combined costs collection: education and training …...combined costs collection: education and...

Combined costs collection: education and training costs collection guidance 2016/17 February 2017

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3 | Combined costs collection guidance: 3 Education and Training Costs Collection

Contents

Quick reference ........................................................................................................ 4

1. Overview ............................................................................................................... 9

2. Education and training guidance ........................................................................... 9

3. Data quality and validation .................................................................................. 11

4. Integrating education and training in reference costs .......................................... 14

5. Understanding the resources used and identifying the costs: proposed change to cost components ..................................................................................................... 27

6: Completing the costing templates ....................................................................... 33

7. Understanding the resources used and identifying the costs .............................. 40

8. Role of Health Education England support and service/ training split .................. 46

Annex A: Clarification of scope: updated for 2016/17 ............................................. 51

Annex B: Validations for education and training cost collection ............................... 53

Annex C. Sources of information ............................................................................ 63

Annex D: Best practice examples from provider visits ............................................. 64

Annex F: Programmes for collection in 2016/17 and years of study ........................ 68

Annex G. Lead employer scenarios ........................................................................ 74


Quick reference Best practice

To help all providers, particularly those with low confidence, we developed a number of best

practice examples which have been developed using feedback gained from visits by

Department of Health to providers following previous cost collections.

Links: Best_Practice

Clarification of scope

A scope of what is and what is not to be collected in the form of an alphabetic list can be

found at the following link.

Links: Clarification_of_scope

Clinical placement: what to include

When capturing the costs associated with the clinical placement it is important to distinguish

between activities that are seen part of the clinical placement and those that are non-

placement related.

Links: Identifying_what_to_include

Confidence ratings

These are seen by providers as an important lever when engaging with clinical colleagues

during the collection process. For this reason all providers will again be required to rate

confidence in their submission.

Links: Confidence_ratings

Cost components diagram

This diagram details the flow for all the cost components associated with the methodology

for collecting education and training (E&T) costs and shows the changes from 2015/16 to

2016/17.

Links: cost_component_diagram

Cost component mapping

This helps you to understand in more detail what activity and cost you must input into each

cost component, particularly following changes from 2015/16 to 2016/17.

Links: cost_component_what_to_include

CSV

This is a submission file created from your data input workbook and uploaded to UNIFY2.


For the Integrated cost collection you will need to create an E&T CSV. You can download

details of how to create a CSV from UNIFY2. Look for Technical guidance for workbooks.

DH eXchange

This was a Department of Health (DH) collaboration tool used for downloading documents

associated with previous cost collections. It was withdrawn as at 31/1/2017.

Director of finance signoff

The director of finance and the education lead are responsible for accurate completion of the

combined costs collection return. Details for signoff can be downloaded from UNIFY2. Look

for Overview of integrated reference costs and education and training collection guidance

2016/17

Five main steps

The five main steps you must take to understand the E&T resources you have used and the

costs involved.

Links: Five_main_steps

Frequently asked questions

These can be downloaded from UNIFY2. This document will be updated regularly so please

keep checking.

Health Education England (HEE)

HEE will support providers to develop their E&T submissions. Follow the link to find out how:

Links: Health_Education_England

Information sources

Ultimately the responsibility for identifying the education and training activity for the cost

collections resides with the providers. However, in verifying activity data providers are

encouraged to contact their relevant HEE local offices to access information.

Links: Information_sources

Lead employer

Where a provider acts as a lead employer and sends trainees to host providers, or host

providers receive trainees from lead employer providers, and there are no chargeback

arrangements to recover costs, follow this link.

Links: Lead_employer_arrangements

Mailbox

All queries regarding the Integrated costs collection should be addressed to

[email protected]. The [email protected] is no longer available.


Mandatory validations

A mandatory validation indicates that the data you have input needs correcting and you cannot

submit a CSV until it is resolved.

See Workbook – E&T section validations also.

Links: Mandatory_validations

Net off of E&T data

To understand the procedure required to reconcile your E&T data against reference costs as part of the Integrated costs collection please take the following link. Details can be found in the Combined costs collection: integrated reference costs and education and training collection guidance 2016/17.

Non-mandatory validations (NMVs)

A non-mandatory validation is not in itself an indication that data is incorrect but it

does indicate that data is outside expected boundaries and may be considered an

outlier.

See Workbook – E&T section validations also.

Links: Non_mandatory_validations

Non-mandatory validation (NMV) – report

For 2016/17, no central validations will be performed by the central team. In line

with this change in approach, no NMV report will be issued during the collection.

Overheads

We understand there are various approaches and methodology to overheads.

There is a guidance document for those who wish to look for instruction. It explains

how to identify and apportion the provider support costs associated with the

provision of education and training activity in NHS providers. This can be

downloaded from UNIFY2. If your costs prove to be high then refer to the overhead

references in the Combined costs collection: Integrated references costs and

education and training collection guidance 2016/17 which also can be downloaded

from UNIFY2.

Part-time working

The cohort years associated with the training programmes are designed to reflect

full-time courses. To understand how to record part-time activity and cost, please

follow this link.

Links: Part_time_working

Publication results from previous collections

Publication results for 2013/14, 2014/15 and 2015/16 can be downloaded from

UNIFY2.


Re-submission of data

Detailed procedures for resubmitting data are in the Technical guidance for

workbooks which can be downloaded from UNIFY2.

See also CSV, Director of finance sign off.

Service training splits

Determines what % of the salary cost and activity you submit is allocated to E&T

rather than service.

Links: service_training_splits

Submit data

Detailed procedures for submitting data are in Technical guidance for workbooks,

which can be downloaded from UNIFY2.

See also CSV, Re-submission of data, Director of finance sign off.

Training programmes

All the training programmes to be included for salaried and non-salaried for

2016/17 can be found through the link below.

Links: training_programmes

Training programmes – new for 2016/17

For details of the new training programmes for 2016/17 and those that are no

longer being collected, follow the link here.

Links: training_programmes_new

Templates – inputting data

How to input cost and activity data to the E&T templates in the integrated

workbook.

Links: template_data_inputting

Templates – updates for 2016/17

For details of changes to the E&T data input templates in the integrated workbook

use the link here.

Links: template_update

UNIFY2

This is an online collection system used for collating, sharing and reporting NHS

and social care data. It is ualso sed to collect E&T data, and the forums contain all

documentation relating to the collection. Details on user guidance for UNIFY2 can

be found in Technical guidance for workbooks.


Workbook – E&T section

Moving to an integrated costs collection meant the worksheets associated with the

E&T collection were incorporated into a combined workbook which also included

the reference costs collection worksheets.

Guidance can be found in Technical guidance for workbooks, which can be

downloaded from UNIFY2.

Workbook – E&T section validations

All validations associated with the E&T data input templates for both mandatory

and non-mandatory validations are in Technical guidance for workbooks which can

be downloaded from UNIFY2.

Links: validations_in_the_workbook

Workshops

HEE will continue to host local sessions to help providers prepare for the upcoming

collection exercise. Where possible these will include education and/or clinical

leads as well as finance.

Links: workshops

Year Zero

In the non-salaried data input template there will be an additional line Year ‘0 in

recognition of providers that find difficulties in disaggregating their non-salaried

costs on a year of study ie Nursing by years 1-3. Please note that this functionality

should only be used as an exception.

Links: year zero


1. Overview

Combined costs collection overview

Introduction, regulatory requirements and board approval

1. All organisations should refer to Combined costs collection: overview of integrated

reference costs and education and training collection guidance 2016/17 before

reading this guidance.

2. It contains information about how to complete the various elements of the collection

and highlights the governance, sign-off processes and timetable.

2. Education and training

guidance

Purpose of the combined costs collection

Background

3. To ensure that providers are reimbursed fairly for the training they deliver and are

empowered to get a better understanding of their spending in this area, the

Department of Health (DH) introduced transitional tariffs for non-medical placements

and undergraduate medical placements in secondary care from 1 April 2013. A

similar transitional tariff for postgraduate/medical trainees came into effect on 1 April

2014.

4. The annual E&T cost collection exercise, introduced in 2013/14, was established to

improve understanding of the costs of placements at provider level to support the

replacement of the current transitional tariffs with a more transparent set of tariffs that

reflect the actual costs of the placements.

5. In 2013/14 and 2014/15 the Department required all NHS providers to complete two

mandatory cost collections: the reference costs collection and the E&T costs

collection.

6. The reference costs collection covers the costs of delivering services in the NHS.

These costs are collected net of E&T income, and other income streams, and are

used to inform the national service tariff.


7. The E&T costs collection covers the costs of delivering education and training in the

NHS, and is used to support ongoing work to replace the current transitional tariff

applied to education and training tariffs.

8. Our aim, shared with the other national bodies, is to collect costs that accurately

reflect the cost of delivering service and education and training, to better inform

setting national tariffs. In 2015/16 there were two mandatory national cost collections,

the business as usual (BAU) reference costs collection and the integrated costs

collection.

9. The integrated costs collection consisted of the E&T costs collection alongside a

second reference costs collection in which the costs of E&T were netted off reference

costs services.

10. In 2016/17 we are bringing the two cost collections together into a single timetable

with a single governance process, the new collection will be called the 2016/17

combined costs collection (CCC).

How the data will be used

11. We will continue to analyse the data to understand the effects of netting off E&T costs

rather than income on:

supporting the development of new tariffs for education and training to replace

existing transitional tariffs

overall reference costs quantum, ie top level differences between income/cost

service level impact, ie which services lose and gain

currency level impact, ie change in unit costs

reference costs index, ie does the distribution change

the quality of E&T costs.

Education and training data – outcomes of 2015/16 collection

12. All 228 NHS providers within the scope of the collection exercise submitted a return

by the agreed deadline.

13. The 2015/16 E&T cost collection was the first time it had been part of the integrated

cost collection. The collection built on the progress of the previous collection with

signs of improvements to data quality.

Mandatory and non-mandatory validations were developed to reflect the results of

previous collections and discussions with stakeholders. Boundaries for some


validations were tightened or applied at a more granular level. This led to greater

consistency in costs at the programme level and makes the validations more

robust at the programme level.

Following the close of the collection window an initial review highlighted

organisations with the most outlier data and a number of providers resubmitted

data.

Across multiple categories there were fewer extreme values than in previous

years meaning that fewer providers submitted data significantly different from the

national average.

The education cost index, which is used to compare the costs of providing

placements at different providers, shows more than 60% of providers were within

15 points of the national average (2014/15 = 54.3%). This indicates that there is

less variation in costs from the index reported between providers. There were also

fewer providers in the extreme tails of the distribution (providers with either very

high or very low costs)

14. The continued collection of the data at this level of granularity is necessary to enable

HEE to establish currencies that are realistic and appropriate for payment. HEE is

currently working on the outcomes of the 2015/16 exercise to inform future currency

design.

3. Data quality and validation 15. Accurate cost and activity data remains important as we look to further understand

the time and resources associated with providing education and training placements

and to inform future education and training tariffs.

16. This section provides an overview of the expectations for the cost collection including

the responsibility and the validations that will be performed on the cost data during

the collection window to improve quality.

Combined costs collection: collating and submitting data

17. The responsibility for completing the combined costs collection should not fall solely

on finance teams. Previous exercises have found that the most successful

submissions came from providers where there were strong working relationships

between finance, training, informatics and clinical teams. Collating and submitting the

data as part of this collection is a local decision.


18. The CCC in 2016/17 will again require providers to net off 2016/17 education and

training costs from 2016/17 reference costs; the same process as the 2015/16

Integrated Collection.

19. We require providers to net off the education and training costs as accurately as possible

and not a straight line apportionment, We appreciate different providers will be at different

stages in their costing journey, but require providers to net off the education and training

costs from reference costs at the lowest level possible. We understand this may mean

working outside the costing system. A proposed methodology developed by NHS trusts for

the netting off education and training costs is included within Combined costs collection:

integrated reference costs and education and training collection guidance 2016/17.

20. The proposed methodology is consistent with the process for 2015/16 and will be

available within Unify2.

Education and training template

21. Following feedback on the 2015/16 process, NHS Improvement consulted (in the

draft guidance issued in December 2016) on proposed changes to the number of

costs components used to collect data as part of the E&T element of the combined

costs collection. Most of the feedback received on the proposal to reduce the number

of cost components was in favour of the new approach. For further details see

Section 5 of this guidance and the associated excel mapping document.

