Alison Moore reports on a collaboration of health and social care organisations that aimed to defeat ‘silo’ mentality by pooling data to target services most effectively
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Integrated care is what health and social care economies aspire to – and many current policies are aimed at delivering the improved care for patients and potential savings that it offers.
At the heart of integrated care is an assumption that partners in providing care already share information to pinpoint trends in demand, analyse overall costs and benefits, and inform decisions about care.
But that often does not happen – information is siloed and decisions about provision of services and the outcomes of service changes are taken without all of this being available.
Some areas have decided this can’t continue and they need better shared data to maximise the benefits of initiatives such as the Better Care Fund and sustainability and transformation plans.
Health and social care organisations in Derbyshire decided to tackle these issues back in 2013, spurred on by commissioning Pi’s Care and Health Solutions to throw additional light on how patients flowed through the system and at what cost.
The Derbyshire Pound
The starting point was the local chief executives who were aware that they often had good data on what happened to patients in their own organisations – but knew very little about what happened to them elsewhere or which other organisations they were in contact with.
With increasing financial pressures across the health and social care system, better information could lead to better use of resources – getting the most out of the “Derbyshire pound” as they described it.
The problem was that they had no way of knowing when people were accessing different services. This changed thanks to the Pi system, which allowed them to see whether people had been into accident and emergency or had some social care contact.
We see people trying to reinvent the wheel all the time and develop their own software to share data. That can mean a delay of months
The organisations that came together to share data included two acute trusts, community and mental health providers, four clinical commissioning groups, two local authorities with social services responsibility, the ambulance trust and a social enterprise providing GP out of hours care.
Patients’ progress through the system could be tracked to provide an aggregated picture.
This information can be broken down by age groups to show which services they came into contact with and identify which groups are repeatedly accessing services.
Brenda Howard, a consultant who was involved with the scheme almost from the start, says there was enthusiasm and support from the chief executives.
When asked what information they wanted from the system, the answer was universally around the flow of patients and service users, and to understand where else they had been.
“They had no idea where the patients had been before they came into their organisations or where they went subsequently,” she says. “We now have unprecedented insight into how patients flow through our collective system. You can plan care better once you know how people are using the system.
“The tool is one thing but it is the use of it which matters. The fact we took an organisational development approach to it was helpful.”
Agreement on information governance was also vital, as was training and support for people to use the tool.
The shared data is pseudoanonymised so that individuals are not identifiable. However, it does allow identification of certain groups with a high use of the NHS: for example, whether patients from particular practices are making disproportionate use of A&E or whether some care homes have a lot of admissions to hospitals among their residents.
Evidence can and has driven changes. One example is around falls: many falls patients are already in contact with hospital services, such as outpatients.
The data has allowed particular outpatient clinics – including, for example, ophthalmology - where a number of patients subsequently go on to fall to be identified.
With STPs providing a powerful lever to get everyone round a table, having shared information is vital to maximise the opportunities to reduce unnecessary use of the NHS and make best use of the money available
Andrew Muirhead, senior public health manager at Derby City Council, says interrogating the ambulance and A&E data has also allowed aspects such as time of arrival and primary diagnosis to feed into the picture.
“We know for certain that falls risk advice was not being routinely offered to that cohort of patients who were already in contact with outpatients,” he says: falls prevention work at outpatients stage is being considered.
Another example is comprehensive geriatric assessments: do they make a difference to patients’ use of other services in the period following assessment?
Interrogating the data – and using a control group who had not received the assessment – has allowed some nuanced information to be pulled out.
After just one week, for example, there was good evidence of lower A&E use and fewer admissions among those who had had an assessment.
This continued at one month and six months after assessment, offering improved outcomes for that group as well as substantial potential savings for the local health economy.
“It is the local evidence base that local commissioners need to consider investment and disinvestment in services,” says Mr Muirhead.
Reinventing the wheel
A similar approach is being taken in Leicestershire – which is also pulling in data from nearby areas where its residents may receive care.
Pi’s Care and Health solution is also being used in Southend to look at cohorts of older people who had repeated hospital admissions. Work there has led to new approaches with monthly multidisciplinary meetings to look at patients at high risk of admissions.
Integrated care is what health and social care economies aspire to – and many current policies are aimed at delivering the improved care for patients and potential savings that it offers
The issues around shared data are not unique to these areas, says Julia Ross, managing director of Pi Care and Health.
With STPs providing a powerful lever to get everyone round a table, having shared information is vital to maximise the opportunities to reduce unnecessary use of the NHS and make best use of the money available.
The challenge for many areas will be to get this work off the ground as quickly as possible – and that means finding ways to share data now rather than in six months’ time.
“We see people trying to reinvent the wheel all the time and develop their own software to share data,” says Ms Ross. “That can mean a delay of months in sharing data when we already have the ability to do it now.”
Integrated services: Why data sharing should happen here and now
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Integrated services: Why data sharing should happen here and now