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Coding clinical work should allow accurate and precise methods of assessing individual or department activity. The NHS financial reforms have increased correct diagnostic coding importance by introducing “payment by results” so that funding is directly linked to patient activity. The aim of this study is to assess the accuracy of procedure codes (OPCS 4.4), and its effect on Healthcare Resource Group tariff codes that directly affect revenue.

A total of ten procedures from ten consultants were randomly selected over one month. Each consultant coded his or her own procedures. From these codes, Healthcare Resource Group tariff codes were assigned to each patient. These were compared with procedure and Healthcare Resource Group tariff codes generated by coding department staff.

Of 100 procedures, four were un‐coded by coding department staff. There was concordance in 35 per cent of cases. Coders only gave one code for each procedure, whereas 35 per cent of procedures coded by consultants were assigned multiple codes. This resulted in 27 per cent of cases generating a different Healthcare Resource Group tariff code. Of the cases, five resulted in a difference of £4,000 or more; however, the overall difference was a £3,367 revenue loss if coder's codes were used.

Study numbers were limited to 100 with five cases showing excessive financial gain or loss significantly influencing the overall result.

Present procedure coding practice is inaccurate and results in Healthcare Resource Group tariff codes that do not accurately represent clinical activity and productivity. Under payment by results, this can result in a significant revenue loss and possibly ultimately future referrals. Therefore, coding practice needs to be improved as a matter of urgency. Arguably, this could be achieved by closer communication between coders and clinicians.

The paper identifies a flaw in the way clinical activity and productivity is assessed at present. This is fundamental to the process on which “payment by results” is based, and therefore must be addressed if trusts are to be financially successful.

This paper provides an overview of the range and development of health informatics, with examples from the literature world wide covering the types of information involved, the areas of application, the impact of evidence based medicine and other professional issues, integrated information systems, and the needs of the public, patients and their carers. While medical informatics certainly comprises a major part of health informatics it is not the main focus of this paper. Medical informatics is the older term and involves the use of information technology and computing specifically for medical science research, and the diagnosis and treatment of disease involving, for example, X‐rays, imaging, resonance, and magnetic scanning techniques. Rather, the scope of this review is the literature relating to the wider concept of the management of information through the interdisciplinary application of information science and technology for the benefit of patients, scientists, managers, staff, and carers involved in the whole range of healthcare activity.

This article reports an important multi‐centre practice‐based review that identifies good practice and an ideal pathway for the healthcare of frail older people, which, if replicated nationally, could result in improved quality of care and better value for money for the NHS. Data on healthcare resource groups (HRGs) in England were examined as a marker for the management of elderly people through the healthcare system. Care pathways in several different NHS trusts were explored via staff interviews. A high variation in treatment outcomes across centres was found. Principles of best practice were identified and include: comprehensive geriatric assessment; the availability of specialist geriatric teams and wards; and shared assessment and co‐ordination between care agencies.

Research and development of out‐patient case mix systems, to plan and monitor resource use in the out‐patient sector, has hitherto not been accorded priority in the NHS. As part of an investigation of their usefulness, a survey of NHS professionals′ requirements for out‐patient case mix was conducted. The results confirmed that there was support for developing out‐patient case mix systems, although different users had different requirements. However, a common theme to emerge was the desirability of constructing holistic systems which cover in‐patient, day‐case and out‐patient care. Additionally, development of care packages was seen as a necessary first step in constructing systems for out‐patient care. Concludes that visit‐based case mix systems are unlikely to fulfil users′ requirements and recommends that case mix contracting projects by Healthcare Resource Groups should be extended to the out‐patient sector, but must recognize that existing systems do not meet users′ requirements.

Management accounting, inter alia, gives information on how resources are allocated within organisations. If managers wish to change patterns of resource allocation, accounting knowledge is pivotal to any change processes. In health care organisations resources follow decisions made by clinicians, hence to have an impact on resource allocations managers must influence them. Direct managerial control over clinicians is not possible or desirable in health care organisations. This article suggests that incentives are an alternative to control in health care and investigates the impact of financial incentives within hospitals, utilising a naturally occurring experimental situation that has arisen between the UK and Canada.

The national tariff system for clinical processes and procedures aims to put a discrete unit cost on clinical activity. Calculating such costs can be subject to a great deal of local variation and interpretation. Given the rising costs of diabetes the purpose of this paper is to ask the question what does a diabetes outpatient appointment in the UK NHS actually cost? This is important in a time of financial austerity and healthcare rationing because it can be difficult to decipher the attribution of costs within the acute hospital setting.

Exploring this question, the author considers the present cost model and analyse in terms of the language of unit model cost; the basic tariff system and how it works in diabetes and looking at internal cost information the author attempts to unbundle the cost to provide a more accurate value for the cost object.

One major finding is that costs and overheads are divided arbitrarily as opposed to being distributed on the basis of measured relative consumption. Alternative costing methods are appraised to demonstrate that a patient level episodic costing approach such as patient level information and costing system (PLICS) which incorporates aspects of activity-based costing (ABC) would be far more appropriate. Using time driven ABC (TDABC), a new patient appointment costs £162 for 30 minutes and a follow-up appointment costs £81 for 15 minutes.

PLICS has the added benefit of greater financial and clinical transparency and this goes some way towards the holy grail of greater engagement with the doctors delivering clinical care.

It would appear that there are different purposes of different costing systems. One can argue that a costing system is there to both contain costs and divide overheads and demonstrate activity. Depending on how data are interpreted costing information can be an agent of enlightenment and behavioural modification for healthcare professionals to show them their direct and indirect costs, their capacity and productivity.

Clinicians and health service managers can see from this practical example how the distribution of costs and resources are unfair and can impede the delivery of a service. By using alternative costing methodologies such as ABC not only do the author gets a better reflection of the true cost of the finished consultant episode but is also able to engage clinicians in understanding how costs are generated.

The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.

A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts.

The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change.

The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of “generative” dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of “degenerative” dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.

Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

The purpose of this paper is to trace the changes in accounting practice in UK hospitals, focussing on costing, funding and budgetary control, and to place more recent accounting changes in their historic context.

The paper is largely chronological and draws from previous research by the author and other secondary sources, both of which are supplemented by reference to government publications, accounting practitioner journals and public records.

The paper argues that contrary to many implicit assumptions in academic accounting studies, our accounting ancestors promoted, and sometimes used, accounting data in pursuit of similar objectives to those advocated in the twenty‐first century. But, although cost information “evolved”, within its historical context, the process of establishing standard costs was slow and sometimes controversial, and the use of such information for funding hospital activity was avoided. In addition, the history of accounting reform in UK hospitals is one littered with disappointing results.

The paper provides an historical context to more recent accounting reforms in UK hospitals and suggests that the long history of “problems” documented in the paper may provide some cautionary counsel to contemporary accounting reformers.

The pursuit of cost efficiency in the British National Health Service has resulted in increased emphasis on devolved financial accountability and the introduction of an internal market. With the aid of a case study, this paper examines alternative forms of governance and proposes that aspects of the internal market and functioning within acute hospital units, are suited to network‐style organisation. The implications of hierarchies and networks for the design and use of management accounting information (MAI) are identified. These are used to analyse the case evidence concerning the roles, intended and unintended, of MAI in the context of organisational change and where multiple, and sometimes conflicting, goals and priorities existed. It concludes that a network approach to the design of MAI is more consistent with the desirable culture, at operational level, in acute units. However, this will only be achieved through deliberate intervention by those who design MAI systems and senior managers, who by their attitudes towards the interpretation and response to MAI, shape overall organisational culture.