The IT and business intelligence requirements for clinical commissioning groups are among the commissioning support functions best done “at scale”, according to a draft report from the Department of Health.
'Towards Service Excellence', which has been leaked to the Health Service Journal (subscription needed), was circulated to cluster primary care trust leaders late last week.
It says: “There is evidence to indicate that initially a national approach might enable the most effective delivery of each of these services.”
The document suggests a total of four areas that would benefit from this approach: business intelligence - or collecting and analysing data; 'major clinical procurement'; back office functions such as IT, estates management, human resources and finance; and communications services.
HSJ reports that officials are considering a range of options for how these services could be structured in the future.
These are: a single nationally-managed service, delivered locally; a nationally-coordinated network, with teams in various locations providing different specialist elements, and the potential for these elements to become separate organisations later; a hub approach, with the potential to create several organisations later; and a national specification and price with a range of approved suppliers.
Elsewhere the guidance appears to recommend strategic health authority-sized bodies to provide some parts of NHS business intelligence.
It says: “Evidence from South Central, West Midlands and East Midlands suggests aspects of business intelligence would be delivered most effectively by operations that cover an average population of around five million.
"If these sized units were replicated nationally this implies that these aspects of business intelligence could be provided from approximately 10 units.”
Guidance on the future arrangements for information services supplied to the clinical commissioning groups has been sought for some time.
In May, Dr Paul Zollinger-Read, director of GP commissioning for NHS East of England and primary care lead for the King’s Fund, told the Primary Health Info conference that GP consortia should follow US physician-led organisations which designed their own information systems.
Central commissioning support does not, however, mean the re-creation of primary care trusts. According to HSJ, the document affirms the ‘market’ model promoted by the coalition government.
“The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to free standing enterprise,” it says.
© 2011 EHealth Media.
We need KPIs that are fit for purposetimbenson 161 weeks ago
In his "Good to Great and the Social Services" Jim Collins says "what matters ... is settling on a consistent and intelligent method of assessing your outcome results and then tracking your trajectory with rigor" (p 8). Collins advocates a minimum set of Key Performance Indicators (KPIs) and argues that one of the key roles of leadership in any organisation is to decide on what these KPIs should be KPIs be, for good or ill.
The NHS Outcomes Framework (with its five domains of mortality, long term conditions QoL, recovery, patient experience and safety) provides a structure for moving forward, but does not specify the type of KPIs advocated by Collins, that will drive day-to-day decisions at every level of the NHS from the point of care to the board room. But this is what we need.
Standardise the information, not the softwarejulianlesaux 161 weeks ago
I agree with Qualguard. In a normal business you don't pay a bill until you've checked that what you're paying for is something you atually wanted, ordered and received. Not so in the NHS. All this stuff about driving down costs is basically flawed because none of us really know with any clarity what we're being asked to pay for. The essence of good clear business transactions within the NHS is to make sure that the people making the charges - the hospital trusts - send out good timely information about what they're charging for: NHS numbers, dates of birth, admission dates, discharge dates, procedure codes, costs. This information has to be standardised so that input from several different trusts can be easily combined and compared. No information, no payment. If the information isn't delivered on time, there should be penalties.
If you can standardise the provision of information, the provision of business intelligence should become a much simpler task. Let the localities do their own thing. The commissioning groups themselves should be publishing transparent information about how much they're spending on business information software, so it should soon become apparent who's getting it done cost-effectively and who's being overcharged. I bet someone could come up with an open-source framework that would do the whole thing for nothing.
Standarise information AND softwareP Millares Martin 161 weeks ago
Clinicians, technicians, and all staff in NHS move around different places while they are training, even after if involved in work in different departments. If each place has a different system of accessing information, is it not more likely that the user is not mastering the software and in consequence fails to input data correctly?
Food for thought.
Simplicity, but not single solutionsP Millares Martin 161 weeks ago
I think there are far too many ways of inputing data, far too many programs, and the complexity of it means data is not adequately treated, is not shared properly.
Examples? Radiology departments locally use a "National Coding system" that is not Read coded. Primary care gets data and can not be filed they way other tests are coded because of it, so you need to know how you dif the information from your software.
QOFs are a nightmare of ticking boxes, and you need to be precise or partial data will not count as assesment done. Locums do not help much on it, Is it because of lack of interest or more likely because data entry in each practice they work is different?
Recently, eHI reported on door codes for vulnerable people been entered in address text boxes and getting filtered to spine, and to mail. A critical incident for those palces affected. why did it happen? Do users know the difference of what information is confidential and what is shared and how?
To me unless there are some clear rules and shared codes for all to apply we will continue in the jungle we work nowadays.
Local needs - and in defence of NHS staff abilitiesMary Hawking 161 weeks ago
Julianlesaux: information comes from other places than hospital trusts - who are supposed to have been providing the information you list (and which practice budget should be charged) for many years.
