13th December 2016
Civica Rountable published in Health Service Journal
As opening remarks in a debate about informatics go, this was a bold one: “Informatics in the NHS is just not done well."
Marc Farr, director of information at East Kent University Foundation Trust, launched this salvo at the start of a three-hour debate on informatics and the Carter Review. No one disagreed. Yes, there are pockets of excellence – but no, on the whole, the NHS does not do informatics well. And as the Carter review has highlighted, this needs to change. The case for delivering savings and efficiencies in back office functions such as informatics is well rehearsed and targets have been set.
That’s only part of the story, though. There is also scope for informatics to improve productivity by extending beyond the routine bread and butter such as reporting A&E attendances and into the realm of benchmarking, highlighting variation, providing early warnings and predictive analysis.
So the challenge to the table was this: what are we going to do about it? Is there scope for a collective response across a region or a group of trusts to share services, improve capability and start to move NHS informatics into a new era of professionalism?
As Dr Farr said: “As long as the information governance is right and the politics are OK, I think that sharing informatic resources is something we could do quickly and at scale.”
To a degree, Dr Farr was preaching to the converted as around the table were gathered representatives of a group of trusts in south east England who already collaborate informally. For example, East Kent Hospitals already provides data warehousing
and real-time mobile dashboards to partner trusts and CCGs in the region. Alongside them sat a few with national remits and directors from Civica.
The group was clear about the vision. They wanted to see professionalised informatics departments supporting hospitals to improve their efficiency and productivity. They wanted to see more automation of mundane tasks, allowing informatics to come into its own, with analysts potentially embedded in clinical teams and supporting a data-literate board.
That’s the vision – but what about the practicality?
Paul Bradbury, group business development director at Civica, addressed the reality of joint working. “Our experience is that when you are forced to work together, it doesn’t work. When people choose to do it, it unlocks powerful ideas and ways of doing different things.”
Sarah Goldsack, associate director of knowledge management at East Sussex Healthcare, added: “We can all collaborate in a crisis.” But when it comes to business as usual, well, not so much.
Yet it is business as usual that requires transformation. In an NHS where a trust informatics team might be as small as three people, with no capacity and little capability to look up and see a wider world, this is a real imperative.
Chris Green, director of information at NHS Improvement’s emergency care improvement programme, recalled his time as an NHS analyst: “I wanted to work with managers and clinicians and find out what would benefit them. You have to go out and talk to people.”
There were repeated calls around the table for informatics to become “a profession, not a job”, with everything that entails from qualifications and CPD through to accreditation and academic links.
Similarly everyone agreed that data quality and timeliness matters.
Stuart Jeffery, director of information and performance at Dartford and Gravesham Trust, argued that real time analytics about bed occupancy could transform bed management from a manually driven process focusing on bed numbers to a clinically driven process focusing on so called “stranded patients” – those who have been in hospital seven days or more. This requires not just high quality, real time data but also clinical transformation.
High quality data can also underpin performance metrics such as ward or individual doctors’ performance. The question was whether this data should be published.
"It’s about more than data,” said Paul Sanders, Civica’s managing director for local
government, health and digital solutions. “It’s about driving the right behaviours.”
Ian Francis, clinical director of strategy at the Queen Victoria Hospital in West Sussex, argued for publication. “Is this bullying? Maybe. But doctors are weirdly competitive and no one wants to be lowest performer.” Ultimately, there is a corporate responsibility for transparency, he added.
Simon Marshall, director of finance and information at Ashford and St Peters Hospitals, was not so sure. These metrics are often managerially rather than clinically driven, he suggested, and informatics should be making clinicians lives easier rather than harder.
Delivering quality data is one thing. Data literacy is another and again there was consensus over the lack of data skills at board and operational management level.
James Scott, head of operational performance at NHS Improvement, said: “Reading and using data is not in the traditional skill set of the NHS operational manager and should be a key part of training.”
Martin West, non executive director at Kent, Surrey and Sussex Academic Health Science Network, said boards were the same. “In my experience, data is historical and driven by national standards, so boards obsess about the ED waiting times or cancer pathways.”
He and others argued for more real time data presented via intuitive and operationally relevant dashboards; more user friendly ways of presenting data such as infographics; and for data that tells us not just how many people breached in the ED last week but also why.
It’s about predictive analytics that can drive clinical behaviour change and information-led operational change and support leaders to make information-based decisions. As Mr Sanders said: “Informatics is a force multiplier.”
It’s a bold plan and the participants were not naïve about the challenges. If they achieve their vision it would launch a new era of informatics in the NHS. As Mr Green eloquently put it: “There’s lots of talk about Big Data but I don’t want to see Big Data. I want to see Big Action.”