22. The aim of the mandatory and non-mandatory validations in the collection is to

reduce ambiguities and improve the quality of the data submissions while also

flagging errors that require mandatory validation in submissions.

23. A non-mandatory validation is not in itself an indication that the data is incorrect;

there are many valid reasons why data may not pass a non-mandatory validation.

These are ‘flags’ for providers that their data has fallen outside certain boundaries, or

is out-lying in a certain category. The validations are non-mandatory because there

may be valid reasons why the information falls outside the boundaries; however as

part of the submission process NHS Improvement asks providers to consider the

accuracy of the data being submitted.

24. See Section 1 of Combined costs collection: overview of integrated reference costs and

education and training collection guidance 2016/17 for details for the resubmission of data

for the 2016/17 cost collections.

25. To enhance the existing validation process, NHS Improvement have increased the

number of non-mandatory provider specific validations in the salaried and non-

salaried templates, alongside the mandatory validations.


26. NHS Improvement have introduced this enhanced functionality within the templates

to lessen the burden on providers during the submission period and enable them to

see real-time validation against their data. For 2016/17, no central validations will be

performed by the central team. In line with this change in approach, no NMV report

will be issued during the collection as all non-mandatory validations will be available

in the template. Only in exceptional circumstances will the central team contact

organisations during the collection.

27. We are also making the following specific changes to the template/validations;

summary sheet to include a validation ensuring 2015/16 activity and cost data is

not resubmitted (a tolerance of 2.5% has been applied)

additional mandatory validations:

o to ensure the minimum cost submitted per hour is not less than £1

o 0% overheads are not submitted

all non-mandatory provider specific validations are now performed within the

workbook including additional validations:

o comparison with 2015/16 submitted course activity

o pre-populated service/training split column

removal of the following provider specific non-mandatory validations:

o duplicate costs

o market share

o service-training splits

o significant % activity

removal of the following non mandatory validations following change in approach:

o entering activity so you must enter both cost components 11 and 12

o entering a proportion of time in training greater than 100%

inclusion of ‘Year 0’ (zero) within non-salaried template for providers that cannot

disaggregate year of study costs within programmes

change in lead employer validations as a result of cost component changes.

28. In proposing the changes as highlighted above NHS Improvement have considered

the burden placed on providers when they are asked to clear non-mandatory flagged

data. It is hoped that reducing the number of validations and refining specific


elements of the validation process specifically to include all non-mandatory

validations within the workbook will lead to improvements while not affecting data

quality.

29. Further information on validations that will be used in the submission of activity and

data can be found in Section 6 and Annex B of this guidance. Any changes to

functionality or additions will be communicated before the collection.

30. For 2016/17 NHS Improvement will again ask providers to feedback on specific areas

within their data submission where they have encountered issues or their data has

been flagged via the non-mandatory validation review form. This is so that we can

check we have reviewed all non-mandatory validations. Without such a process it is

impossible for us to distinguish between providers that have reviewed and opted not

to resubmit and those that have been unable to review. The form will be made

available on UNIFY 2 before the start of the cost collection.

4. Integrating education and

training in reference costs

Scope for collection of education and training

31. The education and training cost collection aims to capture the actual costs to an NHS

provider of students and trainees on a clinical placement at their organisation as part

of a training programme, where this:

is a recognised part of the education/training curriculum for the course and

approved by the higher education (HE) institute and the relevant regulatory body,

as appropriate

has the appropriate clinical and mentoring support as defined by the relevant

regulatory body

is done during the 2016/17 financial year. Please note that the data is requested

by financial year and not academic year to reflect how these placements are

funded.

32. The following organisation types are excluded from the scope of the 2016/17

collection exercise:

NHS ambulance trusts

independent sector providers


social enterprises

GP practices.

33. The success of the exercise depends on the production of cost calculations which are

underpinned by robust activity information. This can only be achieved by involving

both finance and education teams in the process and we would encourage providers

who have not already established these links internally, to do this at their earliest

opportunity.

34. To support those having difficulty securing engagement and buy-in we have

developed a checklist (bulleted below) based on discussions with those who have

developed local systems to interact with clinical and education leads. We would

encourage providers where appropriate to use the checklist below as a start point in

discussions with education and clinical leads:

Set a timetable for the cost collection exercise.

Identify the key contacts as early as possible.

Use information provided by DH to inform discussions and review previous

submissions; ie dashboards, publication data, questionnaires.

Share guidance as early as possible, making them aware of any changes that

may affect them.

Arrange meetings to understand how or why the costs reflect or do not reflect their

experience of the number of placements offered in-year.

Look at the previous year’s return, this will provide opportunity for questions.

Set up systems for the collection of information during the year, such as for

tracking the number of student and student weeks.

Engage with HE institutions for detailed student data to benchmark and validated

local records.

Involve librarians, where possible, to provide library activity by student group to

feed into costing.

35. Those with lead responsibility for co-ordinating collection of responses from clinical

managers should make these contacts well before the actual cost collection exercise.

36. Annex D includes best practice examples developed using feedback gained from DH

visits to providers following previous cost collection exercises and build on areas

included in previous guidance.


37. The examples are not prescriptive: they are a guide for providers in collating their

costs and activity. We will share more examples of best practice as they become

available but we also encourage providers to use local networks to share best

practice and resources where available and appropriate.

38. Please note that the scope of the exercise is intentionally been set wider than the

existing coverage of the E&T tariffs. Working with HEE and key stakeholders we have

identified extra training programmes or changes to existing programmes that will be

added/amended for 2016/17:

salaried programmes added:

o Psychotherapists Years 1 – 5 (this now has its own category, Psychotherapy,

in the salaried data input template)

o Dental Technician Years 1 – 3 (this can be found under Dentistry in the

salaried data input template)

salaried programmes removed:

o Healthcare Scientist Pre-MSC has been removed following feedback.

39. To ensure that we can understand the true costs to a NHS provider of all clinical

placements done at their organisation and in scope of the exercise, the collection

requires the return of the actual cost, irrespective of the existing funding route or

income received.

40. The exception to this approach is where a salaried member of staff is seconded onto

a training course that does not attract a salary, eg a healthcare assistant onto a

nursing course. These instances should be recorded on the non-salaried sheet,

excluding the salary costs because the exercise is only capturing the cost of the

clinical placements they undertake while training as a nurse.

Areas for clarification

41. Annex A includes examples of some of the training programmes and trainee types on

which organisations have requested clarification as to what is included and excluded

from the scope of the collection.

42. The information has been updated for 2016/17 in line with feedback. We will continue

to update the list to reflect any other areas of clarification. The updated annex will be

shared on UNIFY 2 during the course of the collection as appropriate.

43. For 2016/17 changes have been made to the following areas of scope:

Bursary funding: excluded


Catering: excluded

Clinical Exercise Physiology: excluded

MRC Psychiatry: included

Nurse – Apprenticeships, traineeships and Cadet schemes: excluded

Sonographer/Ultrasound technologist/PG Ultrasound: excluded

Psychotherapy: included

Dental Technicians: included.

44. Please note that these lists are not exhaustive. If you still have a query regarding the

scope of the collection, then please direct these to the [email protected]

mailbox.

Identifying what to include as a clinical placement

45. When capturing costs associated with a clinical placement it is important to

distinguish between activities that are part of the clinical placement and those that are

not. The hours spent on activities not related to the clinical placement should be

excluded.

46. The location where the activities are delivered will help in determining what is part of

the placement, but this will not apply in all cases as education providers can deliver

their responsibilities from within NHS facilities.

47. There will also be instances where students come to an organisation on clinical

placement for a set number of weeks, but within those weeks they may have time

allocated to their non-clinical placement activities. If this is the case then it should be

reflected in the recording of the average number of hours for the placement.

Cost of providing additional education activities outside clinical

placements

48. Any costs incurred by your organisation delivering activities related to education that

are outside what is required for clinical placements are outside the scope of the cost

collection exercise. They are often covered as part of the interdependent relationship

with the local HE institution.

49. These activities could include, but are not limited to:

direct teaching in the forms of lectures, seminars, tutorials, etc, on behalf of the

HE institution or other education partners

mailto:[email protected]


formal positions within an HE institution, eg assistant/sub-dean

hosting academic examinations on behalf of the HE institution or other education

partners.

Note: This would include the costs of all cost components – staff costs, facilities,

administration, etc.

50. Although these costs are not those incurred as part of a clinical placement, it may be

beneficial to your organisation if you are able to identify them so that you can build up

a picture of the total resources your organisation commits to the delivery of education

and training and ensure that appropriate agreements are in place for their delivery.

51. Section 7 includes further information relating to a suggested reconciliation process

for the collection exercise. This reconciliation compares the income received against

the costs and looks to identify potential reasons for any variances. The costs of

providing extra education activities outside clinical placements would be one of the

potential reconciliation items to include in this list.

Training programmes

52. The E&T cost collection does not cover all types of training programmes in NHS

providers. In broad terms, it includes are those that are a recognised part of the

education/training curriculum for the course and approved by the HE institution and

the relevant regulatory body. To clarify, the data submitted should be the activity and

costs associated with clinical placements within acute secondary care which are

associated with the training programmes detailed in Annex F.

53. The education and training data required is consistent with the reference costs data

required and will cover the period from 1 April 2016 to 31 March 2017.

54. We are aware that the local labelling of some training programmes may differ from

nationally recognised courses. Where this is the case we ask that the locally defined

training programmes are mapped to the national programmes. If you are unsure

where a particular programme should map to, contact the team

([email protected])to ensure consistent interpretation.

55. For costing the clinical placements, training programmes have been categorised as

non-salaried and salaried training. For further details see below.

Non-salaried

56. Non-salaried training programmes include programmes where it is assumed that the

students spend 100% of their time learning while on clinical placement, and no time

delivering service. These students are not paid a salary by the provider. The costs of

the placement are met by HEE (via local offices), or by the provider directly.


57. There are occasions where an organisation may pay staff on behalf of HEE, with

HEE reimbursing the provider (for example, student midwives in some organisations).

In these instances the individuals should still be classed as non-salaried students and

their salary costs should not be included in the exercise.

58. Where a salaried member of staff is seconded onto a training course that does not

attract a salary, eg a healthcare assistant onto a nursing course, this should be

recorded on the non-salaried sheet, excluding the salary costs. This is because the

exercise is only capturing the cost of the clinical placements they undertake while

training as a nurse.

59. The structure of the templates intentionally does not capture the costs of salary

support, which is outside the scope of this exercise. We are however aware that

some providers may have reflected these costs within other cost components due to

concerns around future funding. We would ask that this is not repeated in 2016/17

and costs are apportioned within the new cost component structure to ensure

consistency and to also support the central team in undertaking comparisons.

60. A change for 2016/17 in response to feedback will see the introduction of a ‘Year

Zero’ line added to the non-salaried input sheet. NHS Improvement is including this

line in recognition of Providers who find difficulties in disaggregating their non-

salaried costs on a year of study ie Nursing by years 1-3. Please note, that this

functionality should only be used as an exception, where Providers are able to

disaggregate their costs by year, the template will still include the functionality to do

so and we would encourage Providers to continue to provide this level of detail.

Image 1 below provides an overview of how this will appear within the workbook.

Image 1: Non salaried template showing year zero (highlighted in green for ease of reference)

61. The quantum of costs associated with locally funded posts should be captured as

part of your high level reconciliation (Section 7), which allows a comparison of the

current income against the costs being reported.

62. There are currently 48 non-salaried programmes listed in the non-salaried collection

template. These are split across eight training categories as follows:

Medical

Dental (Professions Complimentary to Dentistry (PCD)

Undergraduate Dentistry

Allied health professionals

Nursing and midwifery

Pharmacy

Practitioner Training Programmes (HCS)

Operating Department Practitioners.

Salaried

63. The salaried training programmes are for individuals paid a salary by the provider,

and referred to as ‘trainees’ rather than ‘students’. The trainees split their time at the

provider between education and training, and delivering services to patients.

64. The exact nature of this split will vary depending on the organisation involved, as well

as the profession. The proportion of time spent on education and training is also likely

to change as a trainee progresses through a training programme.

65. HEE (via local offices) pays for the cost of training these individuals, and also makes

a contribution towards their salary, depending on the amount of time spent on

education and training.

66. In 2016/17 NHS Improvement and Health Education England have introduced a

change for the collection of service/training split activity. See Section 8 for more

details.

