Those supporting CCGs must work out how to get them useful, reliable data. If they do their job, they could start a new era of benchmarking. By Jennifer Trueland
For the health service’s newest commissioning bodies - and those who are contracted to help them meet their goals - it’s vital to get information on which providers and commissioners can agree.
It’s all the more important - and challenging - when you’re a commissioning support unit working with 13 clinical commissioning groups and dealing with a diverse range of providers from acute trusts to community and mental health and even the private sector.
That’s why Chris Sharpe likes a service level agreement management system which provides “one version of the truth”.
‘Working with 13 CCGs there’s a massive amount of information and you can start to get really good benchmarking’
For Mr Sharpe - head of commissioning finance at North of England Commissioning Support (NECS) - giving CCGs the tools to make commissioning decisions which ensure they are meeting local demand, while getting the best value for the public purse, is more than a job: it’s a matter of personal pride. And to do this, high quality data flow is crucial.
“It’s about getting all contracting and financial information in the one place, reconciling it, and getting it all into the same point before feeding it out again,” he says.
“We can get our data from a variety of sources - with a good level of granularity - and providers and commissioners know they can rely on it, and are talking about the same figures, at least to within a few pounds. That’s really important for the NHS, both for those who are making commissioning decisions and for those who are delivering on contracts.”
NECS, which has been more than a year in the making, but formally took up the reins on 1 April, is a business set up to provide support to commissioning organisations across the North of England. Employing around 750 specialist staff (many from the former primary care trusts), its aim is to enable organisations to meet their commissioning goals and to benefit from economies of scale - with the essential ingredient of local knowledge baked in.
The organisation uses Civica’s Service Level Agreement Manager (SLAM) to collect, reconcile and manage information for commissioners, enabling them to be sure they are basing their decisions on sound intelligence, both hard and soft.
“There’s a huge amount of information in the NHS - one key thing is creating hard intelligence [on finance and activity] - but another important element is soft information, looking at the data and turning it into something useful,” says Mr Sharpe.
“Working with 13 CCGs there’s a massive amount of information and you can start to get really good benchmarking. But it’s not just about acute providers - it’s about data sets from community providers too.”
Meaningful information from the community could include variations in spending on district nurses, for example - if one CCG is spending much more than others, it might want to look at what it’s getting from that extra spend to see if it’s worth it. “That’s the sort of data that gives added value,” adds Mr Sharpe.
NECS head of data management Richard McLeod agrees - and would add that as well as information on financial, clinical and demographic factors, it’s also important to look at outcomes, such as how many patients are readmitted.
For all of these, and to allow people to focus on the job in hand, properly reconciled, high quality information has to be a given. “You used to find that there was a lot of argument with providers about whose figures were correct. If you can cut out the arguing, by making sure there’s one set of figures, that means more time for doing the core part of the job, which is making robust decisions about patient care,” says Mr McLeod.
He recalls working in the NHS before the implementation of SLAM. “There were a lot of information silos - people keeping bits of information in their own ways, so that when they leave, or aren’t there, nobody knows how to access it. With this system we have the right information in the right place at the right time - it’s a lot more flexible and allows a lot more matrix working.”
Making the information meaningful to those who are using it is another important element. “We are providing data to clinicians,” says Mr Sharpe. “They don’t want lists of figures; they want to know what it means for their practice.”
Mr Sharpe says he’s confident that the information his organisation provides is easily as robust as could be expected at this stage and already improving in quality, and it is, of course, subject to external scrutiny and audit. There can be a challenge, however, in persuading all CCGs and providers to be open with their data, although part of the solution to this is ensuring that they understand their responsibilities and what they can and can’t do with information.
And after all, the risks of having poor quality data are potentially serious and far reaching. “Take budgets, for example,” says Mr McLeod. “If your data isn’t sound, how will you know whether you’re overspending or even if you have underspent?”
So what are their tips for a successful implementation of a system like SLAM? “Communication, communication, communication,” says Mr Sharpe, simply. “It’s about making sure that people understand why we’re doing it - and making sure that the appropriate checks and balances are in place.
“My tip would be to start at as granular a level as you can,” says Mr McLeod. “You can always roll figures up, but there are always cases where someone wants more detail - at a practice level, for example. Building in that level of information may seem onerous at the beginning but it is worth it in the long run.”
One of the reasons why SLAM has found favour with Mr Sharpe and Mr McLeod is its flexibility - and the fact that it is developing and improving, building on users’ experience.
For example, traditionally there had to be human involvement in getting the data in and out, but automation of data flow - with appropriate checks and balances - means that the system is streamlined and turnaround is much quicker. “There’s always a demand to get information more quickly, and this is the way forward,” says Mr McLeod.
Lizo Ngqobongwana on data
Good information is the lifeblood of commissioning, as commissioning support units (CSUs) will now be discovering. Officially having come into existence on 1 April, their main source of income is generated by working for the clinical commissioning groups driving the NHS reforms.
Provider management is one of their key service lines. To effectively support CCGs in encouraging GP engagement in commissioning, the CSUs need access to fully validated, trusted and timely information, to ensure that the books balance on a monthly or even weekly basis, as well as to support strategic decisions such as QIPP and changes in how healthcare is provided.
Commissioning will work best if CSUs can provide the information to enable CCGs and providers to work together, even when some of their objectives may be different, or even conflicting. Historically, commissioners and providers spent far too much time preparing data and discussing its accuracy and trustworthiness - time better spent on resolving real healthcare delivery issues.
In our experience, where providers work closely with their commissioners and share trusted information, better outcomes are achieved, using fewer resources. System interoperability is critical to enabling a swift response to demands from GPs for earlier and more accurate pricing information.
Civica has been part of the NHS commissioning process since inception and its service level agreement manager (SLAM) solutions are now used for commissioning by almost 200 commissioner and provider organisations to process some £40bn of NHS funds each year.
We have developed the tools and services to resolve many of the operational issues faced by CSUs, CCGs and GPs. Working in collaboration with both commissioners and providers, through quality assurance, advice and guidance, we have been able to streamline processes so less time is spent preparing information and more on adding value.
The timescale for establishment of the CSUs and CCGs has been challenging, with limited time and resource for them to develop new, robust solutions. Even if this were possible, it is questionable whether these new organisations should be focusing their limited and valuable skills and resources in such an exercise.
This is where CSUs, competing in an open market, will need to forge partnerships with organisations (NHS or commercial) which can assist them in their quest to generate real improvements for patients.
Lizo Ngqobongwana is business development director at Civica UK