“When I started in 2006… my health was of low standard, I was overweight and had low self esteem due to several strokes.
“By 2009 I had lost enough weight to have my diabetic medication stopped, I was fitter, breathed easier and had confidence in myself… I enrolled on a course to begin studying again, such was the confidence that I had developed.”
Insurance companies are information rich, and their success is grounded in the accuracy of their approach to individual and population risk assessment
In Birmingham East and North more than 4,000 people have now had similar experiences as a result of support over the phone at times convenient to them. Evaluation has found significantly improved clinical control and a 50 per cent fall in hospital use and contact with their family doctor. GPs also report that consultations which do take place are much more appropriate and focused.
The target population is people with established chronic disease, who have not been doing well in routine care despite the best efforts of many experienced and able clinicians.
Given the high levels of satisfaction with the service, its effectiveness and the reduction in unhelpful cost, we planned to have 9,000 people registered by the beginning of this year.
We have struggled to recruit them: largely because we have relied on general practice to identify and make first contact with people who may benefit.
This approach was grounded in a commitment to partnership with clinicians and a concern that for many of our target audience contact should come first from a familiar and trusted source.
Over the last two years, these principles have been severely tested. It is frustrating to have available a highly cost effective intervention, but to be reliant on an intermediary to get round to offering it to the user.
We are developing new routes to direct marketing which will allow us to identify and make an offer to people who may benefit. This was an obvious option from the start, except that once primary care trusts start to make direct contact with the populations they serve, the sacred cow of confidentiality starts to moo.
Writing in the magazine Prospect in August, Tim Kelsey of Dr Foster Intelligence took on the civil liberties lobby on this issue. He highlighted the many ways in which any risk to personal information is offset by benefits in responsiveness, effectiveness and cost reduction in public services, with a positive impact for all of us.
As commissioners we are accountable for the wise investment of public money to achieve health improvement and ensure access to safe and effective services. The world class commissioning competencies enshrine this role in the cultural challenge to be “local leader of the NHS” and in technical requirements to demonstrate that we “prioritise investment” and “manage knowledge” to “manage the finances”.
These are real challenges, particularly if we are to be measured on our ability to manage knowledge, but limited in our access to the information which underpins that knowledge.
Insurance companies are information rich, and their success is grounded in the accuracy of their approach to individual and population risk assessment. They require sophisticated analysis of data, advanced skills in impact and expenditure modelling and access to a range of very personal information.
We cannot ensure the health of the NHS if we cannot insure the health of local people. We cannot insure the health of local people unless we have direct access to personal information and use it to provide cost effective services, which are targeted, accessible and relevant.
Professor Ross Anderson, author of Database State, is rightly concerned to protect against state abuse of personal information, however even he notes that “in medicine you have to make sure that the systems are responsive to needs”. To do that we need system access to personal information.
The benefits of this system access operate at a number of levels. Local people have a better understanding of their own health status, care arrangements and opportunities. It enables improved communication between clinicians, consultation and access to information when required urgently. It supports early identification of people who are becoming ill, struggling to find help or abusing free care. It supports commissioners in designing services which are targeted and responsive, finding the people who need them and in minimising variation in practice to release resources for better investment.
It is important that we pay attention to the security of personal information. However, previous debates suggest that the stridency of the civil liberties lobby may override other voices; the prevalence of CCTV on disadvantaged estates has largely been at the request of local residents. The willingness of the population at large to share intimate information on the web suggests that where individuals see benefit in an open exchange of information, they are very willing to participate.
We should be investing more time in developing systems which will allow for that exchange to happen securely for the NHS rather than in locking down the current system. It is ridiculous that we still invest in faxing written information as the most secure method of clinical exchange and continue to deny adults the opportunity to opt into services, unless another adult has given consent on their behalf.