67. A total of 132 salaried programmes are split across the following 16 training

categories:

Acute Care

Dentistry (salaried to include Dental Nurse)

Healthcare Scientists

General Practice VTS


Improving Access to Psychological Therapies (IAPT)

Medical (salaried)

Obstetrics & Gynaecology

Ophthalmology

Pathology

Paediatrics

Pharmacy

Psychiatry

Psychology

Psychotherapy (added for 2016/17)

Radiology

Surgery.

68. The number of salaried programmes we will look to collect against has increased to

132 (from 131) and 16 (from 15) training categories. The additions are:

Training categories

Psychotherapy

Training programmes

Psychotherapists Years 1–5 (this has its own category, Psychotherapy, in

the salaried data input template)

Dental Technician Years 1–3 (this can be found under Dentistry in the

salaried data input template)

69. We have removed Healthcare Scientist Pre-MSC for 2016/17 and will not collect

against this programme in 2016/17.

Part-time working

70. The cohort years associated with the training programmes are designed to reflect full-

time courses. We ask that when providers are capturing part-time activity that falls

into the 2016/17 financial year, this is recorded based on the current stage and

content of the course, rather than the current year of the student.


71. This approach to capturing the costs will enable meaningful comparison with full-time

courses and support the calculation of the true costs of delivering training

programmes for each of the cohort years.

72. For two-year courses delivered on a part-time basis over three years, we propose

that the time is allocated split into 18-month periods.

73. Below is an example of how we would request that you capture the data for part time

courses where the costs fall into the 2016/17 financial year and these are delivered

over longer timeframes than the standard course.

Table 1: Example: how to record part-time activity

Standard course length if full-time

Part-time course length

Full time

Template Year 1

Template Year 2

Template Year 3

1 year course delivered part-time over 2 years

RECORD all (p/t years 1 or 2) where costs and activity fall into 2016-17 financial year

n/a n/a


RECORD all (p/t years 1,2 or 3) where costs and activity fall into 2016-17 financial year

n/a n/a

2 year course delivered part-time over 3 years i.e. Year 1 over 18 months Year 2 over 18 months

RECORD (18 month period) where costs and activity fall into 2015-16 financial year

RECORD (18 month period) where costs and activity fall into 2016-17 financial year

n/a


RECORD (p/t year 1) where costs and activity fall into 2016-17 financial year

RECORD (p/t year 2 or 3) where costs and activity fall into 2016-17 financial year

RECORD (p/t year 4 or 5) where costs and activity fall into 2016-17 financial year

74. We are aware of examples where providers cannot identify the relevant year of the

course from the information available and therefore cannot apply the approach set

out above. Where this is the case we would ask that those responsible for completing

the exercise record this information in the final year of the course.

75. If having read the guidance above, you are still unable to identify where to record

your costs within the template, please direct queries to the


[email protected], including as much detail as possible relating to your

query.

Lead employer arrangements

Host provider

76. Where a lead employer chargeback arrangement exists between NHS providers, we

ask that all the costs and activity incurred by the host provider are included in the

submission. This approach is consistent with last year and requires the inclusion of all

costs within the appropriate cost components.

77. Where chargeback arrangements do not exist, all NHS providers should include

activity and costs incurred as appropriate depending on whether you are a host

provider or a lead employer. This will enable NHS providers to reconcile activity and

costs and also provides the NHS Improvement and HEE with details of local lead

employer arrangements.

78. Please be aware that as previously highlighted, the proposed changes to the number

of cost components which providers are asked to report against has changed for

2016/17. The lead employer guidance has been updated to reflect these changes to

ensure that the requested information is still collected as part of the collection.

79. In the following sections we have looked to clarify a number of frequently asked

questions received in respect of Lead Employer activity. These sections also provide

an overview of the data which is required where Lead Employer arrangements exist.

Within Annex G of this document we have included a number of examples of

potential scenarios which Providers may face when inputting their Lead Employer

data

What is a lead employer provider?

80. The lead employer provider is responsible for the recruitment and employment of

specialty doctors in training for the duration of their training programme which may

vary depending on specialty. Trainees will rotate around host providers in the lead

employer geographical area or wider as appropriate to their training needs.

81. The lead employer will have their own human resources, payroll and recharge teams

to administer the trainees employment contract.

What is a host provider?

82. A host provider receives junior doctors from lead employer organisations to provide

specialty training to the trainees while they are undertaking their placements.


What is meant by recharge?

83. Where host providers receive junior doctors from lead employer organisations,

depending on the arrangements agreed the lead employer may invoice the host

provider for reimbursement of costs associated with the trainee such as salary.

What is unit cost and how is this affected by lead employer/host provider?

84. The actual unit cost (including salary) for the integrated collection is calculated by

dividing the cost of training activity by the number of related training hours. This is

expressed as full time equivalent (FTE) per hour. This is calculated at column AA in

the input salaried template of the 2016/17 integrated workbook. Please go to Image 2

for more details showing where the template calculates unit cost.

85. We are aware that difficulties may arise when the training activity and the associated

salaried cost become separated, ie the activity of training resides in one provider, and

the salary in another. Often the reason for this is a lead employer with no recharge

arrangements.

86. Lead employers could have salaries and no associated FTE activity, or host providers

have host FTEs and no associated salaries, inflating or deflating your training

programme’s actual unit cost.

87. The input salaried template for this year allows you to take account of lead

employer/provider host activity in columns AC – AE. Please refer to Annex G for

examples on how to fill in the input salaried template for typical lead employer/host

provider scenarios.

88. Please note: Where you have lead employer/host provider activity and do have

recharge arrangements, this will be treated as normal input and there is no need to fill

in columns AC–AE.

89. The input salaried template calculates the actual unit cost in column Y, but where

there are lead employer/host provider input t the unit cost can become inflated or

deflated. When columns AC–AE are filled in the template can now give you a truer

cost of training by adjusting the unit cost calculated in column Z. Please go to Image

2 below for more details.

Image 2: Overview of unit cost calculation columns and lead/host provider input columns

When Host trust activity or Lead Trust activity/cost is

entered into columns AC – AE, it can artificially lower or inflate the actual cost per

hour in column Y. Therefore this calculation adjusts the

Host or Lead employer input to give you the true cost per

hour of training

If you have any Host FTEs and no recharge arrangements you will enter the number

here

If you have Lead Employer FTEs and have no recharge

arrangements you will enter the number here

If you have entered Lead Employer FTEs in column AD then you must enter the salary associated with them

here

This will calculate the FTE cost per hour including

salary as per what is actually inputted into the template whether this is

artificially inflated or deflated by Lead employer

arrangements

5. Understanding the resources

used and identifying the costs:

proposed change to cost

components 90. Provider feedback in response to the most recent cost collection exercise suggested

that there are still difficulties in reporting information at the required level of

granularity. It also highlighted the significant administrative burden of allocating the

costs to the components.

Reasons for these difficulties included:

the level of subjectivity in determining what should be captured in each

component

the potential overlap and duplication between some of the components

difficulties at some NHS providers engaging with clinicians and educational leads

to appropriately allocate costs

processes and records not in place locally to adequately record costs at the

required level, ie questionnaires/templates

trainees having different requirements and the teaching scheme being delivered

differently

a lack of control data in HEE local teams, ie learning development agreement

granularity

the requirement for more emphasis to be placed on job plans to split costs of

direct teaching, central education and clinical time.

91. DH analysis supports that feedback from NHS providers. It shows that a number of

NHS providers have simply profiled costs equally across cost components in previous

collections or opted to use a limited number of cost components.

92. As part of the draft guidance released in December 2016, NHS Improvement, in line

with the feedback, proposed to reduce the number of cost components providers

would be asked to report against largely in order to reduce the burden on providers

when collecting, collating and submitting data.


93. As a result, for 2016/17 NHS Improvement will ask providers to report against a

reduced number of components. The new approach will see cost components 1, 5, 6,

7a and 7b combined to create one component named ‘Combined Central Education

Costs’ splitting the component into CC1a – Pay costs and CC1b – Non-pay costs.

The following components remain the same as 2015/16:

Direct Teaching Costs

Cost of teaching staff time spent on training courses

Cost of staff teaching while delivering patient care

Overheads (Please refer to Combined costs collection: integrated reference costs

and education and training collection guidance 2016/17)

Cost of checking a trainee’s work

Course fees and expenses

Total trainee staff cost

Proportion of trainee time in training (now includes a pre-populated column).

94. Images 3 and 4 show how the proposed changes to the cost components will be

implemented in the non-salaried and salaried templates.

95. Image 5 gives a pictorial summary of the various cost components to be reported

under the new approach mapped against the 2015/16 requirements. This image

should also be referenced when completing the 5-step reconciliation process in

Section 7.

96. Under the new approach some providers would see the following benefits :

reduced number of components

combining areas of difficulty identified within components reduces the difficulty

some providers have in apportioning costs

lessens the burden on providers with reduction in components

pay and non-pay split enables providers to identify split of costs

cost of teaching is still collected in the same way to enable analysis

reduction in subjectivity and overlap

less resource/time required for collection of costs.


97. Please see the two Excel Workbooks which provide a mapping of the previous cost

component structure to the new approach for 2016/17.

https://improvement.nhs.uk/resources/approved-costing-guidance/

Image 3: Salaried template: cost component changes

02a_Input – Salaried template in the Combined Costs Collection workbook

This 2016-17 cost component incorporates all elements of last year’s cost components 1, 5, 6, 7a and 7b. These will be separated out into Pay and Non-Pay elements. Please take the following link to a table detailing what is to be input into the PAY column and what is to be input into the Non-PAY column (link)

The cost components 2, 3 and 4 detailed here are exactly as in last year’s collection with the same numbering. Cost component 5 detailed here for Overheads is exactly as last year’s cost component 8 for Overheads. For a detailed table of what to input in these cost components, please take the following link (link)

The cost components 6, 7 and 8 detailed here are exactly as in last year’s collection for cost components 9, 10 and 11 respectively. For a detailed table of what to input into these cost components, please take the following link (link)

This cost component detailed here for service training split is exactly as in last year’s collection for cost component 12. Except for this year this component will be pre-populated with a HEE / Deanery approved value.


Image 4 Non-salaried template – cost component changes

02b_Input – Non-salaried template in the combined costs collection workbook

This 2016/17 cost component incorporates all elements of last year’s cost components 1, 5, 6, 7a and 7b. These will be separated out into Pay and Non-Pay elements. Please take the following link to a table detailing what is to be input into the PAY column and what is to be input into the Non-PAY column (link)

The cost components 2, 3 and 4 detailed here are exactly as in last year’s collection with the same numbering. Cost component 5 detailed here for Overheads is exactly as last year’s cost component 8 for Overheads. For a detailed table of what to input in these cost components, please take the following link (link)

Image 5 Cost component changes to methodology

Co

st o

f C

oh

ort

(£

) =

sum

of

com

po

ne

nts

00

1 –

00

5

001: Pre-placement costs (£)

005: Facilities cost (£)

006: Administration cost (£)

007a: Central Education cost (£)

007b: Placement exams/assessments (£)

001a: Combined Central Education

costs

PAY

2015-16

Time staff spend on pre-placement activities plus associated expenses

The facilities which are used for all the student/trainee activities identified

Time spent by administrator on the programme

Proportion of staff costs for Education Directorate activities (%)

Time and associated expenses which staff spend in respect of exams and assessments

Staff Cost (£)

Non pay cost (£)

Staff Cost (£)

Staff Cost (£)

Staff Cost (£)

Staff Cost (£)

Travel &

subsistence (£)

002: Direct teaching staff costs (£)

003: Cost of teaching staff time spent on training courses (£)

004: Cost of staff teaching while delivering patient care (£)

002: Direct teaching staff costs (£)

003: Cost of teaching staff time spent on training courses (£)

004: Cost of staff teaching while

delivering patient care (£)

Salaried training programmes

008: Overheads cost (£) 005: Overheads cost

(£)

Time staff spent on performing direct teaching

Staff Cost (£)

Staff time spent on training courses for student/trainee teaching

Staff Cost (£)

Course costs (£)

Staff time spent teaching while delivering patient care

Staff Cost (£)

009: Cost of checking trainee’s work (£)

010: Cost of trainees attending courses or examinations (£)

t of teaching staff time spent on training courses

(£)

Cost components 001 to 008

011: Total trainee staff cost (£)

012: Proportion of trainee time in training (%)

2015-16 2016-17

Cost components 001 - 005

006: Cost of checking trainee’s work (£)

007: Cost of trainees attending courses or

examinations

008: Total trainee staff cost (£)

009: Proportion of trainee time in training

(%)

Time spent by staff checking trainee’s work in addition to that done by teaching staff

Staff Cost (£)

The courses and examinations attended by trainees

The cost and expenses

involved (£)

Number of trainees by grade

Staffing cost of the

trainees by grade (£)

Co

st o

f C

oh

ort

(£

) =

sum

of

00

1 t

o 0

07

+ 0

08

x 0

09

001b: Combined Central Education

costs

Non-PAY

2016-17

Non-salaried training programmes


6: Completing the costing

templates

Updates to the templates

98. The move to an integrated collection saw the existing worksheets associated with the

education and training collection incorporated into a combined workbook with the

reference costs collection worksheets (separate guidance available within UNIFY 2).

