Better Data for Informed Commissioning Improving data quality: national developments

1. Better Data for Informed CommissioningImproving data quality: national developments Dr Masood Nazir General Practitioner Clinical Informatics Advisor NHS England

2. About us • The NHS Commissioning Board (NHS CB): • was established as a special health authority on 31 October 2011 and as an executive non-departmental public body on 1 October 2012; • plays a key role in the Government’s vision to modernise the NHS and secure the best possible outcomes for patients. • Renamed to NHS England – 1st April 2013

3. Clinical Informatics Team • Professor Jonathan Kay – Chief Informatics Officer • Multidisciplinary clinical leads • Anne Cooper - Nurse • David Davis – Paramedic / AHP lead • David Low – Consultant Paediatrician • MasoodNazir – GP / CCG lead • Network support team - Head of Informatics, Network support manager, project support • Recognition that clinical input and networks are essential to deliver our goals

4. ‘Zero harm’ NHS Following mid Staffs, need a ‘zero harm’ culture “Unaware of a patient’s history, complications arise in surgeries, diagnostic tests are repeated and patients find themselves repeating their medical history over and over again, sometimes several times on the same day. National Urgent Care Review 2013 – • “Information critical to my care, is made available to all those treating me”

5. Drivers for change Unleashing the power of people - by using data and technology to drive efficiency, effectiveness and quality improvement • The Spending Gap:It is estimated that there will be a shortfall of around £30bn in NHS finances within 5 years, as demand and costs rise. Yet there is unlikely to be a similar increase in public expenditure. Data and technology, through transforming productivity and enabling patients to do more for themselves, can play a major role in filling that gap. The Quality Gap:There continues to be widespread variation in the quality of health and care services, and in the offer to support citizens to manage their health and Wellbeing more effectively. Strategies of transparency, data sharing, and service personalisation are key to reducing variation. In the medium term, data and technology are essential pre-requisites to the transformation in patient outcomes and healthcare costs “The effective collection, analysis and dissemination of relevant information is essential for swift identification and prevention of substandard services; facilitating accountability; provision of accessible and relevant information to the public; and supporting patient choice of treatment.” Robert Francis QC Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

6. Birmingham CrossCity CCG – current configuration Population: • 730,000 patients Number of practices: • 117 practices across 125 sites Formed from 3 PCTs across the city and • Six former groups: • Equity, UBC, SBIC, Sparkfield, BICC, NEB Made up of ten area based clinical networks

7. England expenditure (£m) – 2011/12

8. Key health investment tools • CCG Outcomes Tool–overview of prevalence, demography and outcomes for each CCG (just released – June 2013) • Programme Budgeting Benchmarking Tool – comparative spend data by PCT • Spend and Outcome Tool – looks at spend by programme compared to health outcomes (example on next slide) • Programme Budgeting Atlases – mapping software to illustrate metrics • NHS Comparators – metrics down to practice level – includes inpatients, outpatients, QOF and prescribing data by spend and volume. Practice level data too • Inpatient Variation Expenditure Tool – comparative spend on high volume HRGs • Patient Reported Outcome Measures Tool – actual health gain from interventions such as hip and knee replacements • NHS Atlases–tools containing maps showing variation in quality indicators • Primary Care Commissioning Application – QOF tool providing comparative CCG and practice performance

9. 2. Context Birmingham CrossCity CCG has the fourth highest budget in England

10. Challenges – electronic referrals

11. The Patient-Centred Informatics Model Provided by Informaticians Needed by Analysts A by-product of clinical activity Provided by Analysts Needed by Patients Needed by Clinicians and Commissioners

12. Information is crucial for commissioning Stage 1 What information do you need? Capturing Information & Data Quality Adequate IT systems / processes in place • Stage 2 • Primary Care Data Extraction • Who can do this? • Aetna • McKinseys • HSCIC • UHB • Graphnet /Apollo • MSDi • Bespoke solution Stage 3 Share information in user friendly format ( Dashboard & website) Benchmark & identify gaps

13. 5 stages of grief • Adapted from Elisabeth Kübler-Ross 5 stage model • (Though more modern grief theories such as that of John Bowlby described as ‘ebb and flow of processes such as shock and numbness, yearning and searching, disorganization and despair, and reorganization’ have some attraction) DENIAL ANGER BARGAINING DEPRESSION RESOLUTION The data is wrong It does not apply to me I will get the correct data There is nothing I can do about it Acceptance and action Courtesy of Simon Swift

15. What is Information Specification about? • ISP is getting the right information into the right peoples hands in the format that allows them to understand the data quickly

16. NB: one virtual information system providing information for different clinical/ business needs Corporate information system (static data) Operational management information system (live and static data) Need to ensure end-users have access to the “right information, in the format that allows them to understand the data quickly” Clinical information system (live data) IT: scalable data storage, secure networks, web access, etc

17. Top 10 specialties broken down by Spell & HRG Cost of Spell by HRG Practice Level: Drill down In-patient Module Spell by procedure Cost of Spell by diagnosis

18. GPADS: GP Acute Data System • Accessible via NHS Number from any of the acute activity reports • Summary information from the primary care system, including demographic data, primary care diagnoses, acute activity in last six months and biometrics. • Patient-specific A&E and inpatient admission reports

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24. How does a commissioning body influence anything? •Mandatory elements in contracts •Funding projects • National • Local •Transfer of good practice • Galley of examples Awards • “Do once and share” •Influence by… influence

25. The challenge • Implementing commissioning intelligence solutions is a challenge, a major project and a substantial change to the way care is delivered • But it is achievable, and others have achieved it and gained many benefits • Achieving good data quality remains a challenge, but sharing od data is one of the first steps on the road to achieving

26. Give me a kick when it’s all sorted Dr Masood Nazir: masood.nazir@nhs.net How can we help?