Healthcare delivery It’s important that Trusts pinpoint and


address these issues, so they can make sure they have the accurately coded data they need to hold effective negotiations with commissioners for work that is still covered by block contracts or to secure the income to which they are entitled under the reintroduction of payment for activity.


Incentives and drivers for change There is also that bigger picture on re- introducing direct incentives to deliver more work and support reform. In the short term, changes are likely to be limited. The reintroduction of activity-based payments for emergency and unplanned work would be a significant change that would need careful planning. It’s more likely that policy makers will look at the introduction of new incentives, perhaps rewarding Trusts for carrying out specific checks, tests or procedures, on something like the model of the quality and outcomes framework in GP surgeries. There could also be more experimentation with


payment for pathways. This is already being used to a limited degree. For example, there is a maternity pathway for which Trusts are paid for antenatal care, the delivery, and post-partum care. This could be extended to other areas, although it’s complex because it requires alignment across the NHS, from primary to secondary and sometimes tertiary or specialist services. From a data perspective, that’s challenging, because it requires accurately coded data at each point, with the ability to link activity across different services.


Paying for integrated, preventative care? The really big, long-term idea could be for local healthcare economies to receive a capitated budget to deliver wellness and health services for their entire population. This was one direction that sustainability and transformation


partnerships could have taken when they were introduced a decade ago. In principle, it would provide incentives for


integrated care systems to shift the focus of their attention away from performance managing Trusts and towards joining up services and focusing on prevention, to avoid expensive hospital trips and interventions whenever possible. However, it would be difficult to set up. As things stand, there are real questions about whether the system has the necessary data to profile populations and target interventions appropriately. When these questions come up, there tends to be a lot of focus on how IT systems can be integrated to generate the data required. There’s less focus on making sure that the data in those IT systems is of good quality. Yet accurate coding would be key to such a fundamental shift in the way that healthcare is organised and paid for, and it would require investment. Meanwhile, Trusts need accurately coded data for all sorts of reasons. Accurately


coded data allows them to monitor quality and mortality. It allows them to hold more effective negotiations with their commissioners. It also allows them to claim the income to


which they are entitled under activity-based payments, incentive schemes, or integrated pathways. Judging by the Darzi review and other, recent, policy discussions, more areas of activity are likely to be covered by these in the future, so accurately coded data will become even more important. If some of the big picture shifts on incentives and financial flows are enacted, it will be essential for everybody in the system to know who is being treated and for what. Accurate coding will be key to getting that right.


CSJ


About the author


Adrian Jones is the director for Maxwell Stanley at Clanwilliam UK. Maxwell Stanley is a leading clinical coding specialist in the NHS. Its solution undertakes a targeted and automated identification of individual admissions with potential coding errors and missed comorbidities that impact on performance metrics and income.


August 2025 I www.clinicalservicesjournal.com 53


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