What’s providing local NHS organisations with access to more than 50 separate data quality indicators allowing them to benchmark their performance - free to anyone with an NHS email address?
The answer is the Audit Commission’s National Benchmarker. Set up two years ago, it now has registered users in every acute trust, primary care trust and strategic health authority in England.
It was also joint winner of the excellence in healthcare information management category of last year’s E-Health Insider Awards in association with BT.
It started with coding
The National Benchmarker was born out of the Payment by Results Data Assurance Framework and was initially designed to target clinical coding audits. This is a crucial area, particularly for acute trusts and PCTs, as clinical coding underpins the flow of money round the system.
In the most general terms, it pulls together acute hospital activity data, clinical coding and PbR related data from across England, using the HES/Secondary Uses Services provided by The NHS Information Centre.
It then makes this available to users locally, helping them to compare their data with that of other organisations. This kind of benchmarking allows them to flag up areas of concern and helps prompt discussions about matters such as healthcare management, payments or data collection.
The National Benchmarker provides inpatient and outpatient information, with more than 50 separate data quality indicators ranging from the generic - such as average price of spell or follow-up ratio - to the highly specific - such as indicators looking at the number of intended day cases that ended up staying overnight, or the number of patients with more than one outpatient attendance on the same day.
With such a level of detail, it was clear from an early stage that its relevance went far beyond just PbR data quality. Howard Davis, PbR benchmarking manager at the Audit Commission, says: “It can be used to inform many areas of work: world class commissioning and service redesign, efficiency and productivity, quality accounts and data quality in general, contracting and informatics.”
The tool enables commissioners and providers to get under the skin of their activity and fully understand the complexion of patients being treated, he says. Together, acute trusts and PCTs can use the information to get better value for money and drive down costs within the health economy, while improving access to healthcare in the most convenient manner for their patients.
Real trusts getting real benefits
The team at the Audit Commission designed the National Benchmarker as an easy to use tool for non-analytical staff. Davis says: “I came from the NHS and in part the tool comes from the sense of frustration that I had in trying to get and use this sort of data. I have always tried to develop this as something that will benefit the people I used to work with.”
Feedback has shown that clinicians and senior managers really like it, he adds. “They tell us that it gives them access to the same information as their analysts and finance managers, presented in a simple yet powerful manner, which means that they can be informed and prioritise their staff’s work on the areas with most impact.”
Consultant surgeon Vinidh Paleri is one of those users. He says: “Clinicians need an insight into PbR and how it affects us. When clinicians take responsibility in the coding process, the outcome and coding accuracy increases. The National Benchmarker is a fantastic resource for clinicians as well as managers.”
The Audit Commission’s internal monitoring indicates that the heaviest users at the moment are acute trusts. As Davis says: “That’s probably because they already realise the benefits that analysing their hospital data can bring.”
Salford Royal NHS Foundation Trust is a case in point. It uses the National Benchmarker on a regular basis to investigate outlying specialties.
Claire Oates, service reporting accountant at the trust, says: “It gets people to sit up and take notice. The graphs and reports get service managers, healthcare staff, coders and finance professionals around the table and focuses attention. The detail adds weight to discussions we have with clinicians.”
But Davis is keen that PCTs to use it more extensively. For example, to help them to understand how their population accesses secondary care and identify specialities with high rates of non-surgical activity or potentially avoidable admissions.
“Our aim is to encourage self-monitoring by acute trusts and PCTs, adding to the quality of commissioner/provider discussions at a local level and further driving improvement throughout the NHS,” he says. “Regular use of the National Benchmarker will help focus PCTs’ commissioning strategies on the areas of greatest impact.”
Plymouth PCT is an example of a PCT that has used the National Benchmarker to good effect, to inform negotiations with its key acute care provider. Now both organisations use it to monitor activity as part of their contract.
John Harrison, deputy director of commissioning at the PCT, says: “It's important to have as much evidence as possible when you go into contract negotiations.
“I think that just letting trusts know that you are using it would potentially have an impact. It helps professionalise the relationship with our acute provider. It provides an independent and systematic approach.”
New additions and future plans
As with any such tool, regular updating is vital. In the summer of 2009, the Benchmarker was updated with the only complete set of national HRG4 data, including retrospective data on groups and prices for the last two years to provide acute trusts and PCTs with trend data under HRG4 not available anywhere else.
Added last autumn were efficiency scorecards that help users identify areas where efficiency gains can be made, such as by examining length of stay or pre-operative stay. “These are areas where efficiencies can be used to drive improvements and make savings,” says Davis.
Next steps include plans to include of A&E benchmarking, adding independent sector treatment centres to the data set, developing reference costs analysis, and allowing users to define their own peer groups for comparison.
You can register for the tool, watch a tutorial video or view the user guide via the Audit Commission's website.
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