Assessment
The assessment for this module is in two parts:
Part 1 (20%) How the money gets to provide care for patients
Part 2 (80%) The financial section of business case
Formative Assignment
Upload on will be on Turnitin.
The summative assignment should be presented as a rough outline of your report with examples of your workings and the theoretical concepts you will be drawing upon.
Ensure you ask for specific feedback.
Summative Assignment
Upload of both Part 1 and Part 2 assignments will be on Turnitin.
Ensure that you attach the following (which can be found at Assessment on the Moodle site)
1.Submission statement (see link)
2.A copy of your self-assessed learning – see link.The Student self-assessment sheet helps you assess your report according to the marking criteria and encourages you to think about what you learned from taking this module and how you intend to use this learning in the future
Please note:new University rules state that the word limit must not be exceeded.Please record the word count at the end of the assignment.
This module follows the principles of the University’s Assessment Compact, developed in conjunction with the Student Union, to ensure good practice and transparency in assessment and feedback processes, see: http://www.brookes.ac.uk/aske/BrookesACompact/. Assessment
Assignment – Part 1
Part 1 – 20% of overall assessment
Part 1 How the money gets to provide care for patients.
Present a report of 1000 words (or less) to show the steps by which the money to run your unit / department gets to you to provide care to the patient.Represent this as a flow diagram showing at each point the decision criteria for allocation of money, identifying conflicts of interest and funder expectations or requirements.(Note Diagrams are not included in the work-count.)
Ensure you
Capture all decision making levels from the national to the local (start at the highest level where the money is allocated and work down – eg the UK DoH, HK Hospital Authority, the dominant insurance carrier for the country where you practice, etc.) Note the type of finding at each level (we covered this in Lecture 1: private, public; insurance funds, etc and be sure to identify all sources of funding including payments by patients such as co-payment; Personal Health Plans: patient out of pocket expenses)
Show for each stage the decision-making process – eg how is the money allocated (by block, by patient, by population, by disease, by exceptional payments) and to whom (e.g. to commissioners, provider clusters, hospitals, departments, etc).
Discuss the decision processes that occur at each of these stages and the factors influence these decision.
Discuss the process the funder uses to ensure they get what they pay for e.g. contracts, service level agreements, central policy agreements.
Discuss how this impacts on your management decisions and ability to fund any changes in your service.
Criteria for assessment:
Demonstrates understanding of how funding decisions are made and what influences them;
Demonstrates understanding of how the social, political and macro/micro-economic environment affects funding decisions;
Sources of information are clearly identified;
Presentation is clear and communicates effectively
Assessment
Assignment – Part 2 Summative
Part 2 – 80% of overall assessment
There are two options for this assignment please select the option that best fits your own learning needs
Word count – 2500 (or less), please note
Appendices are NOT included in the word count
Detailed calculations, tables, figures, reference material and other back up data to show detailed workings are not included in the word count
Contents and title pages are not included in the word count
Option 1 – Financial section for a business case for an existing service area development / improvement
This option is suitable for students who are currently employed or have recent experience of service provision. Write the financial section of a business case for a new service within an existing service area or for a service improvement (e.g. expansion, new treatment) that you are familiar with. (2000 words).
In doing this you are exploring the financial and the commercial case for the business or service offering and identifying where you will get the funding for the venture and whether the proposal is worth the investment.
Critically analyse and explain the financial environment in which the service development/ improvement is to take place and clearly present your argument for the investment.(2500 words). Present your analysis in tables (not included in the word count) within your report drawing on the skills you are practicing in the seminar sessions.
Option 2. – Financial section for a business case for establishing / developing a service with private or insurance funding
This is an alternative option for the assignment for non-practicing and international students working in an insurance-driven market
Students intending to set up in private practice may submit a business plan, with emphasis on the financial pages.
Part 2 assessment criteria
Demonstrates ability to critically apply knowledge of policies and strategies and global developments in healthcare to the local situation.
Devises objectives and recommendations which are SMART and display some originality of thought.
Demonstrates ability to research, estimate, justify and present costs of options
Demonstrates ability to apply economic and financial theory to the calculation of costs and the evaluation of options.
Recognises and respects the different needs and expectations of various groups of people
Constructs a clear, coherent and well-structured argument
Shows clear development of knowledge and understanding, and an ability to reflect on one’s own strengths and areas for development (Student Self-assessment Sheet)
Uses an appropriate writing style and Harvard references, and presents work professionally.
