Head of Library and Knowledge Services, Brighton and Sussex University Hospitals NHS Trust
Received date: 4 March 2011; Accepted date: 7 March 2011
In Part 1 of this two-part article on web resources to support commissioning I wrote about the radical, ongoing changes to the NHS brought about by the Government’s White Paper, Equity and Excellence: liberating the NHS. Since then, a number of consul-tations on different aspects of the paper have been published and the new Health and Social Care Bill has been presented to Parliament. The Bill is currently undergoing scrutiny by a public committee, to which anyone can submit evidence until 31 March 2011.
The Liberating the NHS page on the Department of Health (DoH) website (www.dh.gov.uk/en/healthcare/ liberatingthenhs) remains a good source of infor-mation on progress with the transformation. Visitors to the site can download the various consultations, including An information revolution, which made the case that information is a health and care service in its own right, and asked how information should be collected, analysed and shared. The focus here is firmly on data, rather than other forms of information, such as research evidence and best practice, and it is to be hoped that the Government will advocate giving equal weight to all aspects of information when decisions are being made about service improvement.
The DoH has also launched a supplementary website, called Modernisation of health and care (healthandcare.dh.gov.uk), which includes news bull-etins, regular commentary from GP commissioners and DoH executives and videos from interviews and conference presentations. Although the site is a little diffcult to navigate, it is worth seeking out the sections on commissioning, and on the Pathfinder Learning Network (these can both be found under the ‘Context’ tab). ‘Pathfinder consortia’ are the groups of GPs that are taking the lead in developing the GP consortium model and identifying best practice that can then be more widely rolled out. Case studies written by these consortia are available on the site, along with an inter-active map showing where in the country these groups can be found (healthandcare.dh.gov.uk/gp-consortia-map). At the time of writing there are 141 pathfinderconsortia covering around 50% of the population of England.
The previous KnowledgeShare Web Alert looked at websites enabling GP commissioners to network with one another, and to stay up to date with the changing national picture. I also discussed the need for GP commissioners to draw on the work of national bodies, such as the National Institute for Health and Clinical Excellence (NICE), and local information experts, such as NHS library and knowledge services, to ensure that best practice from elsewhere is incor-porated into commissioning plans. In this issue we will consider a number of websites that can provide data sets and assistance with measurement and data analysis, and then broaden this out to look at other resources that may be of use in relation to procure-ment, contracting and other aspects of commissioning.
Data sets, data analysis and measurement
Health and Social Care Information Centre
Formerly the NHS Information Centre, the aim of this organisation is to deliver national data sets and stand-ardised measures and comparisons, and to improve information quality across health and social care (www.ic.nhs.uk/commissionin). TheInformationCentre also has a role in improving the understanding and interpretation of data, so that it can be used effectively to improve quality, safety and productivity.
By joining up disparate sources of data across the country, the Information Centre is able to provide costs and benchmarking information to aid decision making. NHS Comparators, for example, compares activity on a local, regional and national level, using information from Payment by Results, the Quality and Outcomes Framework and demographic population data. This can be found at www.nhscomparators. nhs.uk, and can only be accessed via the NHS network.
The Information Centre provides access to the Hospital Episode Statistics, which can be used to answer in-depth questions about the numbers of surgical procedures, reasons for admission to hospital, waiting times and so on across England. Much of the data are available to download immediately as pre-existing spreadsheets, but visitors to the site are also able to request tailor-made reports on topics of interest. Other data sets include Patient Reported Outcome Measures, social care collections, infor-mation on populations and demography and primary care information such as GP activity. All of these can be found under the ‘Statistics and data collections’ tab.
Other key resources for commissioners include workforce data, the Compendium of Public Health Indicators and an interactive commissioning cycle that directs users to the information they need.
Similar functions to those of the Information Centre are performed at a more local level by the ten quality observatories that were set up in 2009 on the rec-ommendation of the previous Government’s review of the NHS, High Quality Care for All. The observatories were established to provide benchmarking within the strategic health authority regions, develop metrics on behalf of their local GPs and providers and provide support for innovation on the front line. They can be found by accessing www.qualityobservatory.nhs.uk and selecting your local region.
What will happen to the quality observatories once the Strategic Health Authorities are disbanded is unclear; however, GP commissioning consortia will need support and advice on the interpretation and analysis of local data, and the observatories are well placed to meet this need. Their knowledge and under-standing of local requirements is now well established and must not be overlooked in favour of consult-ancies, who will be more expensive and may be less engaged with the needs of patients in the local area.
