Supplement: The NHS needs the complete data picture

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The NHS is data rich but decision makers do not always have access to it. Collaborative commissioning can help the data ‘work for the NHS’, writes Matthew Shelley

puzzle drawing data picture

While collaborative commissioning might well offer opportunities to streamline services and improve outcomes, high quality data is essential to fuel the drive forward. And therein lies the challenge: the NHS is data rich, but that does not always mean decision makers have access to the readily usable information that is critical for raising standards, optimising patient pathways and achieving sustainability.

This can be tough enough to tackle within a single organisation, but new layers of complexity arise in working across multiple NHS bodies, and arguably even more so between health and social care.

‘Momentum is building that the right data is key’

However, commissioners and specialist information providers believe that momentum is building behind collaborative commissioning, alongside recognition that the right data is key.

Julie Wood, director of clinical commissioning group representative body NHS Clinical Commissioners, says there are many examples. She points to developments in Staffordshire where collaborative approaches are being developed for cancer and end of life care.

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“Collaborative commissioning offers a lot of potential if commissioners see the value and grab the opportunities,” she says. A firm believer in subsidiarity, Ms Wood regards it as “a useful tool” that can enable decisions to be taken at the right level.

Combatting lung cancer is one area in which a pan-organisational approach could make sense.

“You have to look at where you can have the influence, so those commissioning care at the beginning of the pathway and focusing on smoking prevention and cessation are very important. Then the CCGs need to look at early diagnosis and referral. When it comes to treatment you may get a group of CCGs working together to commission services for a much larger patch.”

Tim Sheppard on how to use data effectively to collaborate

When so much energy and resource has been channeled into designing a lasting strategy for NHS commissioning, making the leap across the conceptual divide into reality is crucial. It requires many elements: strong leadership, political will and the right technology to name a few.

But to reflect accurately the needs of patients, their families and carers and to act accordingly in an integrated fashion requires more than just a look at data. We need to develop the ability to learn from data what can be changed to affect the system.

How can local health economies, used to working in silos, create a collaborative strategy and put it into action? It will only be through the effective use of data, collected from across organisational care pathways. They will need to look beyond traditional uses of data to capture and measure treatments and interventions – learning from this data means applying more rigorous statistical or predictive models to ensure we understand the “nuggets” of insight that tell us how a change now could impact the service in the future.

Commissioners across sectors, from the NHS and local authorities, will need to collaborate with providers to develop coherent, reliable and efficient patient pathways.

‘We need to develop the ability to learn from data what can be changed’

Take diabetes, where it is clear there is a shift in attitude at a strategic level towards prevention rather than treatment, as a means to contain overall spending while improving outcomes. Designing and implementing prevention programmes will require an understanding of not only which patients are at risk, but exactly which types of patients will go on to experience most problems as a result of the disease in the long term.

A prevention investment structured, targeted and weighted towards those patients with longer term risk can have more impact for the same spend. To do this means learning from real world histories of patients with diabetes, and applying what we learn to forecast the future of disease progression – we can do this now, even at a local level – if we utilise the data we already have in the system, and combine it with models of disease progression in an intelligent way.

Integrated commissioning will only flourish at the local level when there is collaborative working and true visibility across partner organisations, linked with a strong drive and passion to learn and make the most of the data we have access to. The alternative would be a wasted opportunity to put the patient first and reduce inefficiencies.

Tim Sheppard is general manager UK and Ireland, IMS Health

Obstacles ahead

But there are obstacles – a clear and accurate picture of the entire patient pathway, which is accessible to all and has commonly understood measures and standards, is vital for successful partnerships.

Common data sets across the NHS are a big plus, but not everyone uses them in the same way. Governance rules mean that not everyone has access to the same information – and then there are the cultural distinctions between the NHS and social care.

Ms Wood says: “Accessing business intelligence can be an issue – are we always comparing apples with apples? It’s really important to make sure you are using all the analytical tools available so you can be sure you are having the best impact and are comparing the same things.”

Efforts are underway, though, to enable diverse organisations to work together on delivering fully integrated care, and the NHS is increasingly turning to business intelligence organisations to help.

IMS Health UK, for example, is currently involved in projects designed to ensure that collaborators have the quality of data they need and in a form that everyone can understand and act on.

This is seen as the foundation of a shared vision with meaningful agreements on standards and specifications. Peter Lane, lead on healthcare for IMS Health in UK and Ireland, says: “People need to be able to visualise their patient pathways. If you can’t do that then how will you reduce clinical variation, maintain quality and efficiency while delivering the best service to patients?”

‘It is often possible to introduce swift efficiencies by eliminating duplication in treatment’

An initial challenge is to distinguish between the theoretical and actual patient journey. “We worked with one organisation on cataracts. There were supposed to be four steps in their pathway, but when you looked at the figures not one patient of the thousands they had seen had actually had four steps. They were astounded,” says Mr Lane.

With collaborative commissioning the picture has to be from end to end, rather than just a snapshot of what happens in primary, acute or social care.
This, argues Mr Lane, helps identify what change is needed and lays the groundwork for implementing improvements as well as measuring and monitoring the results.

By creating a complete picture of a patient’s journey it is often possible to introduce swift efficiencies and make savings by eliminating duplication and unacceptable variations in treatment.

Beyond that, there are frequent opportunities to take earlier, simpler and cheaper action which benefits the patient and saves money for the NHS. Mr Lane cites analysis that revealed to an NHS organisation how many patients needing a knee replacement would require a second one not long after. They found that a second operation could be avoided or delayed and £500,000 saved if they looked at both knees when the patient first presented.

Break down the barriers

Ideas like these are in harmony with the NHS Five Year Forward View and its pledges to break down barriers, integrate care and provide the flexibility for local care providers to respond to their own populations.

The prospect of substantial financial savings is clearly a huge attraction in an NHS struggling to close the gap between available resources and patient need.

More than that, the NHS devolution plans for Greater Manchester and Cornwall may create an environment ideally suited to collaborative commissioning.
This is something Mr Lane would welcome: “Collaborative commissioning is the way ahead because it has an impact, not just on individual outcomes, but on population health as a whole and will make services better and simpler.”

‘The data needs to work for us, and help us to commission the right services for the right people in the right place’

This is a philosophy that appears to be taking root, for example in initiatives like East Sussex Better Together, which is bringing a more integrated and shared approach across the entire health and social care economy.

Amanda Philpott, chief officer of Eastbourne, Hailsham and Seaford CCG, and Hastings and Rother CCG, and NHS Clinical Commissioners board member, sees collaboration as a way to work through system-wide issues, to reduce waste and design services to suit patients and communities. For her, information is vital, but it has to be useful and has to be usable.

“We have a huge amount of data about our [accident and emergency] and emergency admissions, but as it is currently collected, the ‘so what’ and ‘what can we do about it’ questions aren’t easily emerging from the analysis.

“We need to focus on what we want the data to do. It needs to work for us, and help us to commission the right services for the right people in the right place. The future depends on very good data, sharing that data and working together across organisations, sectors and traditional boundaries.”