Detailed calculations, figures, reference material and other back up data to show detailed workings
Assessment
Assignment – Part 2 Formative
Formative or Draft Assignment
You are invited to submit one early plan/outline of your proposed paper for formative feedback. This is not compulsory and does not contribute to your final mark. It is to enable you to outline your summative assignment and receive tutor feedback.
Evidence from previous experience suggests that students who submit formative draft assignments perform better with their summative assignment.
The outline should not exceed 1000 words.
There will also be a Q&A session at the end of each taught session to answer any queries and support the assignment. This is a whole group exercise; there are no individual assignment tutorials.
Assessment
Assignment Instructions and Guidance
The following are instructions and guidance for the completion of the Summative assignment which accounts for 90% of marks awarded.
The aim of this assignment is to consolidate your understanding and application of finance theory and practice to a workplace investment opportunity.
Instructions
Your assignment should be 3,500 words long (+/-10%), not including referencing. Use Harvard style referencing.
Attach a front sheet with your student number only. This assignment is marked blind – do not include your name or student number on the summative assignment.
Please include the following statement on the cover page of your assignment:
“I confirm that:
1) The material contained in this assignment is my own work. Where the work of others has
Been drawn upon (e.g. books, articles, unpublished papers, videos, audio recordings, electronic publications on disk or the internet) it has been properly acknowledged according to appropriate academic conventions.
2) I have read and understood the University’s statement on Plagiarism, Syndication and Cheating.
3) I have read and understood the Faculty’s statement on confidentiality and this assignment has been amended where necessary to comply with the Faculty’ requirements.”
What the assignment should cover?
The assignment is written as the financial section of the Business Case. The purpose of this document is to set out the
Strategic case – providing brief background and context; referring to the local situation, stakeholder requirements, policy documents impacting on the service and the supporting investment objectives for the service improvement / development.
Commercial case – outlining the current situation and key requirements for change; identifying the key financial considerations and projected earnings; activity and commissioner requirements, governance and/ or policy background (e.g. financial penalties for underperformance, lost revenue due to competition, etc) and quality considerations. It also covers the content and structure of the proposed project. This confirms funding arrangements and affordability and explains any impact on the balance sheet of the organisation; and
Economic case – demonstrating the choice for investment which best meets the existing and future needs of the service and optimises value for money (VFM). This demonstrates that the scheme is achievable and can be delivered successfully to cost, time and quality.
These areas of argument should be incorporated into a structured report. See Recommended Structure
You should use the appropriate tools used in this module to support your assessment of finanical option appraisal, feasibility and risk management.
Getting Started
Decide on your topic – Consider current national policy and guidance (e.g. NHS Mandate, NICE guidance and Quality Standards, Regulatory body (CQC or Monitor) requirements on your service, other national bodies’ e.g Royal Colleges requirements); and local policy and plans (commissioning plans, local profile data (JSNA), organisational performance issues).
With this information consider the need for improvements in the delivery of health and/or social care, and how you would develop a financial business case. You should consider your business case argument to focus around for ONE of the following:
1) To achieve service improvement through investment in your workplace, you may need to negotiate for funded developments or new ways of using existing funds. This could be for staffing, equipment, new services or buildings that you believe would contribute to service improvements.
2) To achieve service improvement through high impact innovation changes identifying investment opportunities to realise significant efficiency gains / savings.
3) To make revenue savings, without unduly compromising service quality, in the projected financial environment.
Choose something that interests you and that will be useful to you in your current position and will have an impact on your development as a manager.
Read around the subject. At Master’s level you should be using research articles as well as books, government publications, relevant policies, web sites and the press. Consider other sources of knowledge such as your practical experience, audits, and discussions with colleagues.
In addition you should be looking at where you can obtain cost / price information (reference costs, tariff, Personal Social Services Research Unit ( PSSRU) unit costs, budgets, etc) develop links where you can with financial management within your organisation
Organise your work. It is important that your report is presented in clear, logical and coherent way. Your report must:
be focused and well presented,
show how the financial and economic theory, knowledge and concepts apply to your argument and inform your decision making.
use illustrations to show relationships and market or economic dynamics
use tables and charts to communicate financial information clearly, effectively and efficiently
demonstrate links with current health policy, and
self-assess your learning. (refer to Marking Criteria)
General Presentation Guidelines
Ensure that pages of the report are numbered, your student number is on every page and that you have included the number of words at the end.
