COMMENT: Information takes centre stage in the new, local NHS

AS THE dust begins to settle on the Government’s plans for the NHS and proposals evolve from broad strategy to detailed definition, it is becoming very clear the NHS will need to radically overhaul the way it manages and utilises information.

GP consortiums have an urgent need to have a transparent view of PCT commissioning this year as they will inherit any deficits that are created during this process from April onwards

Accountability is becoming essential at every level of the new structure. While the service quality measures of QIPP (Quality, Innovation, Productive and Prevention) remain in place, the NHS Commissioning Board will be measured against the new NHS Outcomes Framework, which will define the set of outcome goals to be achieved and associated indicators. In addition, NHS providers will have to publish annual quality accounts, which will also include performance over time and in comparison with peers.

In the short-term, GP consortiums have an urgent need to have a transparent view of PCT commissioning this year as, fundamentally, they will inherit any deficits that are created during this process from April onwards.

However, information must also be used to facilitate better management at a GP practice, consortium and national level; as well as enabling far greater patient choice.

Information glut

The challenge for the NHS is to put in place an effective information strategy to facilitate the transition and enable both effective measurement and management. There is no doubt that the NHS is awash with data. The problem is that, to date, few organisations have used this data to achieve anything more than basic target measurement. If the vision of local empowerment, joined up co-operation with local authorities and, especially, the transition this year to GP consortia, is to be successful, this data glut must be quickly transformed into valuable insight.

The NHS is awash with data. The problem is that, to date, few organisations have used this data to achieve anything more than basic target measurement

The Government will soon publish its Information Strategy, but it is already clear that key aims include the mandatory use of the NHS number, increased use of Patient Outcomes Measurement Study (POMS) data, informatics requirements to support better integration between health and social care, and supporting GP consortia in understanding and fulfilling their information needs including skills and resource requirements.

The cornerstone of supporting this Information Strategy is the Information Centre, which will continue to be the repository for all nationally-collected data and will have a wider remit for defining data standards, as well as being a new legal power to access further data sets deemed of use. This information will then be made available to intermediaries to produce relevant analytics for the diverse NHS stakeholders. It will also make more outcome information available to the public to improve patient choice.

Local insight

However, under the current governance restrictions, while this aggregated information is extremely valuable for national planning, it does not provide the detailed local, patient identifiable information required to manage the local health economy.

In many cases PCTs have not only been very retentive with data, but have failed to effectively exploit analytics to gain value from that data. The result is that GP practices have had little or no access to key information on their own behaviour and performance

For example, to manage unwarranted variation in treatment of specific conditions, GP consortiums and their clinicians need to see the individual patient profiles behind this to validate it, as well as identify and understand the underlying issues linked to each patient that caused the deviations.

By arranging this information correctly, the consortium will be able to see immediately how their practices are complying with agreed strategies; the performance of acute providers around appropriate treatment, and whether or not actual spend on specific patient conditions is in line with expected budgetary spend. For the practice, information needs to be patient centric, but also provide an insight into performance within the GP consortium, including comparative information.

Immediate demand

Critically, the demand for this information is immediate. This year GP consortia are being formed, shadowing the primary care trusts (PCTs) prior to taking control in 2011/2012, from which time the consortia will be responsible for all deficits. It is therefore essential to scrutinise closely the PCTs this year to ensure local budgets are being managed effectively and vital to put in place the right infrastructure to achieve better use of resources from 2011.

However, the difficulty for GP consortia today is achieving access to this vital information resource. Many are struggling to understand what information is available and how best it can be explored. In many cases PCTs have not only been very retentive with data, but have also failed to effectively exploit analytics to gain value from that data. The result is that GP practices have had little or no access to key information on their own behaviour and performance. Hence, those forming the GP consortia have no idea just what information should be available to support the new demands of the NHS.

Strategic risk

It is by ensuring that the right data is in place at all levels to deliver insight into the quality of care and financial impact of decision-making that the NHS will enable the successful transition to the new, local model

It is rapidly becoming clear that one of the biggest risks facing this GP commissioning landscape is the lack of consistent information being made available across the country. The Government’s strategy is to let organisations follow their own path this year. But why let everyone make the same mistakes? There are several leading PCTs and practices that have already created highly-effective information resources. Other, less open PCTs, are far less advanced. There is a pressing need for this best practice to be propagated across England and while, in theory, this is a role for the new NHS Commissioning Board, it is a small element of a far wider remit.

There is, therefore, a strong argument that strategic health authorities (SHA) could become more pro-active in ensuring that PCTs are encouraged and challenged to engage with GP consortia from day one. Either way, an open and transparent discussion is required to ensure these organisations understand the information options, from leveraging the skills of the internal PCT team to working with external suppliers.