Examples of the products that quality observatories can provide can be seen on the website of the South East Coast Quality Observatory (nww.qualityobservatory. nhs.uk), which includes downloadable performancedashboards covering a wide range of topics, from cancer waiting times to immunisation and normal-ising birth. There are online tools for measuring patient experience, World Class Commissioning out-comes, an Obesity Atlas and much more. This site is only available on the NHS network.
Public health observatories
Alongside the quality observatories is the national Association of Public Health Observatories (APHO: www.apho.org.uk). There is some overlap betweenthe activities of the two organisations. The 12 public health observatories produce many data tools, such as health indicators and indices, but they also publish briefings on technical issues, including how to inter-pret hospital mortality data and reports on the state of public health in each of the English regions.
The ‘Publications’ tab on the website allows visitors to browse for these Indications of Public Health, which look at child health, older people, ethnicity and a range of health risk factors. The ‘Resources’ tab allows you to search across all the products that the public health authorities produce, and a useful tip for commissioners might be to search for the term JSNA (or joint strategic needs assessment), as APHO has produced a JSNA resource pack which could be particularly useful. It contains a set of small-area indicators that includes population estimates, mortality, hospitalisation, lifestyle and socio-economic data. The pack also contains guidance on the statistical validity issues inherent in JSNA work, how to predict levels of need over the coming years and how to measure health inequalities.
Quality, Innovation, Productivty and Prevention – Right Care
Right Care (www.rightcare.nhs.uk) is one of the work-streams sitting within the DoH’s Quality, Innovation, Productivity and Prevention (QIPP) programme, with specific responsibility for addressing variation in health spending outcomes across England. Its role is to both design and promote tools that help understanding of how to do things better and more cheaply and to shift spending from lower value interventions to higher value ones.
It achieves this through a blog that highlights articles and analyses conducted by other organisations, for example a report from NHS Wales on variations in elective surgical procedures, or a presentation from the East Midlands Innovation Expo on how evidence-based general practice can reduce emergency admis-sions. In addition, Right Care also produces its own tools to assist commissioners, in particular the NHS Atlas of Variation, which was published in November 2010. This atlas (accessed via a tab at the top of the screen) can be downloaded, or used interactively online. Users can see at a glance those areas of the country that perform well or badly on over forty primary care indicators, like musculoskeletal spend, computerised tomography (CT) scans, or childhood asthma admis-sions. Regions are ranked by their performance, but it is also possible to drill down to the level of individual primary care trusts.
Right Care has also produced a guide to using programme budgeting to deliver improved health care, and a glossary of commissioning terms in order to provide a common language and understanding.
Tools for commissioning
NHS Primary Care Commissioning
Primary Care Commissioning (PCC) is a national, networked organisation funded in part by the DoH, and in part by subscriptions from primary care trusts (all PCTs in England currently subscribe). PCC sup-ports best practice in commissioning and advises PCT staff with regard to contracting, procurement and achieving Government targets while minimising costs. It is committed to working with emerging consortia in the transition to GP commissioning.
In addition to providing regional advisors, and an extensive programme of events and workshops, the PCC website (www.pcc.nhs.uk) includes an expand-ing collection of case studies, how-to guides, briefings, tools and analyses. These can be found under the ‘Commissioning’ tab. A number of generic primary care service frameworks are available here, which help commissioners to consider an integrated approach to enhanced service provision. They have been devel-oped with expert managerial and clinical input and are intended to be localised by individual commissioning bodies. Also to be found in this section is a variety of supporting resources, such as guides to the joint strategic needs assessment process, commissioning patient pathways and enhancing patient engagement, among many other topics.
Video interviews are included in the PCC Live section of the site; they explore the rapidly evolving commissioning landscape through the eyes of different stakeholders. Practice-based commissioners and PCT commissioners share their experiences and their suc-cesses, in particular with regard to developing services based on collaboration between primary and acute care clinicians and managers. Clinical leadership and a systematic approach to using information are highlighted as two of the most important drivers of effective transformation. Interviews with patients and the pub-lic about their expectations of care are also available, along with videos from conferences such as the Your Choice of GP Practice consultation.
Perhaps most useful of all is the collection of Commissioning Tools, which can also be found under the ‘Commissioning’ tab. These are primarily links to tools that have been published by other organisations, such as the Audit Commission’s profile on PCTs’ use of resources, which answers questions about what spending has achieved, or the DoH’s Strategic Health Asset Planning and Evaluation application that en-ables service reconfiguration. There are also tools produced by PCC, including the Health Outcomes Tool, which brings together outcomes data and pro-vides a template for business cases, or the Quality and Productivity Calculator, a health investment toolkit.