There is a big problem with timeliness, sometimes accuracy, and especially information from trusts not covered by PBR - which, with all its faults, does mean that items unclaimed will not be paid.
P M-M, are you suggesting some sort of national system for information management, and if so would you expect it to match the expectations on NPfIT for EHRs?
The Common User Interface - remember that? - was suppoesed to solve the problems of different interfaces for clinicians, but I haven't heard much about it recently.
Are NHS staff - even ones who do not move frequently - really incapable of learning new systems and ways of working?
I agree---NPBIIT is likely to failNeelam Dugar 161 weeks ago
I agree with previous comments.
The problem is much of NHS or commissioning bodies do not even know what information they need. They need to come up with the data they need to support commissioning and ask organisations to feed the data into their central system for analysis.
The analogy can be drawn with Radiation Exposure Monitoring if done at national levels. Hospital systems with they different machine adopt standards and pass information to a national registry.
As said by many of us repeatedly that government strategy needs to encourage innovation & competition for local systems. This is key to transforming NHS.
Same Path, Same Strategy and the Same Resultthe_ehi_insider 161 weeks ago
National Level again ?? Should call it NPFBIT national program for business intelligence.
Some of the smaller companies offer really advanced BI solutions as they are agile and have introduced superior and cheaper components within the product.
Even multi nationals don't have the same vendor or national programs for BI solutions. One size never ever fits all.
NPfBI, NPfCP, NPfBO and NPfCSnicksamuel 162 weeks ago
No doubt the arguments mirror those for the NPfIT. The question to be answered is not "is this a good idea?" but, "given their track record, can DH deliver?" I am not convinced, given what I have seen of their efforts to recover the NPfIT, that they can.
Another important point is the effect of the size of the exercise on the choice of suppliers. Due to the procurement rules, the larger the procurement, the smaller the competition. A major procurement will exclude many companies currently supplying solutions and business size will take precedence over the quality of the solution to be offered.
I await a full view of this report to find out what the authors think "effective delivery" means.
Is this really about the requirements of CCGs?Mary Hawking 162 weeks ago
The previous commentators seem to be taking the view that this is about the whole of the NHS: the article - and, apparently, the report - are dealing with supplying the needs (as defined by the authors of the report) of CCGs.
The article is about the management of information needs for CCGs, and there seems to be very little concept of any local input: presumably if this centralised approach *is* centrally mandated (and provided under contracts by the private sector) the appropriate funding will be obtained from CCG management budgets?
"The document suggests a total of four areas that would benefit from this (national) approach: %u21Cbusiness intelligence%u21D such as collecting and organising data; %u21Cmajor clinical procurement%u21D; back office functions such as IT, estates management, human resources and finance; and communications services."
The major part of clinical procurement is the high volume service - almost regardless of the cost of the individual item (determined anyway by PBR): small volume but high cost services are already to be procured by NHS Commissioning Body rather than CCGs: so what will be left for CCGs to commission?
It does appear that any initial powers to commission locally are being removed by top-down management and the only thing left to CCGs is the responsibility for everything ending in tears.
Yes, yes, yes !!!von Bismark 162 weeks ago
Because Commissioning Support for London was such a cracking success and returned brilliantly for its customer PCTs on their multi-million pound investment (over, what was it, 7 years? in it and its predecessors). Yes, tears were shed all over London when this similarly sized champion of customer need was so cruelly and unnecessarily axed despite its golden record of delivery.... yes yes we need more of the same replicating this success at scale across the whole country. Spread the joy.
Not learning from historyqualguard 162 weeks ago
This is better than their last attempt, although the creeping urge to centralise is still there. That brings in its train monolithiic systems and the problems we all know so well.
What they really should do is specify what is reasonable for providers to supply in the way of commissioning information and how purchasers (for that's what commissioners are) can access and compare that information in the interests of patient care. And that is why we are all having trouble with this - because the centre cannot specify the information adequately.
And until those requirements are met, it is a matter of not learning from history to go ahead and specify systems of knowledge or informatics to cure a problem you haven't diagnosed.
And just what is the purpose of the very expensive NHS IC?
Yes yes yesSer Lenfen 162 weeks ago
Perhaps centralised IT and BI would drive hospital trusts and others to invest more effectively in informatics capability. Their ability to drive real clinical and business process change from their investments in technology. There is still a real shortfall in Trusts' understanding as to how they need to engage with and use IT to drive efficiencies from the business of healthcare.
"Cheaper by the dozen"P Millares Martin 162 weeks ago
I completely agree with a national approach to IT. It is already a very complicated world, with many companies involved and there must be a common approach to guarantee for example connectivity between the different organisations, something which today still is not at grasp. Also considering the inmense costs associated, bulk should provide cost-effectiveness. On top of that the less systems around, the closer they are, the easier for training users and maintaining quality standards or data