Please use 1.5 spacing and Arial font size of 11.
Any appendices should be numbered according to the order in which they appear in the text.
A copy of the completed self-assessment should be included as an appendix to the report.
Submit one copy of your Report in a professional manner.
The Executive Summary, Reference List, Appendices, Tables do not contribute to word count, nor the Student Self Assessment Sheet, which should be attached at the back of your submission.
Assessment
Recommended Structure
Suggested structure for the business case
Executive summary – maximum one side of A4.This is NOT an introduction; needs to say what the recommended option is, what it costs and its major benefits.It is NOT included in the word count
Contents page – NOT included in the word count
Introduction – This introduces the reader to the overarching purpose of the report and therefore needs to:
ogive brief facts about the situation (service provided, where, who, how many)
ostate the problem the proposal will address
osignpost the report
Strategic Context outline the business need, clearly identifying the contribution that will be made to the organisation’s business and why the service improvement / development is required now. This sets the situation in its context; you will be able to draw on any strategic plans and objectives for your organisations or its funders; relate the development to best practice across the world and to any stakeholder (analysis) needs you have identified.
Aim and Objectives State your overarching aim for the project highlighting the benefits to patients and organisation.An aim is a desired long-term outcome. Then specify you your objectives for the project (these are the detailed benefits and show how you will achieve your aim.
Options Appraisal where you are looking at the different options for taking your service improvement, development or business offering forward.You will be undertaking a cost benefit analysis of at least 3 options which will allow you to identify ‘soft’ benefits (those that are intangible and cannot be quantified in financial terms) as well as the financial costs and benefits. In this section you will aim to
oIdentify the different options for the new service, improvement or business offering (at least three, of which the status quo might be one)
oOutline the options (overview of service specification and key operational differences to indicate scale and scope)
oIdentify any trade-offs between options
oIdentify the non-financial benefits using your stakeholder analysis and other relevant information (policy or guidance papers, social trends / market research, etc)
oOption appraisal – minimum of 3 options: detailed financial breakdown (3rd March and other sessions are relevant); benefits analysis (28th April and other sessions are relevant);
oRisk and analysis
oSensitivity analysis.
Commercial Case. In this part of the report you are communicating the affordability of the proposal.
oConfirm how the chosen option will be funded or procured and how the payment mechanism will support the case you have outlined e.g. private patient money, PBR tariff, block contract, insurance policy payment
oHighlight any risks and contingencies explaining if and how they may be countered.
oIdentify your SMARTperformance measures e.g what indicators are important for you to monitor the success of the new service, improvement or business offering (e.g lag indicators (financial targets, revenue, costs, etc; and/or lead indicators (e.g. number of patients (activity), referrals, completed episodes, etc). This shows how the business success will be measured and when (links to SMART objectives)
Summary recommendations – Bullet points are OK but ensure you write SMART recommendations
Appendices are NOT included in the word count
Reading
Core Reading
Van Helden J and Hodges R (2015) Public Sector Accounting and budgeting for non-specialists. London: Palgrave
Bergman, A. (2009) Public Sector Financial Management. Harlowe: Pearson. (also available as e-book)
Guinness L and Wiseman V (Eds) (2011) Introduction to Health Economics. (2nd Edition) Maidenhead: Mc-Graw-Hill Education (available as e-book)
A useful text to develop your finance skills
Atrill P and McLaney E (2014) Management Accounting for Decision Makers. ( 6th or 7th edition) London Prentice Hall.
