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North WestEvidence and Intelligence Workshop
3 August 2012 Public Health England Transition Team
Evidence and Intelligence team
Introduction
Today’s session•Introduction - Jürgen Schmidt, Local System E & I Project Manager, Public Health England Transition Team •Information Management – Robert Kyffin, Senior Public Health Intelligence Officer, Public Health & Social Care, South East •Commissioning Board’s Commissioning Intelligence Model – Ming Tang, Managing Director, South Yorkshire Commissioning Support Service, Helen Brown, Commissioning Intelligence Lead, NHS Commissioning Board, Data Management and Integration Centre representative•Core Offer – Ann Goodwin, Programme Manager, Public Health England Transition Team•Evidence – Anne Brice, Project Lead, Active Knowledge Management•Public Health England: contribution and summary – Jürgen Schmidt •Questions
Objective:
If at the end of the day we both know more about what the other is doing, why and against which odds, then the day was well spent
Further information
Dr Jürgen Schmidt, project lead, [email protected]
Current work in Evidence and Intelligence
• creating a national leadership role for evidence and intelligence (E&I) in PHE, integrating leadership of cancer registration, NDTMS, and cancer (inc. NCIN) and public health intelligence
• creating eight geographical areas of accountability, with multiple office sites/bases where needed
• combining cancer registry intelligence staff with public health observatory staff to create eight evidence and intelligence teams
• developing national cancer registration based on existing move to national system
• developing national NDTMS structure, drawing on existing regional teams and a common model
• providing an excellent responsive service to local partners, including PHE Centres, Local Authorities, Clinical Networks and others as appropriate
Revised to match PHE Regions, PHE Centres, and NHS CB LATs…subject to final
confirmation:
The Map (population in millions)
8.4m
3.4m
6.8m
7.8m
8.8m4.8m
5.5m
6.5m
Context for local public health intelligence work
• What are the relevant changes?
– Physical move and changed functions of DsPH and their teams
– Local Authority public health responsibilities
– Local ‘proposition’ ie. support offer
• Formal requirements:
– NHS planning guidance for 2012/13: To agree arrangements on public health information requirements and information governance by September 2012
– PHE transition guidance checklist item: Are plans in place to ensure access to IT systems, sharing of data and access to health intelligence in line with information governance and business requirements during transition and beyond?
Legal requirements (Act 2012)“Obtaining advice from individuals who taken together have a wide range ofprofessional expertise in the prevention, diagnosis or treatment of illness, and the protection or improvement of public health”
Authorisation Criteria“1.3 Widespread involvement of other clinical colleagues providing health services locally [identified by ..]Arrangements in place between LA and CCG specifying how public health advice to CCGs will be delivered.”
Clinical Commissioning Groups
Commissioning Support Services
Potential NHS commissioning support suppliers should:“Develop an understanding of how their offer will relate to other parts of the commissioning support supply chain and the delivery impact of this (for example by engaging with local authorities and the public health team to establish what they are providing)”
“Work is on-going to establish which elements of Health Needs Assessment and Business Intelligence for NHS commissioners might be secured as part of a ‘core offer’ from Public Health England (PHE) and which components might be provided by NHS commissioning support functions”
Local authority public health intelligence
Information Management in Public Health EnglandWide range of information management projects covering:
• What information do we need
– National data requirements
• How do we access and handle it
– Information governance
– Information standards
– Data management
• How do we use it
– Indicators
– Methods
– PHE web portal
Further information
Robert Kyffin [email protected]
Information Management inPublic Health EnglandNational Data Requirements
• Model for agreeing and defining national data requirements for public health developed and tested at stakeholder workshop and with project advisory group
• Proposal currently being finalised – if approved, work will commence in autumn to establish an NDR Board and Advisory Groups
• Work also underway as part of the PHE Information Management project to clarify the day 1 national data requirements for PHE and ensure ongoing access to these data sets with HSCIC and other suppliers
Information Management inPublic Health EnglandInformation Governance
• PHE Information Governance Project Group established, building on IG structures in PHE sender organisations
• Input into national information governance framework (regulations on uses of identifiable information and s251) and Caldicott 2 review
• Input into IC Code of Practice for Handling Confidential Information and de-indentification standard, etc.