Other sections of the site include ‘Pharmaceutical services’, ‘Dentistry’, ‘Eye care’ and ‘Medical’, each of which contains further useful resources. The ‘Medical’ tab, for example, includes guidance on the balanced scorecard approach, with a guide on developing score-cards and tips on achieving good scorecard results.
A survey of commissioners’ information needs con-ducted by NHS PCC in 2010 found that there were dozens of websites being used regularly to access information, advice and support for commissioning, that none of the commissioners who responded knew about them all. In response they built the Commis-sioning Zone (www.networks.nhs.uk/nhs-networks/commissioning-zone), a website designed to be a firstport of call for commissioning teams, signposting them to the many useful online resources that are available. Documents are broadly split into ‘Policy and guid-ance’, ‘Reports and analysis’, ‘Data and tools’ and ‘Resources’, although they can be further filtered by disease area, or searched across the whole site.
One particularly nice feature is that as well as a ‘What’s new?’ section, there is also a ‘Top resources’ section for each topic area so that users can see what documents have been accessed frequently in recent weeks. Owing to the connection with NHS Networks (discussed in Part 1 of this article), users who filter by specialty are presented with the relevant documents alongside a number of useful networks related to their field of interest. For example, filtering by ‘Urgent care’ reveals links to networks that include the Northern Burn Care Network and the South Central Critical Care Network.
The ‘Resources’ section of the site gives users the opportunity to submit their own local examples of good practice, so there are service specifications from Sheffeld, commissioning plans from Barking and Dagenham, business cases from North East Essex and much more.
Although the Commissioning Zone is a very useful resource, PCC is keen to expand its scope even further by transforming the site into a question-answering service for commissioners. They plan not just to put users in touch with key resources, but to put them in touch with local experts who can work with them to solve problems and assist in the development of local services. PCC already has a team of advisors covering contracting, procurement and other aspects of the commissioning cycle. Over the coming months they will be teaming up with information analysts around the country who can work with local colleagues on measurement, benchmarking and data analysis. The new ‘Ask an expert’ service will also link with library and knowledge service staff around the country who will be able to deliver the most up-to-date evidence from research and best practice to commissioners in order to enhance their business intelligence.
In addition to the above resources, this site also includes a comprehensive look at Commissioning for Quality and Innovation (CQUIN) payments. This brings together DoH guidance and gives the oppor-tunity to view the agreed CQUIN schemes for pro-viders in acute care, community care, mental health and ambulance trusts across the country. Templates, exemplar CQUIN goals and other useful resources are also included.
Supply2Health is a website allowing commissioning organisations to advertise opportunities to provide local services (www.supply2health.nhs.uk). It may be useful for commissioners interested in developing a new service to see what other, similar services have already been developed around the country. In this way, connections can be made and best practice can be more easily shared.
The ‘Structured search’ allows users to find con-tracts according to whether they are currently live, closed or already awarded. You can search by the lead commissioner, the care type or target population, or filter according to a number of different service settings. Once a search has been created and run it can then be saved as an ongoing alert so that users are regularly informed about new services in development.
The ‘Best practice links’ section contains links to useful resources on World Class Commissioning, stan-dard contracts, system management and other pro-curement issues.
NHS Institute for Innovation and Improvement: commissioning
The ‘Commissioning’ section of the NHS Institute for Innovation and Improvement website (www.institute.nhs.uk) was written in collaboration with the RoyalCollege of General Practitioners (RCGP) in order to help support the establishment of GP commissioning consortia. There are links to the RCGP Centre for Com-missioning (www.rcgp.org.uk/centre_for_commissioning. aspx).
Their work on Improving Patient Pathways in-cludes guides on prioritising commissioning oppor-tunities, and on project delivery for commissioners. There is also a link to their Better Care, Better Values indicators, which identifies potential areas for im-provements in effciency and incorporates an inter-active opportunity locator. Users can compare activity by commissioning organisation, or by provider, and can log in to select their own preferred peer group with whom to compare themselves.
GP commissioning is expected to be radical, collab-orative, transparent and sustainable, and so it must be well informed. Evidence-based decision making re-mains high on the agenda as it has for many years, but there is an acknowledgement now of the need for increased integration between different sources of evidence. Evidence from patient experience, evidence from existing managerial and clinical expertise, evi-dence from local and national datasets and evidence from research and from successful local transform-ation projects must all be brought together to ensure that healthcare provision meets patients’ needs. The websites and organisations listed in Parts 1 and 2 of this article will provide commissioning teams with the resources they need to make practical changes that matter to patients.
Commissioned; not Peer Reviewed.