The Department of Health’s Information Strategy is due to be published next month. It’s been a long time in development – it’s nearly two years since the government consulted on its aim to achieve an ‘Information Revolution’. So what should the strategy say if it is to start the revolution?
Put simply, the strategy needs to address two issues: collecting the right information, and making use of that information. In our Commission on the Future of NHS Leadership and Management last year, we argued that the NHS was over-administered but under-managed. There is a parallel here with the state of information. At least in the acute sector, it can feel as if the system is awash with information, but lacks real intelligence. We record, code, collect, collect and collect, but too often we fail to really use that information to drive improvement.
The strategy needs to ensure that the right information is collected for all the different purposes for which it is needed. It needs to meet the different needs of patients making choices, people managing their long-term conditions, and the public holding their local services to account. Clinicians need up-to-date, detailed data about activity, outcomes, experience and cost, at the level of individual patients, consultants and services. Boards need regular reports of trends and changes in key performance measures. Commissioners, health and wellbeing boards and local authorities need analysis of population needs and health trends, which requires data based on geographies rather than providers. There will also be a requirement for Monitor and the Care Quality Commission to gather and analyse information through their roles.
Avoiding information collection overload is therefore a difficult but crucial balance to strike. For the NHS to collect the right information, it needs to capitalise on opportunities to ‘collect once and use often’ but also recognise that different information is needed for different groups and different purposes. It can fatally damage trust, for example, if information ostensibly collected by clinicians for peer review and quality improvement is then used for judgement and management.
One thing everyone needs is information they can trust. Standards for information and data quality are therefore crucial. Standardised definitions and methods of collection are needed to generate comparable information for benchmarking, which is important both for quality improvement and for public accountability. Ensuring the use of these indicators could then require contractual obligations, audits and incentives for improving data quality.
The government also needs to address the gaps that currently exist in information collection. Routine information is lacking in community services, social care, and some aspects of patient experience, among others. Addressing this has to be a priority if we are to have a truly information-led NHS.
It is also vital that the strategy sets out how we can make the best use of information. One of the most important opportunities here is in data linkage. Examples abound of innovative data linkage that can directly lead to better decisions. To pick just three, there’s the Integrated Care Programme in NHS North West London linking information about complex elderly and diabetic patients across multiple care settings, Torbay Care Trust’s linking of health and social care data, and the National Cancer Intelligence Network’s linking of registry data to hospital episode statistics. Encouraging or mandating the consistent use of the NHS number as a patient identifier could be one way to facilitate more of these initiatives.
But information also needs to be interpreted, analysed and then presented in ways that are meaningful to the user. A great deal has already been learnt about how to do this well and this know-how must not be lost. The precise fate of the public health and quality observatories remains unclear, but these organisations must continue to play their crucially important role in providing the intelligence that drives effective commissioning. Within providers, our recent study of service-line reporting in hospitals identified some excellent practice in presenting quality and cost data back to clinicians through web portals and dashboards that genuinely illuminated how they were performing and helped them to make better clinical decisions. And in terms of information for patients and the public, research into how to support patients to make informed choices and how to produce quality accounts for the public all give insights into how to present information well.
Whitehall can’t start revolutions on its own. But it can set the ambition, provide a supportive policy framework, set and require standards, and encourage the spread of innovation. Doing this well has real potential to help transform our ability to make the right decisions to improve quality and efficiency. A well-drafted Information Strategy might just make a difference.
This blog is also featured on the British Medical Journal website.