• Agreement with DH, Health Research Authority and DH Adult Social Care on future arrangements for s251 advisory and approvals functions
Information Management inPublic Health England
Information Standards
• PHE collaborating with NHSCB and DH Adult Social Care to develop a joint operating framework for standards – governance arrangements currently being worked through
• Information standards operating framework to be jointly agreed by Oct-2012
Data Management
• Data flow mapping in preparation for PHE day 1
• PHE data warehouse and safe haven – bring together key public health data resources to provide a single set of core, up-to-date, validated data sets which can be shared as a consistent resource within PHE and beyond
Information Management inPublic Health EnglandIndicators
• Develop standard PHE processes for agreeing and developing indicators (linking with HSCIC indicator pipeline)
• Public Health Outcomes Framework indicator gap analysis
Methods
• Work across sender organisations to develop an integrated approach to analytical methods within PHE
• SOPs completed for a range of subjects including assigning deprivation categories, catchment areas and populations, RAG ratings, using postcode directories, etc.
PHE web portal
• PHOF data reporting
• Portal specification produced
• Software development underway
Commissioning Board’s perspective now ..
Public Health Population Healthcare Advice (AKA The Core Offer)Why?•Good population health outcomes, including reducing health inequalities, rely not only on health protection and health improvement, but on the quality and accessibility of healthcare services provided by the NHS•Local authorities, as part of their statutory functions around public health, will have responsibility for providing healthcare public health advice to clinical commissioning groups (CCGs), •Each CCG will be under a duty to “obtain advice appropriate for enabling it effectively to discharge its functions from persons who (taken together) have a broad range of professional expertise in –
– the prevention, diagnosis or treatment of illness, and– the protection or improvement of public health. ”
•The current resource in terms of public health expertise to provide this service will transfer from primary care trusts (PCTs) to upper tier and unitary local authorities (LAs) as part of the ring-fenced public health budget.
Further informationAnn Goodwin, Project Manager, [email protected]
Core Offer - The how and the what
• A working group was established. The membership included representatives from the Association of Directors of Public Health, the Faculty of Public Health, British Medical Association, Royal College of General Practitioners, GPs from emerging clinical commissioning groups (CCGs), the Local Government Group and the Association of Directors of Adult Social Services.
• Developed the content of the service by linking specialist public health advice to elements of the commissioning cycle, from assessing needs for health services through to planning capacity and managing demand
• Local authorities will be free to deliver this service in a variety of ways. For example, in relatively small authorities it may make sense to locate a team in a single authority, which will deliver the service on behalf of several local authorities. Public Health England will also play an important role in supporting the work of local information and intelligence specialists in the public health team.
• There is nothing to prevent local authorities from agreeing locally to offer a wider range of services over and above the free healthcare public health advice service. This would need to be agreed locally.
• If the healthcare public health service is to be effective there will need to be constructive relationships built between local authorities and CCGs, to ensure that the local commissioning fully reflects the population perspective. The key to making it work will be developing effective local partnerships.
• Subject to Parliament, regulations will clarify further what local authorities will need to provide in delivering this function, although the precise content of the service in each locality will be driven by local agreement, reflecting local needs and available skills and resources.
Core Offer - How much resource?
• The Association of Directors of Public Health surveyed Directors of Public Health to establish how much of their and their accredited public health specialists’ time was currently spent undertaking the elements of the service.
• The estimate was somewhere between 25% and 50% of the local specialist public health team . The guidance, based on the outputs of that survey, suggests (for planning purposes) that something in the region of 40% of the local public health specialist team might be engaged in this work, with a rough coverage of 1 wte specialist per 270,000 or so people. This will vary from place to place, and input will vary across the year and there will need to be local agreement of the inputs and outputs through local planning arrangements, reflecting for example, the number of CCGs.
