Why informatics matters to NHS trusts

John Goulston is clear that informatics and technology are important priorities for him as a trust chief executive. He is not entirely sure, however, that this perspective is a common one.

“Informatics is a key enabler − as much an enabler as estates, as much an enabler as workforce and HR,” argues the head of Croydon Health Services Trust. “Robust data is critical in terms of an organisation being able to see how well it’s doing and where the areas are that it’s not doing so well.”

‘We need broader leadership that’s able to see what we’re trying to derive from informatics and why it’s important’

“Data is used for both clinical and patient safety effectiveness reviews and then also on the resource side, informing how we’re doing in terms of our contracts with commissioners and in terms of one’s income. Then workforce data informs whether you’ve got the right workforce with the right skills and experience − and it is problematic if you don’t.”

His conclusion is clear: “I think informatics is a really important priority, one that I don’t think is seen as a high enough one in general. We’ve not always had the same level of profile for the person looking after informatics as we have had, for example, for the person looking after HR.”

Creatures of habit

Asked why, Mr Goulston points to the classification of informatics as “a technical subject”. A common perception, he suggests, is that it is an area in which specialists should be closely involved but which does not require senior leadership input.

“Of course it has a technical function to it, and it’s important that we have well run technical aspects,” he says. “But it needs broader leadership that’s able to see what we’re trying to derive from informatics and why it’s important.

“Sometimes [in the NHS] we have a habit of making the senior responsible officer for major estates programmes, or major IT programmes; someone with a technical background. And, yes, that’s important. But it needs to be someone who can see the broader picture.”

That was the rationale behind the formation of an informatics board at Croydon Health Services Trust. Mr Goulston is the chair and fellow members include the medical director, a retired surgeon working part time for the trust on informatics issues, the medical director and the director of nursing.

“When I joined the trust, we had a programme board for the deployment of our new IT patient based system [due to launch at the end of August], but that was it. What we didn’t have was a broader group steering informatics through the trust in a broader sense rather than just checking how we are doing on this major programme.”

Information drive

He suggests the issue of top level leadership on informatics will become more pressing as the new commissioning arrangements bed in. “As we move gradually to an outcome based framework for contracts rather than an input based framework, the information that’s going to drive that new framework is clearly going to be very topical,” he argues.

‘The last thing you want is informatics being seen as a technical subject’

It is particularly important matter for Croydon, which provides community as well as acute services. “We’ve struggled with our commissioner in terms of what the currency is for our community services,” Mr Goulston explains. “You might have a nurse with 10 patient contacts a day, but what does that tell you [about outcomes?]

“I think we’ve got a really big piece of work to do in the NHS in terms of being clear on the practical information that we can use to drive an outcome based contract,” he argues. “On the hospital side, we’ve got better information than in the community in terms of data capture.

“But I think whether it’s hospital, community or mental health, we need to start thinking about the types of information we’ve got about outcomes − short term and longer term − and how it drives the contracting process leader to a fair prices. I think it’s going to take us a few years to sort out.”

What is clear, he suggests, is that “the last thing you want is informatics being seen as a technical subject”.

He continues: “The technical side is the basic bit to do the more important thing, which is interpreting the data and doing something about it.”

John Goulston is chief executive at Croydon Health Services Trust