Attributing the costs of health & social care Research & Development – Understanding AcoRD
description
Transcript of Attributing the costs of health & social care Research & Development – Understanding AcoRD
![Page 1: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/1.jpg)
1
Attributing the costs of health & socialcare Research & Development– Understanding AcoRDTrudi Simmons
Senior Manager – Research Finance & Programmes
![Page 2: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/2.jpg)
2
Intoduction
• Reasons for change• Implementation• Basic principles behind the guidance• The attribution process• Common problems in attributing
costs• Question and answer session
![Page 3: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/3.jpg)
3
Reasons for change
Primary reasons are:
• Improving the consistency of cost attribution; and
• Encouraging more consistent funding of the costs of research
![Page 4: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/4.jpg)
4
Implementation 1
• AcoRD agreed by England, Scotland, Wales & NI
• Draft documents shared with stakeholders across UK in advance of publication
• DH taken on board issues and concerns– Working Group looking at key issues around
implementation
![Page 5: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/5.jpg)
5
Implementation 2
• AcoRD published on the DH website in May 2012. Now on the Gov website at https://www.gov.uk/government/publications/guidance-on-attributing-the-costs-of-health-and-social-care-research
• Applies to new grant applications submitted after 1 October 2012
• AcoRD will not be applied retrospectively to studies funded before 1 October 2012
![Page 6: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/6.jpg)
6
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
![Page 7: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/7.jpg)
7
Main difference between AcoRD and ARCO
DH will meet some research costs for charity-funded research taking place in the NHS, where the research grant funder is a member of the AMRC
![Page 8: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/8.jpg)
8
Format of Guidance
Three sections
• 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)
![Page 9: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/9.jpg)
9
Annexes A and B
• The Exemplar lists and FAQs will be updated on a periodic basis in response to issues raised by users
• Must use most up-to-date FAQs• Revised versions of Annexes A and B
published in April 2013.
![Page 10: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/10.jpg)
10
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.
![Page 11: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/11.jpg)
11
The Categories of Costs
Three types of costs:
• Research costs
• Treatment costs
• NHS Service Support Costs
![Page 12: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/12.jpg)
12
Research Costs• Research Costs are the 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
• Research Costs are 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
![Page 13: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/13.jpg)
13
Treatment Costs• NHS Treatment Costs are the 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
• NHS Treatment Costs are met through the normal commissioning process (very exceptionally DH may make a contribution)
![Page 14: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/14.jpg)
14
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
![Page 15: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/15.jpg)
15
NHS Service Support Costs
• NHS Service Support Costs are 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
• NHS Service Support Costs are met from the R&D budget by the Health Departments of the United Kingdom
![Page 16: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/16.jpg)
16
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.”
![Page 17: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/17.jpg)
17
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 – See Annex A for examples
![Page 18: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/18.jpg)
18
Step 2 – NHS Patient Care Service
Activities Activity that is part of NHS Services must be split between:
– NHS Treatment Costs– NHS Support Costs
![Page 19: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/19.jpg)
19
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
![Page 20: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/20.jpg)
20
The attribution processStep 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’
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
The activity is a Treatment
Cost
The activity is a Service
Support Cost
Yes
NoYes
No
Is the funder an AMRC member?
Attribute Research activities between Part A and Part B
![Page 21: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/21.jpg)
21
Treatment Costs• NHS Treatment Costs are the 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
• For the purposes of the attribution process it can be assumed that an experimental intervention/service being tested will continue after the end of the study
![Page 22: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/22.jpg)
22
Treatment Costs cont’d• 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
![Page 23: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/23.jpg)
23
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
![Page 24: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/24.jpg)
24
Funding Part B Research activities• If funder is an AMRC member DH will meet
PART B costs – Activities numbered 16 via Research Capability funding
(RCF) – Activities numbered 15 and 17 via Networks– Activity number 14, Local trial and coordination, through
combination of Networks and RCF
• Non-AMRC funders to meet all the costs of Part B activities
![Page 25: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/25.jpg)
25
Pharmacy Costs
• Work is nearly complete to identify the attribution of specific activities within pharmacy
• But, attribution steps 1and 2 still apply
![Page 26: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/26.jpg)
26
Common issues• Attributing the costs of R&D is complex• 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?
• Remembering that Network support applies to research taking place in the NHS or in a NHS service provider
• Minimise costs through efficient study design• Seek appropriate advice before grant submission
![Page 27: Attributing the costs of health & social care Research & Development – Understanding AcoRD](https://reader035.fdocuments.in/reader035/viewer/2022070404/56813aef550346895da36234/html5/thumbnails/27.jpg)
27
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• Trying to use the commercial costing template
for a non-commercial study – a non-commercial attribution template is being developed
• Assuming that funding for NHS costs works in the same way as funding for research costs