Clinical Coding is still not getting the profile it needs within NHS Wales

Monday, September 14, 2020 - 11:16am

The current pandemic provides a real opportunity to raise the profile and secure improvements to a function that underpins the data upon which the NHS relies

Clinical coding continues to have a low profile at Board level, and arrangements could be enhanced by critically examining the level of investment in resources, good quality source information and engaging medical staff in the coding process.

Timely and accurate clinical coding is essential to the planning, management and oversight of NHS services. During the current pandemic, clinical coding has played a key role in informing decisions on which patients need to shield and is key to understanding ongoing COVID-19 related demand on healthcare services.

In 2013-14 and again in 2018-19, we examined clinical coding arrangements in the seven Welsh health boards and Velindre NHS Trust, and published the reports for each NHS body on our website.

The report we’re publishing today draws on our local audit work to highlight the current challenges and opportunities for clinical coding, including the potential to use the changes made to ways of working during the pandemic to secure new and more sustainable ways of delivering coding work.

The significant step-change in the use of digital platforms during the pandemic has created an opportunity for NHS bodies to increase the extent to which digital records are utilised, increasing with it the scope to reduce the time it takes to code activity, and support smarter and flexible working by clinical coding staff.

Some key facts:

  • Approximately £5.9 million per annum is spent on the NHS clinical coding process across Wales.
  • On average, there are about 1.1 million consultant episodes of care each year that need to be coded, with an expectation of approximately 30 consultant episodes of care to be coded each day per coder.
  • At the end of April 2020, 83% of consultant episodes of care had been coded within one-month compared to the 95% target set by the Welsh Government.

The 2019-20 annual clinical coding audits undertaken by the NHS Clinical Classifications Team identified an accuracy level of 94%, against a nationally recognised standard of 90%. 

Clinical coding is an important but often overlooked function of the NHS, providing the backbone to much of the information used to govern services but its profile in NHS bodies is not yet where it needs to be.

The importance of good quality information has come to the forefront during the coronavirus pandemic and with new ways of working being put to the test during the crisis, now is the ideal opportunity to ensure that clinical coding has the attention that it needs as services start to be reinstated.

Adrian Crompton, Auditor General

Notes to Editors:

  • This report looks at the management of clinical coding across Wales.
  • Clinical coding is the process of translating medical information which describes a patient’s symptoms, diagnosis and treatment into internationally and nationally recognised code which can then be used for statistical and clinical purposes.
  • Information relating to the patient’s symptoms, diagnosis and treatment are coded.
  • The clinical coding process applies to hospital admission activity and procedures undertaken in outpatient settings only.
  • The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £20 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed from the Welsh Government to the NHS in Wales (over £8 billion) and to local government (over £4 billion).
  • The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government.
  • The Wales Audit Office (WAO) is a corporate body consisting of a nine-member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
  • Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself.