Support for Intelligent Commissioning Roger Dewhurst Director of Operations, Information Centre for health and social care

Role of the Information Centre Enabling access to relevant information –“Universal data” Service user level data on social care needs and input Care provided by general practices –Surveys –ESR Development and maintenance of standards and classifications –Datasets, classifications –Reference data –Quality Promoting analysis Building capacity –Informatics review

Commissioning activities requiring support Implementation Targets and Objectives for improvement access effectiveness efficiency satisfaction outcomes Allocation of Resources Commissioning of Services Service Developments Monitor and Review improvement access effectiveness efficiency satisfaction outcomes Service Requirements Demand/ Needs Assessment Existing Services Good Practice Evidence Comparative Performance Need / Demand Assessment & Planning Preferred Service Models Alternative Service Models Costs Benefits Required Option Evaluation and Selection

Commissioning activities requiring support Implementation Targets and Objectives for improvement access effectiveness efficiency satisfaction outcomes Allocation of Resources Commissioning of Services Service Developments Monitor and Review improvement access effectiveness efficiency satisfaction outcomes Service Requirements Demand/ Needs Assessment Existing Services Good Practice Evidence Comparative Performance Need / Demand Assessment & Planning Preferred Service Models Alternative Service Models Costs Benefits Required Option Evaluation and Selection Practice Based Comparators PbR Support “18 weeks” Analysis NICE Prescribing Compliance

Developments within the NHS Secondary Uses Service in 2007/8

Context The development of the Secondary Uses Service is being taken forward as a partnership between the Information Centre and Connecting for Health The central repository of health data for secondary uses Most data to be collected or derived as a by- product of direct care Over time SUS should maintain and provide access to all NHS activity and associated non- patient record based data. Provides the tools and services for an effective and secure working environment for analysis and reporting

Context a secure environment in which patient confidentiality is maintained consistent data collection across the country comprehensive coverage of all NHS- commissioned care enabling linkage of patient-level data from different sources common approaches to the derivation of data items and where appropriate indicator construction, and hence consistency of analysis

Business Architecture of SUS A common and consistent information governance model –Access control –Use of pseudonyms to replace identifiers –Design (e.g. small number suppression etc.) Consistent metadata and reference data Core data warehouse and data marts Associated applications utilising data from the core warehouse Consistent analysis and reporting tools

Business Architecture Security and confidentiality ensured by consistent access control and design Landing Staging Universal Data Warehouse PBR CDS Extract A Core Warehouse and Data Marts ETL Processes Presentation PBC Support Public Health Support Clinical Audit Consistent metadata – business and technical

Practice Level Comparators Implementation Targets and Objectives for improvement access effectiveness efficiency satisfaction outcomes Allocation of Resources Commissioning of Services Service Developments Monitor and Review improvement access effectiveness efficiency satisfaction outcomes Service Requirements Demand/ Needs Assessment Existing Services Good Practice Evidence Comparative Performance Need / Demand Assessment & Planning Preferred Service Models Alternative Service Models Costs Benefits Required Option Evaluation and Selection Practice Based Comparators

Practice Level comparators An NHS wide application providing access to a range of practice level comparators to all practices and PCTs Comparators covering commissioned activity, referral patterns, outcomes, prescribing and identified prevalence Data refreshed quarterly Comparators constructed on a quarterly, rolling annual and financial annual basis.

Building on existing work Better Value Better Care Prescribing Comparators (PING) Healthcare commission indicators NCHOD “Intelligent practice” …

Method of Delivery Web-based access, consistent with access to all applications provided through NPfIT Intuitive ‘dash board’ graphical style presentation Built-in help and supporting information All standardised to allow direct comparison Flags to highlight areas of significance Additional drill down by Specialty and HRG

Local Current position National Some local systems developed, e.g. ASP, GM TIS, MIDAS And some commercial systems e.g. Ardentia, DFI, Sollis Information to support PBC Local

NationalLocal Position as at mid May 2007 Local systemsPBC Comparators Information to support PBC

NationalLocal Future position Local systemsPBC Comparators Information to support PBC

Timescales An initial release made available to early adopters in early April A further release to be available to all practices and PCTs in May Further releases during 2007/8

Comparators within the initial release Activity and Cost (at PBR tariff) comparators for : 1.OP first attendances for source of referral = GP per 1000 population for the six specialities identified for care outside hospital * 2.Total outpatient attendances per 1000 population 3.Non-Elective admissions for 19 ambulatory care sensitive * 4.Non-Elective Admissions per 1000 population 5.Four QOF area admissions per 1000 population (CHD, Asthma, COPD, diabetes) 6.Elective IP Admissions per 1000 population 7.Day case Admissions per 1000 population 8.Total elective admissions per 1000 population 9.Admissions for five procedures with evidence of overuse / 1000 population* * Better Value Better Care indicators

Presentation Style Reflect how most people think rather than how a ‘numbers person’ (statistician) might think. –The statistical rigour must still be available Constrain choices (no free-for-alls at this stage) –The choices available should be useful/meaningful Retain and transfer knowledge –Contextual help –Interpretation help (translate how a ‘numbers person’ thinks of the data into a useful action/warning/caution etc.)

