Commissioning and strategic priorities

NHS policy and the economic climate require increases in the efficiency and effectiveness of services, while increasing value for money from the services it commissions.

Wolverhampton City Primary Care Trust recognises that in order to become a world class commissioner of healthcare services and to address the quality and productivity challenge it faces, it must support the PCT and practice based clinicians and managers to make informed, evidence based decisions which support the strategic priorities of the PCT.

Key challenges identified by the PCT were:

• The shift in focus from PCT based commissioning to practice based commissioning
• The need for improved information quality to inform decisions and to demonstrate improvements
• The need to move the NHS from “data rich, information poor” to “information and intelligence rich, with decisions informed by evidence”
• The need to increase joint working across teams – commissioning, public health, finance and information
• Investments need to be prioritised according to the strategic priorities of the PCT, local health needs and the potential planned benefits.
• How then do you link the information that is collected and provided to the decisions that need to be made by commissioners?

In July 2009, Wolverhampton City PCT in conjunction with Courtyard Group UK developed a methodology which did just that.The Data to Decision model or DIUD was introduced to the PCT by Courtyard through a series of workshop around five of the PCTs strategic priorities. These were:

• Adolescent sexual health services
• Alcohol abuse
• Cardio-vascular disease
• Childhood obesity
• Infant mortality

What is DIUD?

DIUD stands for:  Data, Information, Understanding and Decision. This provides a common sense approach to diagnosing and prioritising information needs, by:

• Starting with the end in mind and asking - what objectives and decisions are you trying to support?
• Recognising that it is information that supports decisions, not data:
• Data is useless unless it is translated into information
• Information must be analysed, presented and made available in a format that can be Understood by the people who are required to make the decisions
• Decisions can then be made based upon the evidence base and the objectives specified at the start of the process
• Ensuring the information that is really needed to support commissioning decisions is identified.

The process

Five multi-disciplinary workshops were held with representatives from public health, finance, information, service managers and users. These identified a number of key themes:

• Many attendees were not fully aware of the strategic objectives that needed to be met and the work that was being developed to achieve them. 
• A multi-disciplinary group is the only way these information needs can be driven out in a pragmatic way
• The focus had previously been on what could be measured, rather than what was required to be measured to achieve objectives and assess progress. 
• Measures were more readily available for acute activity and finance, and less so for indicators that covered clinical effectiveness, patient experience and safety.
• Very little quantitative data about community and primary care data were available, even though systems were in place that could collect it. 
• A lot of necessary information was only available via external organisations, emphasising the need for resolution of challenges around data sharing and information governance.

The outcomes

The DIUD workshops and the improved working arrangements across departments and teams has resulted in an information pack containing most of the data and information required to support the achievement of each strategic initiative. This is now available on the trust’s intranet site and can be accessed by commissioners, clinicians and managers in the PCT.

Further work is being undertaken by service managers and information staff to access external organisations data sources to further enrich the information available to commissioners.   

The work is also influencing the trust’s information and knowledge management strategy, ensuring that the way in which information is stored on our supporting systems best meets the needs of our commissioners, in the context of the decisions they need to make.