Indicative Reading
Funding of Health and Social Care
Appleby J, Galea A and Murray R (2014) The NHS productivity challenge. London: Kings Fund
Barker K (2014) A new settlement for health and social care. London: Kings Fund
Bohm K, Schmidb A, Gotze R, Landwehra, C and Rothgangc H (2013) Five types of OECD healthcare systems: Empirical results of a deductive classification. Health Policy 113: 258- 269
Buck D and Dixon A (2013) Improving the allocation of health resources in England: How to decide who gets what. London: Kings Fund
Galea A, Dixon A, Knox A and Wellings D (2013) How should we pay for health care in future? London: Kings Fund
Humphries R (2013) Paying for social care: Beyond Dilnot. London: The Kings Fund
Mathauer I & Wittenbecher F (2013) Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries. Bull World Health Organ 2013;91:746-756A
Ruth Robertson R, Gregory S and Jabbal J (2014) The social care and health systems of nine countries. Background paper. London: Kings Fund
Thomson S, Osborn R, Squires D and Jun M (2013) International Profiles of HealthCare Systems. London: The Commonwealth Institute
Tsiachristas A, Dikkers C, Boland MRS and Rutten-van Mölken MPMH (2013) Exploring payment schemes used to promote integratedchronic care in Europe Health Policy 113 296- 304
Mladovsky P, Srivastava D, Cylus J, Karanikolos M, Evetovits T, Thomson S, McKee M (2013) Health policy responses to the financial crisis in Europe. Copenhagen: World Health Organisation European Observatory on Health Systems and Policies
NHS England (2013) Fundamental Review of Allocations Policy -Annex C: Technical Guidance to Weighted Capitation Formula for Clinical Commissioning Groups, 2013 Accessed: http://www.england.nhs.uk/wp-content/uploads/2013/08/ann-c-tech-guid.pdf
Economic environment
Appleby J (2013) Spending on health and social care over the next 50 years: Why think long term? London: The Kings Fund
Hurst J and Williams S (2012) Can NHS hospitals do more with less? Research Report. London: Nuffield Trust
Mason A, Goddard M and Weatherly H (2014) Financial Mechanisms for Integrating Funds for Health and Social Care: An Evidence Review. CHE Research Paper 97. York: Centre for Health Economics
Morris, S (1998) Health Economics for Nurses: An introductory guide London: Prentice- Hall.
Mou∗H (2013) The political economy of the public-private mix in heath expenditure: An empirical review of thirteen OECD countries. Health Policy 113 270- 283
Sloman, J., Hinde, K., and Garratt, D. (2010), Economics for Business. (5th Ed). Harlow: Prentice Hall
Tambor,M∗, Pavlova M, Golinowska S, Sowada C, and Groot W (2013) The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these? Health Policy 113 284- 295
Weale A and Clark S.(2010) Co-payments in the NHS: an analysis of the normative arguments. Health Econ Policy Law. 5(2):225-46
Financial management
Bamber M and Parry S (2014) Accounting and Fiance for Managers: A Decision-Making Approach. London: Kogan Page
Bean, J. and Hussey, L. (1998) Managing the Devolved Budget: Essential skills for the Public Sector London HB Publications
Gruen, R. (2005) Financial Management in Health Services, Maidenhead: Open University Press. Accounting Standards Board (2007), Stewardship/Accountability as an Objective of Financial Reporting. June 2007, Accounting Standards Board, UK.
Brignall, S. and Modell, S. (2000), “An institutional perspective on performance measurement and management in the „new public sector‟”, Management Accounting Research, 11, pp.281-306.
Chang, L. (2007), “The NHS performance assessment framework as a balanced scorecard approach: limitations and implications”, International Journal of Public Sector Management, 20(2), pp.101-117.
Groot, T. and Budding, T. (2008), “New public management’s current issues and future prospects”, Financial Accountability & Management, 24(1), pp.1-13.
Business planning
Flin, N. (2007), Public Sector Management. London: Sage.
Foot C, Sonola L, Maybin J and Naylor C (2012) Service-line management: Can it improve quality and efficiency? London: Kings Fund
Ginter PM, Duncan WJ and Swayne LE (2013) The Strategic Management of Health Care Organizations. (7th Edition) Chichester: John Wiley & Sons
Monitor (2014) Facing the future: smaller acute providers. London: Monitor
Wheeler N, Grice D (2000) Management in Healthcare, Cheltenham: Stanley Thornes
Governance
Ansell C and Gash A (2008) Collaborative Governance in Theory and Practice J Public Adm Res Theory 18 (4): 543-571
Epstein MJ and Pritchard B (2000) Counting What Counts: Turning Corporate Accountability to Competitive Advantage. New York: Harper-Collins
Jakubowski E and Saltman RB (2013) The Changing National Role in Health System Governance. . Copenhagen: World Health Organisation European Observatory on Health Systems and Policies
NHS England (no date) Finance Governance Tool for Clinical Commissioning Groups. Accessed http://www.england.nhs.uk/wp-content/uploads/2012/09/fin-gov-tool.pdf
Shah A (2007) Local Public Financial Management. World Bank Publications
Economic Evaluation
Francis J and Byford D (2011) SCIE’s approach to economic evaluation in social care London: Social Care Institute for Excellence
Gray AM, Clarke PM Wolstenholme JL (2010) Applied Methods of Cost-effectiveness Analysis in Healthcare (Handbooks in Health Economic Evaluation) Oxford: Oxford University Press
Rumbold B, Alakeson V and Smith PC (2012) Rationing health care. Is it time to set out more clearly what is funded by the NHS? London: Nuffield Trust
Oberlander, J., Marmor, T. and Jacobs, L. (2001), “Rationing medical care: rhetoric and reality in the Oregon health plan”, Canadian Medical Association Journal, 164(11), pp.1583-1587.