For 2016/17 all the worksheets including the reference costs ‘business as usual’

collection, will be combined in one overall workbook. The final structure of the

education and training worksheets will be in April 2017 alongside the Workbook

Technical Guide on UNIFY 2.

99. The education and training costing templates have been updated to reflect

stakeholder feedback following the 2015/16 Integrated Collection, to further reduce

the ambiguities and drive up the quality of the data submissions. As highlighted in

Section 5, NHS Improvement, in line with feedback, has reduced the number of cost

components providers are required to submit against. In addition to the changes

around the cost components, the expected main changes to the templates are:

summary sheet to include validation to ensure 2015/16 activity and cost data is

not resubmitted within a tolerance of 2.5%

additional mandatory validations:

o to ensure the minimum cost submitted per hour is not less than £1

o 0% overheads are not submitted

all non-mandatory provider specific validations now performed within the

workbook including additional validations

o comparison with 2015/16 submitted course activity

o pre-populated service/training split column

removal of following provider specific non-mandatory validations:

o duplicate costs

o market share

o service-training splits


o significant % activity

removal of following non-mandatory validations following change in approach:

o entering activity so you must enter both cost components 11 and 12

o entering a proportion of time in training greater than 100%

inclusion of year 0 (zero) within non-salaried template for providers that cannot

disaggregate year of study costs within programmes

change in lead employer validations as a result of cost component changes.

100. There will be no increase in the number of sheets required for completion: these will

still be split into non-salaried and salaried with a summary sheet for both and an

overall summary sheet for the education and training element.

101. The 2016/17 collection templates will be made available on UNIFY 2 in April 2017.

Where available, draft workbooks will be shared with providers before release to test

functionality and ask for feedback on structure and content.

Validations within the workbook

102. The workbook will include 18 mandatory validation columns on the salaried input

sheet and 6 on the non-salaried input sheet. The NMVs will flag up any clear input

errors pre-submission. Where a mandatory validation error has been generated, a ‘1’

will appear next to the corresponding row against the relevant validation.

103. The template will not allow a CSV file to be created to upload the data if any of the

validations are outstanding.

104. The mandatory validations can be found at Annex B.

105. To support providers in analysing and benchmarking their proposed data submission

in 2015/16, non-mandatory validations were included in the input sheets to allow

providers to view them before beginning the Unify2 submission process. They will be

included again for 2016/17 and the principles around data being able to be uploaded

to Unify2 with outstanding non-mandatory validations remain. Annex B has more

information on non-mandatory validations. To clarify, no non-mandatory validations

will be performed by the central team in 2016/17: they will all be included within the

workbook for local consideration before upload into UNIFY 2.

106. In 2016/17, the summary sheet associated with the E&T data will include a validation

performed to check an organisation’s submission against the data they reported in

2015/16 within a tolerance of 2.5%. This is a further step introduced by NHS

improvement to increase the quality of the data submitted.


Salaried input sheet

107. There are two main activity columns that need to be completed in the salaried input

sheet:

i. Total service & training hours (all trainees)

108. Please include the total trainee hours (covering service delivery and training) for each

programme. To calculate the training hours we will then multiply the hours by using

the percentage reported by the provider in cost component 12. The training hours

generated through this calculation will be shown in the greyed-out column to the right.

ii. Number of full-time equivalent (FTE) trainees

109. The number of FTE trainees (covering service delivery and training) should be

entered in this column. For example an ST1 working 2080 hours a year, 832 of which

are training (40% reported in cost component 009a), would be reported as 1 FTE not

0.4 FTE. Please be aware cost component 009a will be a pre-populated column that

can be overridden within cost component 009b. Section 8 has further guidance.

110. Please also note that the number of FTE trainees reported will not necessarily equate

to the actual number of trainees (headcount); for example if there are two part-time

trainees who both do half of full-time hours, they would be reported as one FTE for

the purposes of this collection.

111. The collection works on an assumption that salaried trainees will not exceed 2080

hours per year (52 weeks at 40 hours per week). However, where hours do exceed

this assumption we ask that two further activity columns are addressed. This is only

likely to be applicable in a few cases.

iii. FTE hours per week

112. This column calculates FTE hours per week using the two main activity columns

(above). If the value exceeds 40, the column will turn orange in which case the

column to the right (see below) needs to be addressed. If the value exceeds 50, the

column will turn black in which case the two main activity columns need to be

readdressed before submission.

iv. Specify if FTE hours per week >40 is correct

113. If FTE hours per week is between 40 and 50, the cell will turn orange. If it is clear that

greater than 40 hours per week is not correct, the two main activity columns need to

be readdressed before submission. If greater than 40 hours is correct, “Correct”

needs to be selected from the drop down menu.


114. We recognise that some trainees will work more hours than their standard contract.

However, for the purpose of this collection, we are treating these extra hours as

service so they should not be included in the return.

115. There are nine cost components that need to be completed. Components 08 and 09a

are mandatory where activity is entered, except for practitioner psychology

programmes that do not always attract a salary. The mapping document in Section 5

provides full details on how to complete each of the cost components.

Non-salaried input sheet

116. There are three main activity columns that need to be completed in the non-salaried

input sheet:

i. Total number of students

117. The total number of students must be a whole number and should be entered into

this column. Note that this is a straightforward headcount figure and will not be used

to calculate total hours.

ii. Total number of placement weeks (all students)

118. The total number of placement weeks (ie the sum of the length of all students’

placements) should be entered in this column. The value is multiplied by the average

number of hours per week (see below) to calculate the total hours. The greyed out

column to the right shows the average number of weeks per student.

iii. Average number of hours per week

119. The average number of hours in a placement week should be entered here. The

value is multiplied by the total number of placement weeks (see above) to calculate

the total hours.

For example, if:

- you have 2 blocks of placements within the year

- one placement block is 10 weeks and the other is 8 weeks

- there are 20 unique students in each block

- students in the 10-week block are on placement for 20 hours a week

- students in the 8-week block are on placement for 37.5 hours a week


The results would be:

- Total number of students = 20 + 20 = 40

- Total number of placement weeks = (20 * 10) + (20 * 8) = 360

- Average number of hours per placement week =

((20 * 20 * 10) + (20 * 37.5 * 8)) / 360 = 27.778 (3 decimal places)

But if 5 students dropped out of the 8 week block then:

- Total number of students = 20 + 15 + 5 = 40

- Total number of placement weeks =

(20 * 10) + (15 * 8) + (5 * number of weeks actually done) = X

- Average number of hours per week =

((20 * 20 * 10) + (15 * 37.5 * 8) + (5 * 37.5 * number of weeks actually done)) / X

120. There are nine cost components that need to be completed. The mapping document

in Section 5 provides details on how to complete each of the components.

Summary sheets (two sheets)

121. There are summary sheets for salaried and non-salaried inputs which provide the

high level information for all training programmes and will support users in their

reconciliation of the data prior to and post submission.

122. The summary sheets also include a column for inputting the confidence ratings,

which need to be completed prior to upload (see section below on confidence ratings

for further details).


123. As highlighted at paragraph 106, the summary sheet will include an additional

validation to check an organisation’s cost and activity submitted against their 2015/16

data within a tolerance of 2.5%.

Confidence ratings

124. Providers see confidence ratings as an important lever when engaging with clinical

colleagues during the collection process. For this reason they will all again be

required to rate confidence in their submission (at a programme level) on a scale

from 1 (very low confidence) to 5 (very high confidence) in the workbook. The

confidence rating will be used to assess overall confidence in the collated results and

to help with the consideration of outliers in the analysis to be undertaken by the NHS

Improvement.

125. Providers should rate the confidence in their processes and the quality of

assumptions these generate, not necessarily their confidence in the accuracy of the

output. The processes and assumptions will be key to building confidence in the

output, but this will also depend on other factors, such as further development of the

technical elements of the guidance. NHS Improvement will as part of its analysis look

to compare the confidence ratings submitted against previous years to gauge any

improvements which may be a result of improved processes or engagement.

126. This information should be included within the summary sheet of the collection

template. Please note that the template cannot be submitted it includes the

confidence ratings. Below is an indication of what each confidence score represents.

1. Very low confidence

Submission is based on relatively weak assumptions.

There is very little stakeholder engagement with the costing process, or the

information gained is of little benefit to the costing.

Very limited underlying data is available to inform the costing assumptions.

Resources are focused on other areas of the cost collection, so very low

confidence for this programme.

2. Low confidence:

The costing is based on limited involvement from Education Leads and other

stakeholders.

Some underlying data is available, such as surveys with very low return levels.

The assumptions might be based on anecdotal evidence from brief discussions

with stakeholders, such as consultants or education leads.


The costing might involve broad assumptions and extrapolation of evidence from

similar programmes.

3. Moderate confidence

There is good involvement from education leads and stakeholders, with useful

information gathered to understand costs or confirmation that previously gathered

information remains appropriate.

Examples of engagement maybe general information from the education lead,

deanery, and limited survey results, interviews that help to build assumptions.

There is a reasonable level of underlying data collected, allowing for decent

costing assumptions.

4. High confidence

There are strong assumptions based on a high level of stakeholder engagement

or confirmation that previously gathered information remains appropriate.

Assumptions are based on high quality underlying input data, such as

programme-specific information and sound accounting data.

This may be a detailed description by the education lead of what generally

happens for trainees on a particular year, on a particular programme.

The assumptions are driven by strong survey results and interview feedback,

building solid costing assumptions.

Costing techniques are well developed and advanced.

5. Very high confidence

There is very strong engagement from the most appropriate stakeholders for the

programme.

This high level of involvement provides highly reliable information as a basis for

assumptions.

Strong survey results and interview feedback from appropriate sized samples

provide consistent results.

Key assumptions are verified against alternative sources of information, building

greater confidence in the outputs.

Costing techniques are highly developed and advanced.


7. Understanding the resources

used and identifying the costs 127. Figure 1 below sets out the five main steps of the recommended approach to the

education and training cost collection exercise. It is written from the perspective of a

provider based on experience of the collection in 2013/14.

128. Although the ultimate output of the exercise is the cost of the education and training

activities in scope and the costing element of the exercise requires a significant

amount of work, it is probably the smallest element and one which can only be

completed once earlier steps have been completed.

129. The exercise is in reality an information collection exercise about the resources

consumed in the delivery of the activities in question and it needs to involve a wide

variety of organisational staff as well as finance teams.


Figure 1: Five steps to education and training cost collection

Step 1: Identify the training programmes in your trust and identify a lead for each

130. One of the first tasks in completing the exercise should be to consider the national list

of training programmes and identify those run in your own provider. The list of

programmes within the scope of this exercise which we request data on is in Annex

F.

131. Useful information about the programmes you currently run and for which you receive

some form of income, is available in your Learning and Development (LDA) schedule

and/or via any other agreements you may have with HEE. You can also use the

information contained in the LDA schedule as a sense check at the end of the

process, although we realise there may be local variation in content.

132. In identifying programmes, please note that you may find you do not provide clinical

placements for all of the years of a programme. Once you have identified the training

programmes at the provider, the next action is to identify who is the best person to

act as lead for each programme. It is essential that appropriate leads are established

and that it is clear that all parties involved understand what information they are

responsible for collecting in the two steps set out below.


133. In some organisations but not all there may be nominated education leads. Budget

holders for the relevant staff group are useful initial contacts if it is not clear who the

lead or education supervisor is for a particular programme.

134. Experience in 2013/14 helped to identify that for some programmes:

It is likely there will be a designated individual with the lead responsibility for the

programmes related to a specific profession, for example in pharmacy services. In

these cases it is often easy to identify and agree an overall lead for the provision

of the information.

You might need an overall lead, for example the head of midwifery for midwifery,

but then have individual leads for the different elements of the training pathway

within the programme, such as antenatal and postnatal for midwifery.

