Private Healthcare Information Network Transparency in private healthcare

1. Private Healthcare Information NetworkTransparency in private healthcare Matt James, Chief Executive HC 2013, 16 April 2012

2. Agenda Why do we need greater transparency? What is PHIN? What will PHIN do? What

3. How does quality in private healthcare compare with the NHS? “Private healthcare in the UK may help you to jump the queue; it may buy you a private room and better food; but the one thing it does not buy you is better care. That, at least, is the theory – the understanding – which underpins the NHS.” Roger Taylor, God Bless the NHS, Faber 2013 How much do we really know?

4. There is information already in the public domain (but you really have to know where to look)

5. NHS Choices lacks data on independent care, and does not include private care Most data fields for independent hospitals show “n/a” In practice, most data is submitted and available via NHS SUS/ HES or other sources. So where is it?

6. Public Health England (HPA) infection control reporting on independent hospitals is hard to find http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1272032580726

7. NHS HSCIC PROMs data needs expert interpretation

8. What is PHIN? A network of member organisations in private and independent healthcare which collects data from each member and publishes comparative information, helping patients, policyholders and their GPs to make better-informed choices and hence to raise standards.

9. Twelve organisations will be included initially, representing 196 independent hospitals

10. PHIN’s service covers over 1 million patient episodes each year delivered in independent hospitals • PHIN’s data for 2012: • Privately funded: 650,000 • NHS-funded: 400,000+ • Website covers independent providers only at this point NB: draft data

11. Website – information and navigation • Search by • Location • Procedure • Age

12. Volume is visually compared to independent peers, with explanatory information available Volume These charts tell you how many of this procedure type each hospital performs relative to other private and independent hospitals. A pink line across the top (darker blue) segments indicates that the hospital conducts a larger than average number of these procedures, while a pink line across the lower (light blue or grey) segments indicates that the hospital conducts fewer than the average.* Volume of activity is not, strictly speaking, a direct indicator of quality, and it is not possible to say with certainty what is an ideal or clinically safe minimum volume of activity. In general, doctors recommend that patients are operated on by a surgeon who has sufficient regular experience of the operation. This data can only show how many of these operations are performed collectively by all the surgeons in a given hospital. As such, you may want to ask your surgeon how often they have performed the operation. Within Private and Independent Hospitals, all operations are performed personally by the consultant surgeon, and are not delegated to junior doctors. *The relative size of the four segments indicates the total number of procedures undertaken by the hospitals in that segment relative to others.

13. Length of stay distribution, not just average, is well-received by patients Length of Stay These charts show how many nights patients have spent in each hospital following treatment over the last 12 months following this type of procedure. This is usually called ‘Length of Stay’. The ‘average’ tells you what you might typically expect, whilst the chart below shows how this varies. For example, whilst patients may, on average, stay five nights in hospital, it may also be common for patients to be discharged after either three nights or seven depending on the speed of their recovery. Your consultant will tell you what to expect based on your age, general health and other factors. For simpler procedures, length of stay may be zero nights, or ‘day cases’. Time spent in hospital is given largely for information, rather than as a clinical quality indicator. Neither shorter nor longer is necessarily better or worse: in general, you probably don’t want to spend any more time in a hospital than is strictly necessary, but you also need to know that you will stay for as long as is necessary to ensure a good recovery. However, if the results for your hospital look noticeably different to other hospitals, you may want to discuss this with your consultant. A shorter length of stay or a higher ‘day case rate’ may be used by some hospitals, notably within the NHS, as an indicator of efficiency, rather than a measure of quality.

14. Further indicators require ongoing development A More data collection B Link to NHS data C Partner data Three development tracks: Depending on the type of indicator, the lead time between their being commissioned and available on the web site might range from between 3 months and 15 months. • Patient experience (F&F) • Readmissions • Unplanned Transfers • Mortality • PROMS • Joint replacement revision rates • Cardiac procedure mortality rates • Hospital acquired infections • Surgical site infections

15. We have a clear, timetabled plan for extending the range of indicators

16. All roads lead to greater transparency • Commitment from providers • Encouragement from insurers • Permission from the Competition Commission • “We have been presented with no evidence to suggest that information available to private patients should be not at least as extensive as that available to patients treated in the NHS”. • We will assume that the Francis recommendations apply • We want to work ever more closely with the NHS

17. Questions you may be left with Will PHIN deal with pricing? Will you show information on consultants? Will you include NHS providers and PPUs? Will we ever see private patients included in HES? What can the NHS learn from PHIN’s data? What role will insurers play? Is private data as good as NHS data? How will PHIN ensure that it answers patients’ needs and questions?