Klein R and Maybin J (2012) Thinking about Rationing. London: The Kings Fund
Reading
Resources: Costs & Prices
Costs and Prices
The following resources can be accessed for information that is useful in developing your business cases, understanding the costs associated with activities and where relevant national prices paid by commissioning bodies.
NHS England Specific costs and prices
Monitor Approved costing guidance England (2015)
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/404708/Approved_costing_guidance_-_17_Feb_2015.pdf
Department of Health Group Manual for Accounts 2014-15: The final version of DH Group Manual for Accounts 2014-15 has been posted to the download section under the NHS Manual for Accounts 2014-15 section. (5 January 2015)
Reference costs can be accessed
https://www.gov.uk/government/collections/nhs-reference-costs#published-reference-costs
National tariff information can be accessed via
The consultation for 2016-17 proposals https://www.gov.uk/government/collections/201617-national-tariff-proposals
National tariff (2014-6): https://www.gov.uk/government/publications/national-tariff-payment-system-2014-to-2015
PSSRUUnit Costs of Health and Social Care compiled by Professor Lesley Curtis
http://www.pssru.ac.uk/project-information.php?id=354
Gov.UK Local service budgets for 2015 to 2016
https://www.gov.uk/government/collections/local-service-budgets-for-2015-to-2016
Department of Health (2012) Budget setting for NHS Continuing Healthcare
http://www.personalhealthbudgets.england.nhs.uk/_library/Resources/Personalhealthbudgets/Toolkit/HowPHBwork/SettingBudget/PHB_guide_Budget_setting_for_NHS_CHC_v2.pdf
Reading
Useful Web Resources
For Health Economics:
York University information resources in health economics:
http://www.york.ac.uk/inst/crd/econ.htm (Centre for Reviews and Dissemination)
http://www.york.ac.uk/res/herc / (Health Economics Resource Centre)
Oxford University Patient Reported Outcomes Measurement group established a number of important resources focussing on Patient-Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs)
http://phi.uhce.ox.ac.uk/newpubs.php
National Institute for Health and Care Excellence is a government body evaluating best practice and performing Health Technology Assessments of treatments for England
https://www.nice.org.uk/
Office of Health Economics conducts research and provides consultancy services on health economics and related policy issues that affect health care and the life sciences industries.
https://www.ohe.org/
For general finance
Chartered Institute of Management Accountants (CIMA) is a professional association which provides education and develops research into a wide range of areas affecting the global economy, different sectors and organisations
http://www.cimaglobal.com/
Healthcare Financial Management Association (HFMA) is a membership organization for healthcare finance leaders. It seeks to research and address gaps throughout the healthcare delivery system and bridges them through the establishment and sharing of knowledge and best practices.
https://www.hfma.org/
For the UK (England)*
National Audit Office investigates financial performance as part of governance.The NAO reports evaluate the value for money of public spending and recommend how public bodies, nationally and locally, can improve services.
https://www.nao.org.uk/search/type/report/sector/health-and-social-care
Monitor is the sector regulator for health services in England, Its role is to set the price of care (PbR tariffs) and monitor the financial health of organisations within the sector.
https://www.gov.uk/government/organisations/monitor
Kings Fund comments on health and social issues.John Appleby leads on commenting on the financial health of the UK (England) healthcare system
http://www.kingsfund.org.uk/topics/governance-and-regulation
For international comparisons:
www.oecd.org (Organisation for Economic Development and Cooperation)
www.who.int (World Health Organisation)
Additional useful reviewed resources may be found at:
Intute are the UK higher education, further education and skills sectors’ not-for-profit organisation for digital services and solutions.
www.intute.ac.uk/socialsciences (validated web-based resources)
*Scotland, Wales and Northern Ireland have devolved responsibility for health and social care and have different systems and processes for funding and governance.
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