Core Offer - Agreements• The development of a local service agreement agreed with CCGs via
a compact or Memorandum of Understanding between the local authority and CCG, specifying public health inputs and outputs, and outlining the reciprocal expectations placed upon the CCG. The ‘shadow’ period from April 2012 to March 2013 will be useful developing appropriate agreements.
• These agreements can be underpinned by an annual work plan for the healthcare public health advice service agreed by both the CCG and the local authority Director of Public Health specifying the particular deliverables for the twelve month period.
• Further accountability could be provided, for example, by the Director of Public Health and CCG jointly presenting to the relevant health and wellbeing board information setting out how the service had been provided that year. This might cover the process for engaging with public health expertise, names and teams, how the time had been spent, how statistically robust any data had been, lessons to be learnt for next year.
• Where there are concerns about the quality of the advice received we would expect this to be raised at the local level initially with the local authority.
Core Offer - Example MOUsNottingham• Outlines reciprocal responsibilities• Not just about healthcare advice• Specifies the resource• Offers to provide training etc
Worcestershire• Outlines reciprocal responsibilities• Not just about healthcare advice
What don’t they cover ?
Core Offer - What next?
• Local Public Health Transition Plans• Discussions with CCGs /CSS’s /Health and
Wellbeing Board• Data from CSS’s to support the ‘Core Offer’ should
be free of charge• Agreement between partners as to the ‘What’, ‘How’
and by ‘Whom’• Named Informatics leads in CCGs/CSS’s/Local
Authority
ww.dh.gov.uk/health/2012/06/public-health-advice-to-ccgs/
Active Knowledge Management
• Connecting people with knowledge – understanding and acting on user needs so that both explicit sources (internal and external) and implicit or tacit knowledge can be sourced, managed and accessed– includes Knowledge Platform: develop a single, accessible, user focused
and authoritative web-based evidence site for professionals, to make evidence easily available to all and to encourage the use of best evidence in practice
• Connecting people to people – so that relevant stakeholders, networks and communities can be found, mapped and connected
• Active knowledge services – integrated, tailored knowledge services that provide expert navigation, mediation and training to facilitate efficient knowledge translation
Further information
Anne Brice (Project Lead) [email protected]
Anh Tran [email protected]
Active Knowledge ManagementConnecting people with knowledge
Active Knowledge ManagementContent development group
• Feed into discovery phase of web portal design – all content has secure access transition
• Produces explicit process documentation and guides for content providers and users, including a content development strategy that includes:– Taxonomy– Editorial processes and standards
• Mechanism for co-ordination and alignment of PHE content and services with other national agencies and providers
• Workflow and integration of knowledge platform with active knowledge service
Active Knowledge ManagementConnecting people with people
• Potential relationships across the wider public health system will include PHE, the NHS, Local Authorities, and a range of stakeholders and partners, all of whom will need to be connected in order to share and learn from the knowledge that is available to them
• Audit of current networks, discussion groups will help us understand the relations between different groups, and how they could interact in the future
• Communities of practice audit and social network analysis will help us survey and map current and potential tools for knowledge exchange
Active Knowledge ManagementActive knowledge service
• Audit of existing library and knowledge services supporting the public health system to gain a better understanding of current provision, risks and issues
• Produce an audit report presenting the findings and documenting key strategic issues
• Engage library and knowledge service colleagues in the development of the specification for public health knowledge services
• Produce a knowledge service requirements specification informed by engagement with library and knowledge service colleagues and analysis of user needs
PHE proposition
a) Local public health intelligence: what are the issues?– Functions and data flows– Information Technology– Information Governance – Transition plans
b) Alignment of main E&I projects: PHE proposition– On April 1, 2013, local public health intelligence teams across the
country will have successfully completed their transition to their respective Local Authority. Issues around local access to PHE products and services, IT connectivity, Information Governance constraints, will have been solved so as not to impede business continuity.