For nursing students who could be significant in number and have placements

across the wards in your organisation, you might need to have your head of

nursing as an overall lead with a group established to include representative leads

from the different types of placement, eg wards, theatres, outpatients, critical care

units.

There may be instances where it is more appropriate to nominate leads for

specific aspects of training which could go across programmes.

135. In terms of medical staff, for undergraduate medical students, there is likely to be a

co-ordinator for each year of the programme. For postgraduate medical trainees it is

more difficult, as information is likely to be required both at a specialty level and also

at an organisational one through central medical education teams.

Step 2: Establish the amount of activity across the different programmes

136. Once the initial identification of training programmes delivered within the provider is

complete and individual clinical and education leads/co-ordinators have been

identified, the next step is to determine the activity (ie the number of trainee and

student hours spent on courses or clinical placements) across the provider, against

each of the training programmes, during the 2016/17 financial year.

137. We recognise that the academic year (August/September to July/August) does not

tie-in with the financial year (April to March). However, courses and placements begin

at different points during the year and will run for different lengths of time, whereas

organisation costs are reported based strictly on the financial year start/end and all

statutory financial returns are based on this period. Activity and related costs should

therefore be identified and reported against each training programme based on the

financial year.


Step 3: Establish and collect the resource information required

138. Once activity information has been identified for the different training programmes in

step 2, the next step is to establish what information needs to be collected against

each programme to identify the resources involved in its delivery. This will then

ultimately allow the assignment of appropriate costs.

139. There will be different activities the delivery of education and training including direct

teaching activities, associated administration activities and central activities such as

facilities and overheads. This means that there are a number of different components

to the total cost and the exercise requires organisations to submit their costs broken

down into these cost components.

140. The table included in Section 5 (Image 5) provides a pictorial summary of the various

cost components to be reported (the yellow blocks) and shows both the resource

information (blue blocks) and costing data (green blocks) required to calculate the

ultimate cost of a programme of activity.

141. Cost components 001 to 005 are relevant to the costing of both non-salaried and

salaried placements. Components 006 to 009 only apply to salaried placements and

reflect the requirement to capture the element of a trainee’s salary which relates to

the time they are being trained.

142. The mapping document in Section 5 goes through each of the cost components in

more detail and provides a useful checklist on what does and does not fall in each

component.

143. As a starting point the programme leads identified in step 1 and finance staff should

review the list of components for each programme, ensure a joint understanding of

what is required and agree a methodology for collecting the required information.

Some information may be easily obtainable through routinely available finance

information and for some components no further data collection may be required.

144. Many cases, however, will require information gathering and the leads identified

should then work to gain the necessary information about the resource information

required in the blue blocks. This will help finance colleagues calculate and assign

costs, as described in step 4.

145. There are a number of options for how you might wish to collect information to allow

these costs to be calculated. Objective methods should be used as far as possible

but we recognise that a degree of subjective judgement – with the agreement of

senior clinical, finance and education colleagues – will be required. The method

chosen and the degree of subjective judgment used should be appropriate for your

organisation and proportionate to the scale of costs and resource usage.


Step 4: Calculating and assigning costs to the resources identified

146. This sets out the areas you will need to consider when calculating and assigning

costs to the resource information collected in the previous step. The mapping

document in Section 5 provides more details about the costing of individual

components.

147. Please remember that we require the expenditure incurred in 2016/17, so when

costing up resource information please apply the 2016/17 costs and use actual salary

costs rather than average points on a scale. If you need to apply a standard cost for a

group of staff, we suggest you calculate an average cost based on the total actual

2016/17 spend for the group involved.

148. It is likely that many costs will have to be split across cohorts or indeed on occasions

across programmes, so a methodology for apportioning a calculated cost may be

required. Time spent is one suggested way of apportioning costs but in some

instances apportioning cost using numbers of students/trainees may be more

appropriate.

149. NHS Improvement costing standards (English Costing Standards) provide guidance

on the classification and allocation of direct, indirect and overhead costs. As far as

possible, the same approach needs to be taken for costing education and training

activity as is taken for costing service activity.

150. An exception to this and an area of potential deviation from the clinical costing

standards in relation to this exercise is the calculation of overheads. To support

organisations looking for further information associated with this calculation, The

Department of Health published a Guide to calculating overheads associated with

education and training. This guide has been developed in conjunction with NHS

colleagues to be used by NHS providers during the collection exercise and will be

made available within UNIFY 2 as part of the pre-collection resources.

151. The guide addresses issues around consistency. We appreciate that until a

standardised approach to the apportionment of overheads for education and training

is agreed and mandated that there will be inconsistencies in the allocation of

overheads. While we cannot mandate the use of this, and appreciate that some

providers will use the NHS Improvement approach, we would encourage providers to

use this guide in the interests of consistency and future work around analysis and

audit. Outcomes from the 2015/16 collection highlighted that the difference in

approach would affect overheads apportionment. The overheads guide will be

available within UNIFY 2 for the 2016/17 collection process.

152. We have again worked with provider colleagues following the 2015/16 collection exercise to understand the potential reasons for the increase in overhead apportionment when using the DH overheads guide.


Combined costs collection: integrated reference costs and education and training

collection guidance 2016/17 includes a number of steps, developed by provider

colleagues, to be considered where the percentage is higher than expected.

153. Providers are requested to sense check the overhead element they are including as a

% of total costs submitted, with their normal overheads assumed.

Step 5. Populating the template and sense checking the proposed submission

154. Information needs to be submitted for every training programme you have

students/trainees for, and captured in the relevant part of the collection template. See

Section 6 for information on completing the costing templates.

155. Feedback from previous collections has flagged up concerns about not being able to

reconcile the submission to a control total and anxieties about excluding certain items

within the collection which are currently funded from HEE income.

156. To respond to this feedback we suggest organisations complete a high level

reconciliation. A template to use in completing the reconciliation will be made

available on UNIFY 2 before the cost collection period going live in June..

157. Undertaking such reconciliation will help providers identify whether a submission is

reasonable and support the consideration of the data as part of the internal sign-off

process. Outside the collection this approach will also help to feed any subsequent

internal communications and act as a record of issues that fall outside the scope of

the exercise.

158. Some possible reconciliation items for inclusion in the list include:

locally funded postgraduate trainees which are in the scope of the exercise

lead employer costs (please see Section 4 and Annex G)

the share of activities an organisation provides on behalf of a partnership or region

funded activities that support the training of the whole workforce but are not

related to the actual clinical placement or individual trainee

income received for backfilling staff released to undertake a training activity

the difference between the actual salary costs of the postgraduate trainees in

post, compared to the standard pay scale on which the postgraduate medical tariff

is currently based.

159. When completing the current income column in the reconciliation table you should

include all the relevant income from HEE and income you should receive through

your learning and development agreement (LDA).


160. Where detailed LDAs exist they will provide valuable information on the funding

assumptions in the income.

161. It is also worth remembering that the current tariffs are in transition. It might therefore

be helpful to compare the balance above to the income you will receive at the end of

the transition period.

162. Once all known reconciliation items have been included, the resulting balance will

give a clearer understanding of how the submission compares to income and how

this balance falls across the different staff groups.

8. Role of Health Education

England support and service/

training split

Support

163. This section of the guidance has been updated for 2016/17 and reflects how HEE

staff will support the education and training element of this exercise.

164. HEE will continue to support providers in developing their education and training

submissions in the following ways:

provide a network via HEE local teams to put providers in touch to share best

practice and benchmark the outputs of the exercise; HEE will provide the relevant

contacts on request

support NHS Improvement to circulate key messages and help raise the profile of

the exercise; focusing on engagement with education leads and developing

targeted communications to be shared with them.

165. HEE will continue to host local workshops to help providers prepare for the upcoming

collection exercise. Where possible, these workshops will be aimed wider than

finance to include education and/or clinical leads. These will support the engagement

of the exercise required by providers and be a forum to share best practice and

feedback key issues to the central team. HEE plans to ensure that all sessions have

taken place before the end of May 2017. The central HEE will communicate more

details of the arrangements.


166. HEE has identified education and training representatives who can build up

knowledge to support education and training costing. Please email Rozeen Mahroof

([email protected]) at HEE for more details.

Information sources

167. Ultimately responsibility for identifying the education and training activity for the cost

collections rests with providers so it is imperative that there are adequate systems for

collecting the relevant information. We encourage providers to contact their relevant

HEE local offices to access information to verify activity data. If you are unsure of

who to contact within your HEE Local office please email Rozeen Mahroof who will

be able to direct you to the most appropriate person.

168. It should be noted that posts, placement allocation plans and learning development

agreement schedules are mostly planned activity, so information on these is a useful

starting point, but actual activity may differ from planned.

169. HEE continues to work to improve consistency and address local variability hin HEE

local offices:

Postgraduate: all HEE local offices use the intrepid system to record their

postgraduate posts; all providers also have access to this system. Each provider

should have designated staff that can access this system and routinely accesses

this information. Please contact your HEE local office for any queries on this

system. For details of your HEE local contact please contact Rozeen Mahroof.

Non-Medical: there is currently no common system to record this information so

there is a lot of variation in the levels of data held:

o four systems used by seven local offices

o six local offices do not currently use a system – instead the information is held

in one/several spreadsheets.

170. HEE’s local teams may also be able to use their existing communications routes to

advise staff that are responsible for education and training activity/finance on other

useful sources of information, such as activity data from the university. Other useful

sources of information that should be available are:

placement allocation plans received annually from HE institutions: sent to

providers direct from university

learning and development agreement schedules: sent to provider finance

departments direct from HEE local offices.


171. HEE is standardising LDA schedules nationally, focusing on consistency of

information and format. Further information on this, including an example LDA to

indicate the level of detail, will be shared once available.

Higher Education Funding Council for England/Health Education

England split

172. HEE and the Higher Education Funding Council for England (HEFCE) have recently

been working to understand the costs they fund and any overlap. HEE will produce a

summary of the costs involved which clearly identifies whether responsibility for

funding is linked to the academic requirements (funded by HE institutions, via HEFCE

and tuition charges) or clinical placement requirements (funded by HEE).

Work of Higher Education England: service training splits

173. HEE continues to build on earlier work to improve support to providers around cost

component 009a –‘ Percentage of time in training’. This has involved working with

professional leads, meeting postgraduate deans and liaising with different bodies via

the HEE advisory groups (HEEAGs) to develop further information on expected

service/training splits.

174. As with 2015/16 the service/training splits produced centrally and based on

professional opinion may not be consistent with how training is delivered locally. In

response to this NHS Improvement and HEE for 2016/17 are including the

service/training splits within the template as a pre-populated figure.

175. These splits will cover every specialty and every year of training and be an expected

percentage based on professional input and analysis of previous year’s data. An

extra column cost component 009b will be included in the worksheet alongside the

pre-populated service/training split column. This column will enable providers to input

their own percentages where they are confident that the required engagement has

taken place, and will override the pre-populated service/training split. We encourage

providers to submit actual data where these are available to improve the analysis of

the data.

176. At the time of publication, HEE continues to work with stakeholders (as outlined at

paragraph 173) to determine what the service/training split percentages should be for

each salaried programme/year and will validate a pre-populated value into each line

of the template for the 2016/17 collection. Extra information will be made available

where required.


Overview of changes to cost component 009a (service/training split)

177. For the 2016/17 Integrated cost collection, service training split percentages will be

pre-populated into the workbook in template ‘02a_Input – Salaried (See image 6)

178. You will still be required to enter 100% of the activity and cost for both training and

service into the other input columns as normal.

179. If you disagree with the figure included in the pre-populated column and wish to

change this based on local professional input, an extra column next to the pre-

populated column will allow you to input your data. We would only encourage

providers that intend to submit a confidence rating of 4 or above to adjust the

percentage shown within the pre-populated column. Following the collection the NHS

Improvement may wish to contact organisations that have amended the pre-

populated column with their own percentage to inform analysis and future work.

180. The normal total costs calculation is (adding cost components CC001 – CC008

together) + (service training split [CC09a] * CC008). Therefore Column S will be the

CC09a service training split used unless the value in Column T is greater than zero,

in which case this will be the percentage split used.