A three-dimensional approach

The role of the Information Centre to create a national repository of NHS information is undoubtedly significant. But its restrictions are very real and require serious consideration by SHAs, PCTs and GP consortia alike.

To be truly effective, information collection and business intelligence needs to be considered on a three-dimensional level: local intelligence to support GPs and their commissioning consortia, linked with community and social care data to support their joint needs and service planning. In addition, aggregation of a sub set of this granular data needs to feed the emerging PCT clusters from June and the commissioning boards that replace them. And, finally, national data is required to support strategic health planning and the public.

The Government’s focus on extending the national information repository makes sense. But the danger in the short-term is not arming GPs and GP consortia with the information required to support effective decision-making. It is by ensuring that the right data is in place at all levels to deliver insight into the quality of care and financial impact of decision-making that the NHS will enable the successful transition to the new, local model.

CASE STUDY:

SHREWSBURY and Telford Hospital NHS Trust has been working in partnership with MedeAnalytics to implement a solution that enables it to make decisions based on evidence, rather than subjective information.

Since go-live, the trust has been able to identify bottlenecks in the system, redesign services, increase efficiencies and, most importantly, continue to deliver high-quality patient care.

The data used to be held in multiple databases, which meant you had to request the specific facts you required from the information department and they had to manipulate the data to give you the answer. This significantly slowed down our decision-making process, or meant we had to make decisions based on instinct

The main provider of district general hospital and acute hospital services to half a million people in Shropshire, Telford and Wrekin and Mid Wales, the trust’s highest priority is to continue to improve the quality of the services in the new NHS commissioning landscape.

Steve Shanahan, finance director, explained: “It is vital to have the tools in place to be able to see where there are inefficiencies in practice and, perhaps, which department or existing process is costing the trust the most money. In the region we have an ageing population; people tend to retire to the area, so numbers of attendees are unlikely to decrease and, therefore, we have to be able to be more efficient with our existing resources. By utilising intelligent informatics, NHS managers can plan where existing procedures need to be streamlined and where resources can be redeployed to deliver a more productive and efficient hospital.”

One of the key drivers for introducing the MedeAnalytics solution was the plethora of information in the NHS and the difficulties accessing this data.

Shanahan said: “Historically, we had a problem gaining access to the data in our existing system in a short timeframe. The data used to be held in multiple databases, which meant you had to request the specific facts you required from the information department and they had to manipulate the data to give you the answer. This significantly slowed down our decision-making process, or it meant that we had to make decisions based on instinct.”

They selected MedeAnalytics’ Acute Trust Performance Analytics solution and then added the Coding Analytics.

Jill Price, assistant director of financial management, said: “Initially we looked at building a data warehouse internally. However, we soon realised that this would require a huge monetary investment as well as a dedicated resource team, which was simply not feasible for our organisation. That’s when we selected MedeAnalytics, with whom we worked intensely in the earliest stages of the project, to rapidly install a solution that would enable the trust access to critical financial information, inpatient and outpatient activity, as well as data specifically focused around our A&E attendees.

“Previously, information was held in disparate systems, not only making access to the information difficult, but it was also prone to error as data was manually entered into multiple databases. Through the MedeAnalytics solution, we are now able to source data from one central location that takes feeds from existing systems, reducing time-consuming manual procedures and ensuring consistency of information across the trust.

The solution allows all employees to quickly drill into high-level information, facilitating informed decisions that are based on facts and figures

“Most importantly, the solution allows all employees to quickly drill into high-level information right through to information based on an individual patient level via a visual dashboard display or report, facilitating informed decisions that are based on facts and figures.”

Samantha Cook, head of business information, added: “Information stored in this way has provided the organisation with the data to support business cases and service redesign. We work closely with the continuous improvement team to develop the data to support projects in a bid to reduce pre-operative length of stay, convert inpatients to daycases where possible, and improve outpatient and theatre utilisation.

“As an acute trust we need to be able to respond to queries raised by our local commissioners on a patient-by-patient basis within tight deadlines. The solution allows us to analyse the tariff components quickly in an easy-to-view format and resolve the query, facilitating payment for services provided. When guidance on tariff calculations change each year, MedeAnalytics adjusts the solution appropriately to include these changes, allowing us to analyse the financial effects to the organisation and assist in the planning process.”

The trust is currently introducing a three-year service improvement programme. Part of that programme is developing service line reporting and patient-level costing, for which MedeAnalytics is providing the back-end analysis of the data. This will help managers set differential targets based on this information, facilitating their understanding of where cost improvements can be achieved and helping meet government-led agendas like that of Quality, Innovation, Productivity and Prevention (QIPP).