As the government’s reforms being to take shape, embracing change and utilising information to drive UK healthcare forward is central for general practices, trusts, managers and clinicians. Paul Fitzsimmons explains the role business intelligence must play in enabling organisations to understand the new health economy.
As the dust begins to settle on the government’s radical plans for the NHS and proposals evolve from broad strategy to detailed definition, it is becoming very clear that the NHS will need to radically overhaul the way it manages and utilises information.
Accountability is becoming essential at every level of the new structure. While the service quality measures of quality, innovation, productivity 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, commissioning consortia have an urgent need to have a transparent view over PCTs commissioning this year as 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.
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 cooperation with local authorities and, especially, the transition this year to commissioning consortia, is to be successful, this data glut must be quickly transformed into valuable insight.
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 data, informatics requirements to support better integration between health and social care and supporting commissioning 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 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.
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.
For example, to manage unwarranted variation in treatment of specific conditions commissioning consortia 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-centered but also provide an insight into performance within the consortium, including comparative information.
It is rapidly becoming clear that one of the biggest risks facing commissioning consortia 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 also 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 NHS Commissioning Board, it is a small element of a far wider remit.
There is, therefore, a strong argument that strategic health authorities could become more proactive in ensuring that PCTs are encouraged and challenged to engage with consortia. 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.
The role of the Information Centre in creating a national repository of NHS information is undoubtedly significant. But its restrictions are very real and require serious consideration by SHAs, PCTs and 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 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.