181. In the example in Image 6, you will see that for Acute Internal Medicine ST1 40% has

been added to the override column. This means that the pre-populated service

training split (48%) has now been overridden and is 40% based on local calculations

182. All figures used in Image 6 are for demonstration only.

Image 6: 02a_Input Salaried template in the combined costs collection workbook

When you enter activity and cost into cost components CC001 – CC008 the “Total” and “Calculation” columns will formulate using the service training split percentage value in Column Q as normal, but where a value is greater than zero in Column R, then this percentage value will be used instead of Column Q.

This column where there is a value will override the service training split in Column Q. If you enter a value into this column, NHS I may ask you to feedback with your analysis for the override after the collection.

The service training split percentage will be hard coded with a Health Education England (HEE) / Deanery expected % value into Column Q, you will not have to add a value. You can override this value by entering a value into the override Column R. The value in Column R will become the training service split. Cost components CC001 – CC008 are not shown here for illustrative purposes.

Annex A: Clarification of scope:

updated for 2016/17

Area (alphabetically sorted) Included Excluded

Advanced nurse practitioner

Anaesthetic nurse

Apprentices

Armed forces / Ministry of Defence training posts

Assistant practitioner

BSc European Nursing

Bursary funding

Catering

Clinical exercise physiology MSc

Clinical fellowship

Clinical pharmacy PG Diploma programmes

Continuing professional development (CPD)

Dental technician (included in collection for 2016/17)

Dental trainees in GP practices

Dip HE Diagnostic Imaging

Dual field nursing

Erasmus students

Foundation pharmacy

GPs GP trainees on a clinical placement within a trust.

Clinical placements that take place in GP

practices.

International students who are HEE commissioned (non-medical) or counted in the HEFCE target (for medical and dental) as determined by the Medical and Dental Council

Locum doctors

A locum doctor hired under a fixed term specialty training

appointment (FTSTA) or locum appointed trainee

(LAT) who holds a national training number (NTN) or visiting training

number (VTN) registered onto a

specialty course working towards Certificate of

Completion of Specialist Training CCST.

A locum doctor employed under a

Locum Appointment for Service (LAS).

Medical Training Initiative (MTI)

Maternity leave (both statutory and occupational)

Medical laboratory scientific officer (MLSO)

MRC Psychiatry

National Institute for Health Research (NIHR)

National recruitment


Area (alphabetically sorted) Included Excluded

Neonates This is a subspecialty

under Paediatrics, record activity and cost there.

Nurses

Education and training costs associated with second registration

nurses (excluding salary component).

Return to practice nurses.

Nurse – apprenticeships, traineeships and cadet schemes

Nurse – elective student placements

Open University students who are undertaking one of the relevant courses and are on placement at the trust

Out of programme experience(OOPE)/out of programme research (OOPR)/out of programme training (OOPT)

Excluded unless they are deanery approved and part of compulsory

learning towards Certificate of

Completion of Training (CCT).

Private finance initiative costs

Pharmacy summer placements

Physician associate

Post qualified chemists training programmes

Preceptorship

Psychotherapists (included in collection for 2016/17)

Selected study component (SSC) in a secondary care setting

Selective/special study module (SSM) in a secondary care setting

Self-funded students/trainees

Social workers

Sonographer/ultrasound technologist /PG Cert Ultrasound

Special study unit (SSU) in a secondary care setting

Specialty and associate specialist (SAS) doctors

The costs incurred (if any) by your organisation delivering activities related to education that are outside othat required for clinical placements

Trust-funded posts (ie salaried trainees who are paid for by the trust itself, rather than via the local HEE office) with a NTN or VTN


Annex B: Validations for

education and training cost

collection 1.1. There are 18 mandatory and 6 non-mandatory validations as detailed below.

1.2. Changes for 2016/17 are as follows. The mandatory and non-mandatory validations

associated with lead employer were active in the data input salaried template in last

year’s collection and detailed under a supplementary guidance which for this year

has been incorporated into the main guidance (Section 4) and so these validations

are now detailed in this Annex G.

1.3. Other mandatory validations to be introduced are 0% overheads and unit costs less

than £1. For non-mandatory validations. Also for non-mandatory, where activity and

costs submitted for this year are either the same as last year’s submission or within

2.5% will be flagged within the summary sheet. This will be based on the total amount

of cost and activity submitted and not at a programme level.

1.4. The mandatory validations for “entering activity so you must enter both cost

components [011] and [012]” and “you have entered a proportion of time in training

[012] greater than 100%” will be removed. Also the Non-mandatory validation

“Service-training split (Cc012) outside expected boundaries” will be removed. These

deletions are a result of cost component 012 having a pre-populated value based on

HEE / Deanery expectation entered into the salaried template for this year.

1.5. The non-mandatory validations reported last year that will no longer be reported this

year are:

service/training splits

duplicate costs

significant % activity

market share.

1.6. As highlighted previously, all non-mandatory validations will now be done in the

workbook to reduce the burden on providers submitting their data. There will be no

centrally issued non-mandatory validation report for 2016/17; providers will only be

contacted on an exceptional basis.

Mandatory validations

i. You have entered activity but no associated costs

ii. You have entered costs but no associated activity

Aim How does it work? Based on Sheet in template

To ensure that activity and cost are both submitted for each input - with the exception of lead employer.

Highlights where costs are submitted without activity or vice versa.

The exception to this validation - as in the guidance on reporting lead employer arrangements (Section 4/Annex I) – is where lead employer entries are made, costs and no activity (and vice versa) will not incur a validation

Both

iii. You have entered negative values iv. You have entered non- numeric values

Aim How does it work? Based on Sheet in template To prevent the submission of negative and non-numeric values.

Highlights where negative or non-numeric values are submitted.

Negative and non-numeric values may affect the calculations and non-mandatory validation reports being done in UNIFY2.

Both

v. You have not entered both trainee hours and FTE count

Aim How does it work? Based on Sheet in template

To ensure that both hours and FTE count are input for each training programme where data is being reported

Highlights where trainee hours are submitted without the number of FTE trainees or vice versa.

The number of FTE trainees is used to validate the activity (hours) submitted. It is also used to calculate pro rata salary costs to validate the costs entered in cost component 008

Salaried


vi. You have entered lower than expected hours per FTE

Aim How does it work? Based on Sheet in Template

To ensure that the number of FTE hours per week reported is realistic.

Highlights where FTE hours per week (column F) is less than 30. Any data less than this cannot be submitted without approval from NHS Improvement

We do not expect that a full-time trainee would do less than 35 hours per week. Standard full-time contracts often range from 37 to 40 hours per week.

Salaried

vii. You have entered higher than expected hours per FTE


To ensure that the number of FTE hours per week reported is realistic.

Highlights where FTE hours per week (column F) is greater than 40 hours. If the provider is certain that the input greater than 40 hours is correct they have the opportunity to specify in column G. The validation has an upper limit of 50 hours per week and data greater than this cannot be submitted without NHS Improvement approval

We do not expect a standard contract to exceed 2080 hours per year (52 weeks at 40 hours per week) but the validation allows for exceptional circumstances. We recognise that some trainees will work extra hours exceeding their standard contract. However, for the purpose of this collection, we are treating these extra hours as service and therefore they should not be included in the return.

Salaried

viii. You have entered staff costs [008] more than 30% greater than the highest national salary


To avoid errors when inputting salary costs; this was one of the most frequent issues in the past.

Highlights where the pro rata salary

costs (cost component [008] divided

by the number of FTE trainees) reported exceed £61,941.

The maximum boundary is the highest possible basic salary for the programmes included plus 30% to account for on costs, London weighting and/or non-consolidated payments.

Salaried


ix. You have not entered both student numbers and placement activity

Aim How does it work? Based on Sheet in Template To ensure that both placement activity (weeks and hours) and the number of students are inputted for each training programme where data is being reported.

Highlights where student numbers are submitted without placement activity (weeks and hours) or vice versa.

The number of students is used to validate the activity (weeks and hours) submitted.

Non-salaried

x. You have either entered:

(a) average placement weeks > 52, or

(b) average hours per week > 40

Aim How does it work? Based on Sheet in Template To ensure that the average number of weeks and hours per week per student are realistic

Highlights where: (a) average placement weeks is greater than 52, or (b) average hours per week is greater than 40

We do not expect that a student to do more than 40 hours of clinical placement a week. Data greater than this cannot be submitted without approval from NHS Improvement

Non-salaried

xi. You have entered a total number of students that is not a whole number

Aim How does it work? Based on Sheet in Template To ensure the total number of students is realistic

Highlights where the total number of students is not a whole number (integer)

The number of students is a headcount not WTE count and is used to validate the activity (weeks and hours) submitted.

Non-salaried

xii. You have entered 0% value for overheads

Aim How does it work? Based on Sheet in Template To ensure there is an overhead associated with each training programme

Highlights where no cost has been allocated to the overhead cost component

Cost component associated with overheads which has zero cost where there is associated activity will be highlighted.

Both


xiii. Unit cost per hour is > £1.00

Aim How does it work? Based on Sheet in template To highlight unit costs that appear unrealistic

The report will provide details of any line of data submitted by the trust where unit costs (per hour) are less than £1.00

We do not expect that any training programme’s unit costs would be less that £1.00 per hour and may suggest an imbalance of cost against activity

Salaried

xiv. You have entered Host trust activity greater than total number of FTE trainees

Aim How does it work? Based on Sheet in template To ensure the activity you have allocated for a particular programme as a host provider does not exceed that of the overall activity for your organisation

The activity you have reported in Column AC for host provider is either equal to or less than the activity reported in Column J

Your activity as a host provider for a particular programme cannot exceed the overall activity of your organisation. Either all the activity is associated with you as a host provider in which case this should equal the overall activity or it will be less if the trust has other extra activity in the trust

Salaried

xv. You have entered Lead trust salary greater than total salary in cost component [008]

Aim How does it work? Based on Sheet in template To ensure the salary you have allocated for a particular programme as a lead provider does not exceed that of the overall salary for your organisation

The salary you have reported in Column AE for lead provider is either equal to or less than the activity reported in Column P

Your salary as a lead employer for a particular programme cannot exceed the overall salary of your organisation. Either all the salary is lead employer in which case this should equal the overall salary or it will be less if the provider has extra salary as a result of extra other activity within the organisation

Salaried


xvi. Host activity equals the total number of FTE trainees therefore salary should be zero

Aim How does it work? Based on Sheet in template To ensure that where host activity equals the overall activity in the provider for a particular programme, means there should not be any salary associated with this activity

The activity you have reported in Column AC equals the activity you have reported in Column J, and Column P is zero. If not, then flag the validation

Your activity as a host provider where it equals the overall trust activity for a particular programme will not have a salary associated with the activity as the salary will exist at the lead provider instead

Salaried

xvii. You entered activity so you must enter cost component [008]

Aim How does it work? Based on Sheet in template To ensure where there is activity associated with a particular training programme there will also be a salary cost

The activity you have reported must have an associated salary cost in column P

Your activity associated with any training programme will have an appropriate salary cost linked to it

Salaried

xviii. You must enter both Lead Employer FTE and salary

Aim How does it work? Based on Sheet in template To ensure that lead employer provider data input is taken into account properly in the salaried data input template

Ensure that if data is input into column AD there must be data associated with column AE and vice versa

Where there are lead employer calculations in the salaried input template, both columns AD and AE must be filled in, that is both activity and salary cost.

Salaried


Non-mandatory validations

Provider specific validations –validations specific to the provider and will be reported throughout the process for consideration

1. Unit costs higher than expected

Aim How is the information used?

What happened in 15-16? How will it work? Flagged on the template?

To highlight unit costs which appear unrealistic

Unit costs are used to inform

calculation of organisation specific ECI

tariff and currency development

The equivalent validation in 2015/16 flagged up unit costs over specified maximum boundaries

The report will provide details of any line of data submitted by the trust where unit costs per hour (exc salary) are greater than 2 x the 15/16 average for each course1 and or unit costs are greater than £50

Yes – salaried and non-salaried

Exceptions to the rule include:

1. If the 2015/16 course average is less than £5, the maximum boundary will increase to £10.

2. If the 2015/16 course average is greater than £40, the maximum boundary will decrease to £80.

3. If there is no 2015/16 average for a course, the maximum boundary will be £50.

Note:

1. Providers wishing to compare against 2016/17 averages will need to review the verification report during the collection

window. These averages are subject to change during the collection depending on the number of submissions and

organisations that have submitted.


2. Pro rata salary costs higher or lower than expected


How will it work? Based on Flagged on the template?