Further releases An extended range of indicators Additional functionality Reflecting users’ requirements

Additional Comparators Secondary care –Outpatients OP first attendances rate by source of referral (GP, tertiary etc) (plus cost) First : follow-up ratio –Non-elective Patients with non-elective admission rate Non-Elective Bed days per 1000 population (or av. Occ beds) Short stay Non-Elective admissions rate (incl. cost) Emergency readmission rate –Elective Elective IP+DC Admissions per 1000 population (plus cost) Patients with Elective (IP or DC) admission rate % days cases (for audit commission basket of procedures) –Waiting times Percent referral to first OP >=6 weeks Percent decision to treat to inpatient/day case treatment>=13 weeks –Overall Acute Total cost of acute (admissions +outpatients) Total admissions (elective + non-elective) (plus cost)

Additional Comparators Quality and Outcomes framework (for 2005/06 indicators) Prevalence data for all areas – (Coronary heart disease, Coronary heart with left ventricular dysfunction, Stroke or TIA (transient Ischaemic attack), Hypertension, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease (COPD), Asthma, Epilepsy, Hypothyroidism, Cancer, Mental Health (MH) Admissions v Quality and Outcomes framework Admissions per 1000 patients for CHD, COPD, Diabetes Mellitus and Asthma Admissions per 100 patients on the disease register for CHD, COPD, Diabetes Mellitus and Asthma Patients admitted per 1000 patients for CHD, COPD, Diabetes Mellitus and Asthma : Patients admitted per 100 patients on the disease register for CHD, COPD, Diabetes Mellitus and Asthma Prescribing v Quality and Outcomes framework Costs for prescribing of: –Diabetes drugs per 100 patients on the diabetes disease register –Diabetes reagents per 100 patients on the diabetes register –Inhaled steroids and beta agonists per 100 patients on the Asthma and COPD registers –Statins per 100 patients on the CHD disease register Defined Daily Dose prescribing for: –Diabetes drugs per 100 patients on the diabetes disease register –Inhaled steroids and beta agonists per 100 patients on the Asthma and COPD registers –Statins per 100 patients on the CHD disease register Influenza vaccination: –Percentage of patients on the asthma register who have received ‘flu vaccination –Percentage of patients on the CHD register who have received ‘flu vaccination

Additional functionality Use of “needs” weighted populations Practice groupings Peer group comparisons

PbR Support Implementation Targets and Objectives for improvement access effectiveness efficiency satisfaction outcomes Allocation of Resources Commissioning of Services Service Developments Monitor and Review improvement access effectiveness efficiency satisfaction outcomes Service Requirements Demand/ Needs Assessment Existing Services Good Practice Evidence Comparative Performance Need / Demand Assessment & Planning Preferred Service Models Alternative Service Models Costs Benefits Required Option Evaluation and Selection PbR Support

PbR Processing Updated version of HRG 3.5 and 2007/8 tariffs Continuation of “managed” service extracts Online reports and analyses

PbR Indicators Support for the Audit Commission’s PbR Data Assurance programme Construction of a range of indicators –Using consistent data and methodology to PBC comparators Provision of web based access application for Trusts and PCTs

18 weeks Analysis Implementation Targets and Objectives for improvement access effectiveness efficiency satisfaction outcomes Allocation of Resources Commissioning of Services Service Developments Monitor and Review improvement access effectiveness efficiency satisfaction outcomes Service Requirements Demand/ Needs Assessment Existing Services Good Practice Evidence Comparative Performance Need / Demand Assessment & Planning Preferred Service Models Alternative Service Models Costs Benefits Required Option Evaluation and Selection 18 weeks Analysis

 CDS Version 6 –Enable 18 weeks-specific data items to be loaded into SUS –Enable reporting via Extract Mart and HES  18 weeks SUS application –Linking events to give Referral to Treatment times –Retrospective and Prospective Reporting Overview of SUS and 18 weeks

 CDS Version 6 –Dataset and XML Schema defined –Schema approved; dataset still being approved –To be published on SUS &18 weeks web sites  18 weeks SUS application –Business Requirements produced and approved by DH 18 week Executive Board –SUS Service Provider developing specification Current position

18 weeks data items  Pathway Identifier  RTT Start Date  RTT Stop Date  RTT Status SUS Functionality  XML Data Input  SUS Data Load  Extract Mart output  HES Output 18 weeks solution– CDS Version 6

BT SUS Data Warehouse CDS CAB SUS Core Data Warehouse 18 Weeks Data Mart Record Linkage - Referral to Treatment Periods Construct Reporting Structure - enable reporting by dimensions Retrospective Reporting Prospective Reporting Patient Level drill down RTT and Events SUS 18 weeks reporting solution

 SUS will create RTT Periods to support reporting –From incoming Choose & Book and CDS records  Using CDS Schema 6 fields where available: –Pathway identifier (to link), RTT Status, start and end  An algorithm, where Schema 6 is not available –To provide useful data during the transition to Schema 6 –Based on previous trials, but using more data. –Output can only approximate Schema 6 based linkage Linkage of Referral to Treatment

RTT Event Linkage OP Other A&E Tertiary Assess Diag (OP) Diag (IP) Diagnostic phase OP 1 st Outpatient Appointment Decision to treat GPIP OP Follow-up Treatment/ Discharge 18 weeks Data flows Elective Admission List Admitted Patient Care Outpatients (Care Activity) Future Care Activity A & E Choose and Book

Initial User Group DH/SUS 18 week team 18 weeks Business Requirement and Specification BT development environment SUS Pilot Reporting environment Wider User Group Local NHS Input SUS Live 18 weeks Reporting environment 18 weeks report development approach

Details still being finalised Report Prototyping Summer / Autumn week data landing (CDS v6 and CAB) Dec 07 XML Supplier Compliance Testing Nov- Dec 07 Trust migration to CDS v6 Jan-Mar weeks reporting Mar/Apr 08 Timescales for Delivery