Reorganisations might be familiar at Richmond House, but revolutions are rarer. With the information strategy officially paused, has the promised NHS spring turned to winter, asks Asthma UK chief executive Neil Churchill.
Further setbacks would indeed be a pity, as the information revolution was one of the reforms which met with most enthusiasm among patient groups.
The coalition’s strategy for revolutionising information about public services still lacks definition. Upon entering government, a mass of raw data about government spending was launched into the public domain, with the intention of fostering a knowledge industry to interpret and apply it. The recent launch of the 2012-13 outcomes framework was better but still left a lot of work for patients to do, if they were going to find the best doctor to meet their needs.
What patients need is more information and not necessarily more data. Much good work is being done, notably the recent focus on care records, but the final strategy needs to show how various initiatives are connected and where the focus will lie between data and intelligence.
If the character of the information revolution is yet to be defined, one pointer will be the fate of the quality observatories.
The quality observatories have played an important role in honing decision making, and not just within the NHS. One of the difficulties many doctors have is knowing which patients to refer to risk management services. But tools can help identify patients most likely to be admitted into hospital or spot unacceptable variations between practices, for example.
Few organisations employ dedicated teams of statisticians and even managers with numerate degrees need reminding how to manipulate and interpret data. The observatories have worked hard to make their expertise accessible. Their “ask an expert” pilot has made it possible to obtain precise and helpful answers to practical modelling challenges and the “skills builder” approach has helped managers improve their ability to model desired outcomes for change programmes.
With better intelligence needed across the system, the expectation must surely be that the quality observatories will survive in some form. But what kind of institution will they be? And what kind of information strategy will they herald?
In the coming months I will be hoping for clarity on three questions. First, will the focus narrow to the production of common datasets, dashboards and benchmarks or will there still be a strong emphasis on inquiry? The most difficult issue in research, scientists often say, is working out what question to ask. It is fine to start with a dashboard if the problem is well understood. If it is not, then support will be needed to interrogate options and design the right study.
Second, will the observatories support the whole health system or will they become a restricted resource for commissioners? Their value in better commissioning is well established. But there seems little doubt that providers have benefited from observatory support. Access to decent evidence on the links between activity, cost and outcome has never been more critical as managers seek productivity gains of up to 10 per cent.
The wider health system also stands to gain. I have been impressed by the openness of quality observatories to patient groups seeking to understand some of the variability in performance. By working with us, they have enabled us to ask the right questions and interpret data more effectively, which has made the process much less adversarial than when we relied more on published datasets.
Third, will there be more of an emphasis on the application of information to decision making, or will data largely be left to the professionals? Patient groups will be in a critical position as patients ask for help to understand what data means but this is not a role many organisations are ready to play.
Research funders like the Economic and Social Research Council have long laid stress on knowledge transfer as an outcome of research. The same principle applies to the NHS. Making intelligence available is a step forward. Helping diverse organisations gain the capacity to generate intelligence themselves and apply it in practice is a further leap.
Information can be a force for good or ill, depending on how it is created and used. For it to be a driver of performance improvement, we need to retain the inclusive, enquiring approach pioneered by the quality observatories.