccine requirements and to ensure the
programme is being implemented in a timely manner. Vaccine uptake will be
measured against a fixed denominator based on school rolls at the beginning of
the school year so will be regarded as provisional data that may be returned by
the PCT before the information is recorded on child health information systems

The annual return will give PCTs the opportunity to provide an accurate return
based on a revised denominator, recorded at the end of the school year. It is
expected that eventually all PCTs will extract this data electronically, once CHIS
systems have been fully adapted. This data will be published by the Department
in an ‘Annual Immunisation Statistics’ publication by the Information Centre and
will also be used to monitor performance in ‘Vital Signs’”

       2.2 Funding

Total funding for the routine, catch-up and accelerated catch-up programmes was
detailed in Prof. David Salisbury’s letter of 30th January 2009. This outlined a total
spend for the HPV programme at £42.3 million for year 2009/2010.
Information Standards team
NHS Health and Social Care Information Centre
Page 2
                                                          Standard Cost Model - HPV

   2.2 Background detail

    The majority of PCTs are using a School based programme, 95% of the
     person hours are spent at the PCT with the other 5% at GPs
    Cervarix (The HPV vaccine of choice for this programme) costs £85-£100
     per dose.

   3. Coverage

There is one ROCR approved data collection for HPV that this report covers:

ROCR/OR/0228                 HPV immunisation programme - vaccine monitoring
                             minimum dataset

   4. Approach

The exercise was undertaken across a sample of Primary Care Trusts (PCTs) we
issued two different questionnaires:

 1) To be completed by a manager in each organisation who had an overview of
the whole process and
2) To be completed by individuals involved in the collection

In addition to the questionnaires 2 PCT’s were visited.

Organisations were asked to provide burden and feed back on the whole end to
end process, including collecting, collating, validating and submission of data.
Some organisations did not provide data for all of these areas.

The overview questionnaire asked 3 main questions:

      Within your organisation what is the total time taken by colleagues in each
       occupational group to complete the data request for a typical month?

      What problems, if any, have you encountered when completing this data

      Have you any other feedback that you would like to give about this

Information Standards team
NHS Health and Social Care Information Centre
Page 3
                                                          Standard Cost Model - HPV

   5. Results

The following table illustrates the number of Trusts from which responses to the
questionnaires were received.

    Type of Trust             Number             Number of           % response
                             contacted           responses               rate

Acute Trusts                      0                   0                  0.0%
Mental Health Trusts              0                   0                  0.0%
PCTs                             20                   6                 30.0%
Ambulance Trust                   0                   0                  0.0%
Care Trust                        0                   0                  0.0%
Total                            20                   0                 30.0%

A number of staff groups are involved in the HPV collection. The proportions of
which are shown in the table below:

            Occupational Group                   Proportion %
Senior Manager                                       2.6%
Manager                                             11.6%
Clerical & Admin                                    44.7%
Healthcare Ass.                                      7.4%
Nurses                                              31.1%
Director                                             2.5%

Data from the participating organisations indicates that the end to end process
creates a significant burden. The data collected is extrapolated below to give a
total burden for all Organisations for one year.

                        Proportion %              Years
Collecting                       49.5%                     55.0
Collating                        23.1%                     25.6
Validate                         18.1%                     20.1
Input                             9.3%                     10.3
TOTAL                           100.0%                    111.1

    As collecting the data and the majority of the time spent collating the data
       is required for clinical control of the vaccination programme this is not part
       of the ROCR process. The ROCR burden is 30.4 years (3.1 days per
    The sponsor of the collection has questioned 70 PCT's and is suggesting a
       typical burden of 3 days per survey/organisation.
    This calculation does not take in to account any extra burden for the
       proposed catch up programme or proposed collection of vaccine supply
       data which the sponsor suggests will create an additional burden of 11.5
       days per survey/organisation (an additional 114 years in Total).

Information Standards team
NHS Health and Social Care Information Centre
Page 4
                                                       Standard Cost Model - HPV

6. Issues

In response to the question “What problems, if any, have you encountered when
completing this data request?” The following responses were received.

                                     Proportion of the 6
                                      Organisations %

Need to collect data from                  66.7%
different sources
Will need to wait for data that is         33.3%
available at different times
Available data does not match              16.7%
the data requested
Unclear questions / guidance               50.0%

7. Comments received during the review

    No CHIS system in place
    We use RiO and upload our own data of the vaccines given. This takes
      time as we have large sessions over 60 girls.
    I have one admin and my time as a team manager is often taken up to
      help load the information onto the system
    We have a CHIS system for half the county and this does lessen the time
      involved with data collection
    No CHIS System in PCT
    Newham PCT deployed CHIA (Child Health Interim Application) through
      CfH Programme for IT. HPV data collection is not part
    It is also necessary to look across both commissioning PCT and evolving
      provider service. This PCT is developing into a separate stand alone
    GP Practices late in submitting monthly returns so data submitted
    Questionnaire is open to different interpretations of what information is
    From the HPI website I can visually see what our %uptake is
    We use an Access database
    HPI system is ok to use
    Population number given by the education authority is wrong, missing
      about 200 pupils
    Process
           o Data is collected at the school session at pupil level on paper forms
           o Pupil data and vaccination detail entered on to a spreadsheet
           o Spreadsheet is summarised to give number of doses administered.
           o Doses administered is reconciled to stock movement then entered
              to the HPA system

Information Standards team
NHS Health and Social Care Information Centre
Page 5
                                                           Standard Cost Model - HPV

8. Resources used in carrying out this assessment

IC staff spent 25 hours on this review of the HPV collections. The time covered tasks
such as:

      Designing and issuing questionnaires
      Corresponding with Trusts
      Meetings and travel time
      Meeting with the sponsor
      Record keeping
      Report writing.

Trusts took approximately 15 minutes each to complete the questionnaire. The IC
met with colleagues from 2 Trusts each meeting was approximately 2 hours. Thanks
are due to colleagues at these Trusts for their time.

9. Summary & Recommendations

It was clear from the visits that the time spent collecting the data is essential for
clinical control. The 30.4 years spent on validating and inputting the data to populate
the dataset is a significant burden.
Recommend that the collection sponsor reassesses the time burden on Trusts in
November 2010 after the catch up programme has completed in September 2010
and that the ROCR licence should be reviewed at this time.

Information Standards team
NHS Health and Social Care Information Centre
Page 6

To top