To ensure that the salary costs being reported by trusts are in line with expectations and national guidelines

The salary costs are used to inform:

the total quantum for the trust and wider NHS

unit costs

calculation of organisation specific Education Cost Index (ECI)

The report will provide details of any line of data submitted by the trust where cost component 008 divided by the number of FTE trainees is greater than or less than the salaries as per NHS pay-rates2

The standard salaries are taken from Pay & Conditions Circular (M&D) 2016 and Pay Circular (AforC) 2016. An additional 30% is allowed at the top end for on-costs, London weighting and 1% bonuses.

Yes – salaried

2 Sensible salary cost ranges:

Year / Course Min Max +30%

FY1 22,862 33,431 FY2 28,357 41,686 ST1 30,302 45,170 ST2 32,156 47,205 ST3 34,746 49,660 ST4 36,312 52,117 ST5 38,200 54,573 ST6 40,090 57,028 ST7 41,979 59,484 ST8 43,868 61,941

Dental Nurse 15,251 29,195 Band 2-4 IAPT 19,217 45,793 Band 4-6

Pharmacist pre-reg 21,909 37,001 Band 5 Pharmacy Technicians 19,217 29,195 Band 4

Healthcare Scientist STP 19,217 45,793 Band 4-6 Healthcare Scientist pre-MSC 19,217 29,195 Band 4 Healthcare Scientist Graduate 19,217 45,793 Band 4-6

Healthcare Scientist HSST 19,217 45,793 Band 4-6 Psychology 26,302 45,793 Band 6


3. Percentage of overheads



To highlight where the overheads being reported appear unrealistic.

Overheads are used to inform


The report will provide details of any line of data submitted by the trust where overheads (by programme) are over 30%

It is expected that there will always be overhead costs associated with a training programme. The 30% maximum boundary has been developed based on previous data to highlight outliers

Yes – salaried and non-salaried

4. Placement weeks per student higher than expected



To ensure that the number of placement weeks being reported by each trust is in line with expectations and national guidelines

The number of placement weeks is used to calculate the total hours, which directly affects

unit costs

calculation of organisation-specific ECI

The report will provide details of any line of data submitted by the trust where the total number of placement weeks divided by the total number of students is greater than expected

Based on the assumption that students are required to do a minimum number of classroom hours, ie not clinical placement

Yes – non-salaried


5. Salary costs outside national pay rates (adjusted for Host / Lead activity and cost)



To ensure the salary costs reported by providers are in line with expectations and national guidelines adjusted to take into account host/lead activity and cost



unit costs


The report will provide details of any line of data submitted by the trust where cost component 008 (minus lead salary entered in Column AE) divided by the number of FTE trainees (minus host activity entered in Column AC) is greater than or less than the salaries as per NHS pay-rates (see NMV 2 above)

The standard salaries are taken from Pay & Conditions Circular (M&D) 2016 and Pay Circular (AforC) 2016. An extra 30% is allowed at the top end for on-costs, London weighting and 1% bonuses.

Yes – salaried

6. Lead employer (Column AE) Salary costs outside national pay rates



To ensure the salary costs associated with lead employer activity reported by providers are in line with expectations and national guidelines and cost



unit costs


The report will provide details of any line of data submitted by the trust where cost reported in Column AE divided by the activity reported in Column AF is greater than or less than the salaries as per NHS pay-rates (see NMV 2 above)

The standard salaries are taken from Pay & Conditions Circular (M&D) 2016 and Pay Circular (AforC) 2016. An extra 30% is allowed at the top end for on-costs, London weighting and 1% bonuses

Yes – salaried

Annex C. Sources of information Sources of information to consider

Source of information Potential use Contacts/examples

Information from financial systems

Will:

help to highlight any resources and departments that are directly related to education and training and will require apportioning across the exercise.

act as a check to ensure appropriate resources are highlighted by programme leads

to support costs calculations

Ledgers, PLICS, Service Line Reporting, general costing systems, etc

Contracts with external funding bodies

Will help to highlight and understand the programmes and resources which are funded via HEE funding. Depending on level of detail in the LDA a significant level of useful information could be gained

Contracts with HEE local offices such as the LDAs

Medical education managers

Face-to-face discussions/interviews with relevant staff either on a one to one or focus group basis

To build up the detailed information

required on each placement

Consultants, consultant personal assistants, junior doctors, practice facilitators, placement managers, administration staff, mentors, teaching staff and staff in the areas where teaching takes place during patient care

Discussions with external organisations including educational establishments

May help to establish whether there are

any expectations of the placement set out.

For example, there might be a course

handbook for each year of the

undergraduate medical student’s degree,

which includes expectations of a clinical

placement

Educational establishments

Deaneries

Surveys/questionnaires Some organisations have used this to determine the % service/training split

Samples of postgraduate medical staff

Members of staff who facilitate the training

Job plans/diaries of teaching staff To assess the time spent teaching while delivering patient care or administration staff spent on central education activities

HR department

Medical staffing departments

Department deads

Individual staff

Workplace-based assessment documents of postgraduate trainees by assessors

CbD, Mini-CEX, and DOPS

Annex D: Best practice examples from

provider visits

Area Example of best practice

Preparation: review of previous year

Local analysis and use of the Department of Health dashboard to identify unrealistic costs or outliers from previous year’s collection. These were used as a starting point for discussions with education /clinical colleagues.

Clinical engagement To increase awareness and understanding of the collection, trusts set up ‘masterclasses’ for clinical directors. These were drop-in sessions which explained the history of the funding, the tariff and cost collection and what engagement was required from them.

Information sources (relationship with HE institutions)

One trust reported that local universities provide the head of nursing with an allocation report for nursing placements every six weeks. The report details the student programme, year group, number of weeks on placement, study days and department/ward area.

The trust also keeps a capacity report to share with universities.

Information sources The programme leads map the student information received from HE institutions to an internal database. The financial year information can then be extrapolated as required.

Collecting ‘real-time’ data

The programme lead sent out an email with the stats sheet to the educators a week before placement started requesting they fill it out throughout the placement (with specific instructions not to do an end-of-placement estimate).

The programme lead suggested that educators ask the student to maintain as many of the stats as they can, as students tend to want to record what they are told on placement, and are more likely to maintain an accurate record for the same reason. Educators liked this as they then see it as more of a shared responsibility and are more likely to comply with the task.


Collecting ‘real-time data’

One trust maintains a large working folder (shared drive) that all the individuals responsible for the collection have access to.

Using the folder to share information: student numbers are completed monthly by the education leads in each division. The numbers are collected for each week by programme and year group, eg a (fictional) example of the structure of the template for allied health professionals:

Course Year

Education lead Week commencing

7th Apr 14th Apr 21st Apr

Etc…

Occupational therapy

1 John Smith 5 5

Occupational therapy

3 John Smith 12 12

Dietetics 1 Tina Jones 2 2 2

Dietetics 2 Tina Jones 1 1 1

Collecting the information from consultants/trainers

The head of costing and medical education manager set up meetings (interviews) with the lead consultants in each area of medical training and went through cost components 001-009a in detail.


Using Survey Monkey or other online tool for medical surveys of consultants and junior doctors. The response rates for different specialties were recorded and detailed thoroughly.



The main body of the consultant/trainer survey was designed to provide a percentage of consultant time training while delivering patient care to inform cost component 004. The three questions asked for each area are:

1. How many hours do you spend on X activity a year (eg in theatre)? 2. What percentage of the time do you have medical students/trainees with you? 3. What percentage of the time when medical students/trainees are with you is

dedicated specifically to their education?

Salary information Trainer and trainee salaries were sourced from the provider ledger. Where the name of the trainer/staff was unknown the average consultant or appropriate grade pay was used from the ledger.

Annex E: Library and knowledge services 1.7. This annex contains some summary level education and training splits for library and

knowledge services using information captured in a survey u by the HEE Library and

Knowledge Services Leads in 2013/14.

1.8. The table details the % usage of library and knowledge services broken down by type

of provider.

Type of provider Education: mean (Average) %

Education: median %

Education: mode %

Acute: university/teaching trust 61% 68% 70%

Acute: district general hospital 68% 71% 75%

Care trust 61% 75% 75%

Mental health/learning disability 59% 60% 60%

1.9. This information is shared as a starting point for discussions. It is worth noting that

the % split for education and training varies significantly across organisations.


Annex F: Programmes for

collection in 2016/17 and years

of study

Salaried training programmes

Acute care

Acute internal medicine Years 1 – 6

Anaesthesia Years 1 – 7

Emergency medicine Years 1 – 6

Intensive care medicine Years 1 – 7

Dentistry

Foundation programme (Dental) Years 1 – 2

Dental & maxillofacial radiology Years 1 – 4

Dental nurse Years 1 – 2

Dental technician Years 1 – 3 (new for 2016-17)

Endodontics Years 1 – 3

Oral and maxillofacial pathology Years 1 – 5

Oral medicine Years 1 – 5

Oral microbiology Years 1 – 5

Oral surgery Years 1 – 4

Orthodontics Years 1 – 3

Paediatric dentistry Years 1 – 4

Periodontics Years 1 – 3

Prosthodontics Years 1 – 3

Restorative dentistry Years 1 – 5

Special care dentistry Years 1 – 3

General practice VTS

GPVTS Years 1 – 2

Healthcare scientist HSST

Higher Specialist Scientific Training (HSST) Years 1 – 5

Healthcare Scientist Graduate Diploma

Nuclear medicine Years 1 – 2

Radiotherapy physics Years 1 – 2

Radiation physics Years 1 – 2

Reproductive sciences Years 1 – 2

Healthcare Scientist STP (Scientist Training Programme)

Audiology Years 1 – 3

Cardiac Science Years 1 – 3

Clinical Biochemistry Years 1 – 3

Clinical Immunology Years 1 – 3

Clinical Measurement & Development Years 1 – 3

Clinical Perfusion Science Years 1 – 3

Clinical Pharmaceutical Science Years 1 – 3

Critical Care Science Years 1 – 3

Cytopathology Years 1 – 3

Gastrointestinal Physiology Years 1 – 3

Genetics Years 1 – 3

Genomics Years 1 – 3


Haematology and Transfusion Science Years 1 – 3

Health Informatics Science Years 1 – 3

Histocompatibility & Immunogenetics Years 1 – 3

Histopathology Years 1 – 3

Imaging (ionising radiation) Years 1 – 3

Imaging (non-ionising radiation) Years 1 – 3

Medical Device Risk Management & Governance

Years 1 – 3

Microbiology (including: infection control & epidemiology, virology, bacteriology, mycology, parasitology)

Years 1 – 3

Neurophysiology Years 1 – 3

Ophthalmic & Vision Sciences Years 1 – 3

Physical Sciences Years 1 – 3

Radiation Safety Physics Years 1 – 3

Radiotherapy Physics Years 1 – 3

Reconstructive Science (Maxillofacial Prosthetics)

Years 1 – 3

Rehabilitation Engineering Years 1 – 3

Reproductive Science Years 1 – 3

Respiratory & Sleep Sciences Years 1 – 3

Un-defined Clinical Engineering Years 1 – 3

Un-defined Medical Physics Years 1 – 3

Urodynamic Science Years 1 – 3

Vascular Science Years 1 – 3

IAPT

High intensity therapist Year 1

Psychological wellbeing practitioner Year 1

Medical

Allergy Years 1 – 7

Audiovestibular medicine Years 1 – 7

Cardiovascular medicine Years 1 – 7

Clinical genetics Years 1 – 6

Clinical neurophysiology Years 1 – 6

Clinical pharmacology & therapeutics Years 1 – 7

Dermatology Years 1 – 6

Endocrinology & diabetes Years 1 – 7

Foundation programme (Medical) Years 1 – 2

Gastroenterology Years 1 – 7

General (internal) medicine Years 1 – 5

Genito urinary-medicine Years 1 – 6

Geriatric medicine Years 1 – 7

Haematology Years 1 – 7

Immunology Years 1 – 7

Infectious diseases Years 1 – 7

Medical oncology Years 1 – 7

Medical Ophthalmology Years 1 – 6

Neurology Years 1 – 7

Nuclear medicine. Years 1 – 5

Occupational medicine Years 1 – 6

Paediatric cardiology Years 1 – 8

Palliative medicine Years 1 – 6

Pharmaceutical medicine Years 1 – 6

Physicians Associates Years 1 – 2

Rehabilitation medicine Years 1 – 6

Renal medicine Years 1 – 7

Respiratory medicine Years 1 – 7

Rheumatology Years 1 – 7

Sports & exercise medicine Years 1 – 6

Tropical Years 1 – 7


Obstetrics and gynaecology

Community & reproductive sexual health Years 1 – 6

Obstetrics & gynaecology Years 1 – 7

Ophthalmology

Ophthalmology Years 1 – 7

Paediatrics

Paediatrics Years 1 – 8

Pathology

Chemical pathology Years 1 – 5

Diagnostic neuropathology Years 1 – 5

Forensic histopathology Years 1 – 5

Histopathology Years 1 – 6

Medical microbiology & virology Years 1 – 5

Molecular Pathology Years 1 – 5

Microbiology Years 1 – 5

Paediatric & perinatal pathology Years 1 – 5

Virology Years 1 – 5

Pharmacy

Pharmacist pre-reg Year 1

Pharmacy technicians Years 1 - 2

Psychiatry

Child & adolescent psychiatry Years 1 – 6

Forensic psychiatry Years 1 – 6

General psychiatry Years 1 – 6

Medical psychotherapy Years 1 – 6

Old age psychiatry Years 1 – 6

Psychiatry of learning disabilities Years 1 – 6

Psychology

Clinical psychology Years 1 – 3

Counselling psychology Years 1 – 3

Educational psychology Years 1 – 3

Forensic psychology Years 1 – 3

Health psychology Years 1 – 3

Occupational psychology Years 1 – 3

Sports & exercise psychology Years 1 - 3

Psychotherapy

Psychotherapists Years 1 – 5 (new for 2016-17)

