We need a new generation of challenger organisations to fill the gap, writes Alex Kafetz
It was a throw-away comment in a CEO’s blog about corporate evolution.
Most people glossed over it, some NHS managers breathed a sigh of relief, and for a few it was like the sound of gears crunching, a car clumsily put into reverse with no-one looking in the mirror.
Last week, after three years of prevarication, Dr Foster confirmed the end of the hospital guide, and with it the end of proper transparency in the English healthcare system. Their CEO, David Rose, explained this away as strong regulation diminishing the need and that the hospital guide was pseudo-regulatory, but in positioning it like this Mr Rose misses the point.
The hospital guide had been the cornerstone of a burgeoning industry of independent organisations using data to publicly scrutinise NHS services
It was never about competing with the Care Quality Commission – indeed, towards the end, Dr Foster and the CQC had bilateral information sharing. Instead the guide was about pushing the whole system to move from a time of a secret society to a position where information and intelligence means patients and clinicians have equal power.
The hospital guide had been the cornerstone of a burgeoning industry of independent organisations using data to publicly scrutinise NHS services. These threw up some hard-to-take but ultimately welcomed new information about the quality of care – mortality rates in Stafford, infections in Maidstone, accident and emergencies overcrowded.
But one by one, all of these have withdrawn from the market: Capita not longer publishes its alternative guide, the BBC abandoned weekly winter watch, the Nuffield Trust doesn’t divulge its quality watch data at unit or hospital level (or make the data available), and even Sir Brian Jarman hasn’t published hospital standardised mortality ratios since 2011/12. Even HSJ in the past had columnists analysing routine health data, but now relies on Freedom of Information act requests to learn about hospital performance.
All this means that “government” (ie Department of Health and its arms length bodies) is now the monopoly publisher of data about the NHS. This is dangerous. For all his talk of “intelligent transparency,” Jeremy Hunt’s time in office has coincided with a period when the market died.
So why is this important?
We have of course the well used NHS Choices and its sister site MyNHS, which the health secretary heralds as the centrepiece of his strategy, but these are government administered and government funded. Indicators are decided laboriously by committees (some of which I sit on) and can a government funded site really hold a government funded health service to account?
The transparency from external sources, often called challenger organisations, are needed to keep pushing the boundaries, to trial new and perhaps controversial measures before they take two years becoming “official statistics” and to create patient movements.
One such example is in patient safety. At this year’s NHS Confederation conference, in a matter of fact way, the health secretary mentioned in his speech how many “never events” (wrong site surgery and foreign objects post surgery) has occurred in the NHS in the previous month. No-one complained or commented.
It was accepted as a small but crucial part of the ambition to make the NHS the safest system in the world. I was part of the Dr Foster team that published the first system-wide analysis of these data in 2009, to a high volume of complaints and comments, quickly accompanied by some cease and desist letters from NHS providers.
“The data is inaccurate, you can’t use these to measure safety, it will deter reporting, we don’t know the benchmarks” were just some of the many reasons we were told these metrics should never be published.
I’d like to advocate that any organisation accessing patient level data would have an expectation, either implicit or contractually, that they will run an intelligent transparency function
Now, a few year later they are routine. The challenger organisation took the risk and the flak, pushed the government to commit to the measures and paved the way for these to have the prominence they deserved. It was the same story with risk-adjusted mortality rates, told through the Stafford Inquiry.
So how can we kick start a thriving industry of challenger organisations? Certainly, the private sector has become more risk averse (lawyers advising not to do this), and patient groups have shown little appetite to move into the space. I’d like to advocate that any organisation accessing patient level data, from private companies to not for profits to universities, would have an expectation, either implicit or contractually, that they will run an intelligent transparency function alongside their primary use, be it research, commercial purposes, population health analysis etc.
This would be funded at their cost but an expectation on applying and accessing data.
For example, if a management consultancy is analysing hip fracture data to sell pathway optimisation improvements to foundation trusts, they would be expected to publish this analysis at a non threatening level such as by STP or at regional level and make the analysis available under an open data licence.
Normal rules of information gathering, no small numbers or any chance of identifying patients would of course apply. Anything exceptional could then be taken on by government and published on My NHS. It’s a shame the old guard have decided not to be transparent, but let’s encourage a new breed to take their place.
Alex Kafetz is COO of ZPB and an independent member of the Department of Health’s transparency programme board. He edited six editions of the Dr Foster hospital guide from 2008-2013.