What role for information in the new NHS?

Information is destined to have a key role in the new vision for the NHS. The NHS White Paper published last week sees GPs shaping local services according to the preferences of their patients, with consortia of GP practices replacing primary care trusts (PCTs) as the lead purchasers of health care.

It talks of an 'information revolution' that will make information more readily available to support patients' choices about their care, and to increase public accountability.

This focus on information provided for and by patients and the public is welcome. But is it enough? Will the 'information revolution' fill the current gaps in information and meet the needs of the new, redesigned NHS? Will it deliver the information that GPs will need in their new roles, and do current data flows align with the proposed architecture for the NHS?

Equity and Excellence: liberating the NHS builds on Lord Darzi's drive for measuring and reporting on the quality of services, defined as clinical effectiveness, safety and patient-reported experience, including a proposal to gather information on the performance of individual clinical teams – a welcome development, as more information is certainly needed on the quality of services. But current data flows are inadequate for these purposes, and the completeness, quality and use of national clinical audit data needs to be driven much more vigorously. As the quality accounts published recently show, trusts' participation in national clinical audits is patchy and even then, the data submitted is often incomplete. But clinical audit gets only a passing mention in the White Paper.

We also need better information on the quality of services provided by private providers. The previous government made a start on this, but there is a chasm between the range, depth and comparability of information available on services provided by NHS organisations and that available on their independent counterparts. With independent health care providers taking on a growing role in the NHS, and patient choice being set out as a driver of quality improvement, there is more need than ever for comparable information across all providers – NHS and private.

Information is vital for assessing the health needs of local populations, their access to care, the quality of services, and health outcomes. But the health White Paper doesn't address how existing information flows will be adapted to reflect the new architecture of the NHS.

GP consortia will need good information about their patients and their populations to inform commissioning and improvements in population health. Consortia will according to the White Paper need to have 'sufficient geographic focus' but this remains as yet undefined. GPs are expected to address public health, health inequalities and social care in partnership with local authorities, whose geographies (and therefore resident populations) are unlikely to correspond neatly with those of GP consortia.

Current NHS and health information systems mostly relate to existing, statutory geographical entities (eg, PCTs, local authorities, wards). A major transformation would be needed to reorientate information systems and data flows to deliver relevant data for the new GP consortia populations.

If GPs are to be accountable for £80 billion of public funds, the fitness of available data flows to support these tasks also needs urgent consideration. The potential misfit of information flows could also make it difficult for the NHS Commissioning Board to assess the performance of GP commissioning consortia. And how will outcomes be measured at GP consortia level?

Urgent consideration is needed of the implications of the White Paper for the information that the new NHS will need to conduct its day-to-day business competently, raise quality and improve health outcomes – and all this in an increasingly constrained fiscal environment.

We cannot wait to find out that the information foundations do not align with the castle they are designed to support. The proposed information strategy offers an opportunity to drive improvements in information on quality and outcomes, fill the gaps, and assess the fitness of information flows for supporting the new NHS. Will this opportunity be grasped?

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Comments

#183 Mary E Hoult
volunteer

Informatics is key to the success of the current white paper,sadly if targets are abandoned by the major hospitals a key control for the operation of the board will be lost.The new NHS consistution is also in it's early stage of development and not ready for full use.These comments are confirmed by the informatics being the only area not involved in any change.It would wise for large Trusts to keep targets therefore keeping control of their internal structures.

#194 concerned

Patient information is about so much more than further embedding the 'choice' agenda and building league tables for hospitals and care providers which have proved so damaging in the education sector; raising expectations unrealisitically and creating an annual panic when the admissions round hits.

It's disappointing to see the white paper focus so much on patients giving feedback and ratings on their care whilst neglecting the substantive information about conditions and treatments that patients tell us they actually need. All the evidence base around patient information hones in on the need for patients to be given personalised, accessible information in the right format for them at the right stage in their patient journey, with appropriate support from people, including medical practitioners (who continue to need to develop and improve their skills in speaking to patients and carers and ensuring they have understood the information they are given).

Knowing which GPs and hospitals score highest in patient satisfaction is one thing (and I'd question whether that drives improvement as the coalition seem to suggest it will - what is their evidence for this?), but having an information revolution that truly helps and supports patients and carers from diagnosis to treatment and beyond is something entirely different and not really addressed at all in the white paper, to the detriment of all involved.

#208 Dorothy Grace
Informatics Consultant

If commissioning by GP consortia is going to work effectively, then the data analysis behind the strategic and operational commissioning decisions is absolutely vital. The main stumbling block is the mis-match of areas and boundaries between the different health and social care providers, and this must be tackled if we are serious about commissioning cost-effectively. A total culture shift has been necessary among PCT staff who for years analysed data from secondary care and called it 'commissioning'. Even now, several years after the radical change in funding started in 2003-4, the thinking is slow to turn around from reactive to proactive, to bring together data from all providers in all care sectors. This is what GP consortia will need to do to commission effectively, provide appropriate services and improve health outcomes. Knowing one's population is the key to improving healthcare and providing it at the point of need cost-effectively.

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