Radiology

Clinical oncology Years 1 – 7

Clinical radiology Years 1 – 6

Surgery

Cardiothoracic surgery Years 1 – 7

General surgery Years 1 – 7

Neurosurgery Years 1 – 7

Oral & maxillofacial surgery Years 1 – 8

Otolaryngology (ENT) Years 1 – 7

Paediatric surgery Years 1 – 7

Plastic surgery Years 1 – 7

Trauma & orthopaedic surgery Years 1 – 7

Urology Years 1 – 8

Vascular surgery Years 1 – 7


Non-salaried training programmes

Allied Health Professionals

Arts therapy Years 1 – 2

Chiropody / Podiatry Years 1 – 3

Diagnostic radiography Years 1 – 3

Dietetics Years 1 – 4

Occupational therapy Years 1 – 3

Orthoptics Years 1 – 3

Orthotics / Prosthetics Years 1 – 3

Paramedics Years 1 – 3

Physiotherapy Years 1 – 3

Speech & language therapy Years 1 – 4

Therapeutic radiography Years 1 – 3

Dental (Professions Complimentary to Dentistry (PCD)

Dental hygiene Years 1 – 3

Dental nurse Years 1 – 2

Dental therapy Years 1 – 3

Dental hygiene & therapy Years 1 – 3

Dentistry

Dental undergraduate Years 1 – 5

Medical

Medical undergraduate Years 1 – 5

Nursing & Midwifery

Adult nursing Years 1 – 3

Children's nursing Years 1 – 3

Dual Field Nursing Years 1 – 4

Learning disability nursing Years 1 – 3

Mental health nursing Years 1 – 3

Midwifery Years 1 – 3

Occupational health nurse Years 1 – 2

Specialist - District Nurse Years 1 – 2

Specialist - Health Visitor Years 1 – 2

Specialist - Other Years 1 – 2

Specialist - School Nurse Years 1 – 2

Operating Department Practitioner

Operating department practitioner Years 1 – 3

Pharmacy


Pharmacy Years 1 – 4

Healthcare Scientist PTP (Practitioner Training Programme)

Anatomical pathology Years 1 – 3

Audiology Years 1 – 3

Blood sciences Years 1 – 3

Cardiac physiology Years 1 – 3

Cellular sciences Years 1 – 3

Clinical photography Years 1 – 3

Genetic sciences Years 1 – 3

Infection sciences Years 1 – 3

Medical engineering Years 1 – 3

Neurophysiology Years 1 – 3

Nuclear medicine Years 1 – 3

Ophthalmic & vision sciences Years 1 – 3

Radiation engineering Years 1 – 3

Radiation physics Years 1 – 3

Radiotherapy physics Years 1 – 3

Rehabilitation engineering Years 1 – 3

Renal technology Years 1 – 3

Respiratory & sleep physiology Years 1 – 3


Annex G. Lead employer

scenarios

Lead employer: illustrated examples of data input

1. Four examples of typical scenarios for the data input of lead employer/host provider

arrangements are detailed below. These are purely illustrative and do not necessarily

reflect typical provider input. They also assume that there has been no recharge

arrangement(s) for the trainee salaries by the lead employer organisation to the host

provider.

Example A: Host provider with no activity

2. This means that you are a host provider with all your FTEs coming from a lead

employer organisation(s) and have no FTEs employed by your own provider for the

particular training programme you are inputting data for, and also you have no

recharge arrangements in place with the lead employer organisation(s).

Example data

Data to input Data value Host FTE trainees 10 Total service and training hours 20,800

Total cost of cost Component s 1 – 8 £50,000

Cost Component 009a 50%

3. Input of this data to the input salaried template for the relevant programme would look

like Image 7.

Image 7: How to input Example A data

Even though you have entered the 10 Host FTEs into column J as

normal you must also enter them here so that column Z can make its adjustment calculations and that the mandatory and non-

mandatory validations will not be triggered

The unit cost calculations in columns Y / Z / AA are all the same as there is no salary

or any of the Host trust’s own FTEs involved

This is the total added cost of Cost components 1 -7

(columns have been hidden for the purposes of this

illustration) + (CC09a * CC08)

Pre-populated split

Note that there is zero salary because there has been no recharge levied

by the Lead employer trust

Enter the training hours as normal

Enter the 10 Host FTES as normal

Example B: Host with activity

4. This means you are a host provider with FTEs employed by your own organisation as

well as FTEs coming from a lead employer organisation(s) for the particular training

programme you are inputting data for, and also you have no recharge arrangements

in place with the lead employer organisation(s).

Example data

Data to input Data value

Your own FTE trainees 90

Host FTE trainees 10

Total salary for your own FTE trainees £3,150,000

Total service and training hours 208,000

Total cost for cost Components 1–8 £550,000

Cost Component 009a 50%

5. The above tabled data would look like Image 8 which shows you how the input

salaried template should be filled in.

Image 8: How to input example B data

Even though you have entered the 10 Host FTEs into column J as normal you must also enter them here so that

column Z can make its adjustment calculations and that the mandatory and non-

mandatory validations will not be triggered

This adjusts for the deflated cost per hour

calculated in column Y by calculating for just your own 90 FTEs and their

cost

This calculates the actual data entered for FTE cost per hour (which includes

salary) therefore the cost will be slightly deflated because you have more hours

dividing into a lesser total cost as a result of you recording the 10 Host FTE

activities but not their salaries

This is CC008 * CC009a + CC001 to CC007 (which are hidden for the purposes of this illustration)

Pre-populated split

This is the salary costs for your own trust’s 90 FTEs only. Because the 10 Host FTE salaries are incurred at the Lead Employer Trust and you have no recharge in

place to incur the cost for them, you will not input their salaries here. The Lead Employer trust will record the 10 FTE salaries in their own input salaried template

This includes your own 90 FTEs plus the 10 Host

FTEs

This activity includes all the FTEs entered in column J, therefore

includes your own 90 FTEs plus the 10 Host

FTEs

Example C. Lead employer with no activity

6. This means you are a lead Employer provider with FTEs employed by your own

organisation but have no teaching activity for the training programme you are

inputting data for as these FTEs are posted to a host provider(s) and you have no

recharge arrangements in place for them.

Example data


LET Hosted FTE trainees 10

LET Hosted FTE trainee total salaries £350,000

Cost component 009a 50%



Image 9: How to input Example C data

If you enter FTE numbers in column AD you must enter

the total cost of their salaries here. If you do not a mandatory validation error will trigger. See Image 12

Declare your 10 Host FTEs into column AD as Lead employer, these are not

entered into column J. Also entering the 10 FTEs here prevents mandatory and

non-mandatory validations from triggering.

The unit cost calculations in columns Y / Z / AA are

zero as there is no activity hours for calculating unit

cost

This is CC008 * CC009a + CC001 to CC007 (which are hidden for the purposes of this

illustration). CC001 to CC007 are zero in this example, however it may be the case that

there are some cost due to the recruitment and administration etc. as Lead employer of the FTEs, if this is the case input them to the

relevant cost component as normal

Pre-populated split

Even though there is no activity, the 10 Host FTE salaries are incurred by your trust

because you have no recharge arrangements as Lead employer with the

Host trust(s)

There are no FTEs in your trust. The 10 FTEs are

posted to a Host trust(s) entered in column AD

There is no FTE activity at your

trust; the 10 FTEs have been posted to Host trust(s) entered

in column AD

Example D: Lead employer with activity

8. This means you are a lead Employer provider with FTEs employed by your own

organisation as well as FTEs posted to a host provider(s) for the training programme

you are inputting data for, and also you have no recharge arrangements with the host

provider(s).

Example data:


Your own FTE trainees 80

Lead employer hosted FTE trainees 10

Your own FTE trainee total salaries £2,800,000

Total service and training hours 166,400

LET Hosted FTE trainee total salaries £350,000

Total costs for cost components 1-8 £400,000

Cost component 009a 50%



Image 10: How to input Example D data

If you enter FTE numbers in column AD

you must enter the total cost of their

salaries here. If you do not a mandatory

validation error will trigger. See Image 12

Declare your 10 Host FTEs into column AD as Lead employer; these are not entered into column J. Also entering the 10 FTEs here allows column Z to adjust for the

inflated calculation in column Y and also prevents mandatory and non-mandatory

validations from triggering

This adjusts for the inflated cost per hour calculated in column Y by calculating for just your own 80 FTEs and

their cost

This calculates the actual data entered for FTE cost per hour

(which includes salary), therefore the cost will be slightly inflated

because you have less hours dividing into a greater total cost as a result of you not recording the 10

Host FTE activities but including their salaries

This is CC008 * CC009a + CC001 to CC007 (which are

hidden for the purposes of this

illustration)

Pre-populated split

This is the total salary cost for both your own 80 FTEs + the 10 FTEs you

have hosted at another Host trust(s). You record the hosted FTEs as you have no recharge arrangements in

place and are incurring the salary cost.

This is your own trust’s FTEs but does not include the 10

FTEs you have hosted to another Host trust(s) and

detailed in column AD. The other Host trust will record

the activity instead.

This includes all FTE activity entered in column J,

therefore this does not include the 10 Hosted FTEs

detailed in column AD

Lead employer provider specific non-mandatory validations

(NMVs) columns

10. Lead employer provider specific NMVs have been added to the input salaried

template; these can be found at columns AZ and BA.

11. They are, ‘Salary costs outside national pay rates (adjusted for Host/Lead activity and

cost)’, and ‘Lead Employer (Column AE), Salary costs outside national pay rates’.

Please see Image 11 for details.

12. All information appertaining to NMVs and how to interpret them can be found at

Annex B. Note that non-mandatory validations are not in themselves an indication

that data is incorrect, and there are many valid reasons why data may not pass a

non-mandatory validation.

Image 11: Provider specific NMVs for lead employer

When you input Lead employer total salary into column AE for the FTE number entered in column AD, and this is more than expected for

national pay rates then this will flag a validation.

Where you have inputted Host and Lead data this can affect the calculation of Salary costs outside national pay rates in column

AY, therefore this NMV adjusts for this and if National pay rates are still outside the expected norm then it will indicate so.


Mandatory validations for 2016/17

13. There are 4 lead employer mandatory validations added to the input salaried

Image 12: Lead employer mandatory validations

This validation indicates that the number of Host FTEs you have

entered is equal to the Total number of FTEs in Column J. This means that

all the FTEs are Host trusted; therefore there can be no salary as the Host FTEs do not have a salary

because there are no recharge arrangements in place to record a

cost.

This validation indicates that the salary cost entered in the Lead

Employer salary column AE cannot be greater than the salary costs entered in cost component

008.

This validation indicates that you cannot enter a number of Host

FTEs in column AC greater that the total number of FTEs recorded in

Column J.

This validation indicates that if you enter Lead employer data then you have to enter both

columns AD and AE.

Contact us:

NHS Improvement

Wellington House

133-155 Waterloo Road

London

SE1 8UG

0300 123 2257

[email protected]

improvement.nhs.uk

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© NHS Improvement 2017 Publication code: CG 16/17

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