A business critical briefing from HSJ’s Intelligent Information for World Class Commissioning conference
- Sir Muir Gray, chief knowledge officer, NHS. Download Mr Gray’s presentation.
- Dr Duncan Ross, commissioning adviser, the NHS information Centre
- John McIvor, chief executive, NHS Lincolnshire
- Dianne Conduit, PCT relationship director, Humana Europe Ltd
- Dr Bobbie Jacobson OBE, director, London Health Observatory
- Professor Brian Ferguson, director, Yorkshire and Humber Public Health Observatory
- Andrew Kenworthy, chief executive, NHS Nottingham City
- Nick Manson, associate director of knowledge management and clinical information, NHS South Central
Securing and analysing the information essential to drive effective, intelligent and world class commissioning, Sir Muir Gray, chief knowledge officer, NHS
- The use of knowledge has not reached all parts of the NHS yet but it needs to.
- The NHS needs a new working structure based around patients, systems, networks and knowledge.
- The NHS needs to learn best practice from wherever it is.
- There are probably 10 large sources of data. These need to be organised.
- The chief knowledge officer (half the PCTs have one) should be responsible for getting knowledge into action.
- Challenges include: putting information in front of decision makers changes value judgements; politicians do not like information that contradicts them; patient-centred care is challenging to clinicians; all PCTs face demographic changes; NICE is approving a significant number of new cancer drugs that may skew expenditure.
Assessing local need to influence planning and deliver world class commissioning, Dr Duncan Ross, commissioning adviser, the NHS information Centre
- Tools and information are available on the NHS information Centre website.
- The Information Centre has five main programmes: clinical, public health indicators, information for patients, workforce planning and productivity, information for commissioners.
- The Information Centre is looking to improve access.
- On beta test at the moment is My IC, a tailor-made desktop where all the relevant sources of information are presented.
Strengthening partnership working to ensure the effective sharing of information, John McIvor, chief executive, NHS Lincolnshire
- General managers in bands six, seven, eight should be able to use and be enthusiastic about information. Some are just not up to it.
- Data quality is important and there is a cost/quality trade-off.
- The Audit Commission’s payment by results review shows that data quality has not improved over the years and so it will be necessary to set standards in the contract for error rates.
- The national contract needs more incentives and levers to meet data quality standards.
- Most models are based on linear predictions, which may not be a good basis for planning. One option is to use scenario planning to test and ensure robust decisions are made.
- In collecting any data, the aims and objectives must be clarified. It may need data from big systems or maybe non-computerised elements of the system.
- NHS Lincolnshire has well-defined partners and a policy of sharing information.
- There are concerns about collaboration on a regional basis because this may duplicate national tools such as the Information Centre and not be local enough to bring in other partners.
- The Lincolnshire research observatory is a single point to access data that is jointly funded and has shared staff.
- The future is in more partnership working. There is a need to overhaul IT systems and remove boundaries between parties.
Ensuring data is accurate, robust and helpful to better understand patient pathways, Dianne Conduit, PCT relationship director, Humana Europe Ltd
- There is a need to prioritise the development of pathways based on information.
- Pathways with great variation between providers should be reviewed.
- There should be agreement on the clinical thresholds for treatments and the development of criteria for low value treatments.
- The current acute contract is seen as embryonic and needs to define better the standards and commissioning arrangements.
Developing effective “bottom-up” approaches to information reporting in London, Dr Bobbie Jacobson OBE, director, London Health Observatory
- London is a large, complex city with many health and partnership organisations.
- These organisations do not have a critical mass to support their own information function.
- If every organisation had its own database, information and analytical functions, there would be duplication and waste.
- The types of information that can be produced and the toolkit are on the CSL website.
Implementing economic thinking to future-proof commissioning, Professor Brian Ferguson, director, Yorkshire and Humber Public Health Observatory
- In terms of efficiency, the NHS has had 56 per cent real terms growth to 2011, but the question is has the service delivered this level of additional value? If not, then the tighter financial constraints may just increase efficiency.
- There is a lot of information, but some of it is not used (such as QALY) because of a culture of not using evidence.
- There is a conflict between payment by results which encourages hospital admissions and the drive to keep people out of hospital.
- The Spend and Outcome Tool (SPOT) is a very useful source of data.
- With predictive modelling tools, a lot of data is based on synthetic estimates such as lifestyle indicators. It is necessary to be very careful when extrapolating from this data. In modelling, it is best to take one step at a time and understand how tools can be used and whether the methodology behind them is transparent. There is a risk with commercial tools that it is not possible to see the methodology used.
- In future, there is a need to look at the big areas where there is no evidence to support activity. For example, there is no evidence of a requirement for follow-up on chronic disease in hospitals. Decisions need to be expressed in opportunity costs to understand the impact, stating the alternative cost of not decommissioning.
Benchmarking performance to identify room for improvement, Andrew Kenworthy, chief executive, NHS Nottingham City
- PCTs need to use benchmarking to meet the current financial challenges.
- PCTs needs good benchmarks to work out how to spend millions less. Up-to-date information is required and it is necessary to be clear on which indicators to use and which to ignore.
- If information targets the right audience and is delivered in the right way it can be effective.
- Implementing effective benchmarking requires good leadership.
Information for world class commissioning - the South Central experience, Nick Manson, associate director of knowledge management and clinical information, NHS South Central
- NHS South Central has developed a collaborative operating model to strengthen commissioning and to develop system change.
- It was developed by using strategic sourcing applied to the commissioning cycle and provides more granularity, with guides to almost everything.
- Nationally, “establishing the evidence” has been developed to improve quality and productivity. It is a single portal to provide evidence where both quality and productivity improves within a scheme or change. There will then be six high impact areas that should be undertaken.
Derek Miller is an independent consultant, currently working at South West London Acute Commissioning Unit.
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