– User defined requirement of PHE service provision to the local system (the ‘proposition’)
– A business model for the service, distinguishing baseline from additional activity
– Underpinning theses deliverables, PHE factsheets and guidance (incl. checklist) about IG and IT connectivity for local PH systems
PHE proposition – overall picture
• National PHE functions including data requirements, informatics (IG, standards, quality), surveillance strategy.
• National advocacy for better evidence and data • Partnership work with IC, NICE, ONS, etc to make them most
useful for the local system• National products and tools around data, evidence and
experience in a form most useful to the local system. Focus on PHOF topics, DPH Annual Reports and JSNAs
• Guidance on use of both PHE and non-PHE products • Responsive ad-hoc service• Direct line to PHE E&I• Education and training on PH E&I topics• A professional network (forum) for intelligence staff• Opportunities for staff from LAs to undertake attachments in
PHE
PHE propositionFamily of health profiles project
Objectives
– To develop an integrated approach to the production of generic and themed health profiles and atlases for England.
Products from this Project:
– Proposal to PHE for an integrated, cost-effective approach to health profiling, including: strategic governance, systematic user engagement, systematic indicator production and methodologically robust programme and project management
– Process for prioritising new and existing health profiles based on a set of values
– Recommendations for continuing, updating or decommissioning existing health profiles based on application of these values
Next steps
– Agree a PID with dependencies and formal governance process probably through the Health Profiles Programme Board
PHE propositionPHE Local Intelligence – Key strands• Active dissemination of national tools and other outputs –
includes training in use of tools, running workshops, advising on how and where they can add value and have impact at local level and providing a feedback loop
• JSNA support• Local public health intelligence network support, training and
CPD• Specialist intelligence support and expert advice - include
theme specific expertise (e.g. child health), health economics, statistics and modelling, GIS, evaluation and social marketing/behaviour change.
• Benchmarking data and bespoke analysis (incl. HES)• Evidence and knowledge management support - working
with local teams to identify actionable insights from the evidence base that would result in outcome improvement
PHE propositionNational PH Intelligence Training Strategy
Objectives:
1)Capture, share & review developments in local PHI training & CPD activity
2)Explore partnership approaches to PHO training & CPD delivery
3)Continue development and application of technology-enhanced learning methods
4)Implement the PH Workforce Strategy
5)Undertake a training needs assessment of staff moving into I&I roles in PHE
and
(though not in terms of reference)
Co-ordinate PHO response to PH Workforce Strategy consultation
PHE proposition - What next?
• Business model PHE• Business model LAPH• Business model Clinical Commissioning Group• Business model Commissioning Support Service• All these need to be complementary• So there …
Update on CCG Intelligence Programme, Delivery of DMICs & links with Local Public HealthPresented by Helen Brown, & Ming Tang
Local Public Health Transition Team Workshop 3 August 2012
Contact: [email protected]
1. CCG intelligence requirementso The Commissioning Intelligence model (CIM)
2. Proposed Delivery Model & whole system working
3. Early thoughts on Public health data flows
4. Development and Delivery of DMICs
5. Suggested links between LA PH & DMICs
Objective
Vision & Headlines of CCG Intelligence Programme
o The programme started out to understand the commissioning Intelligence requirements for CCGs from a bottom up approach
o It involves strong clinical leadership to drive the national vision for intelligence to enable large scale health improvement for patients
o We are co-designing the CCG Intelligence Delivery Model
o Support the CCG authorisation and CSS assurance processes
o Facilitate the sharing of current intelligence solutions and tools
o Advice and support to develop one version of the truth shared across the patient journey and beyond
LAs and CCGs will need to use
the same common data
when producing this intelligence
LAs and CCGs will need to use
the same common data
when producing this intelligence
There is an opportunity to use the same version of the truth.There is an opportunity to use the same version of the truth.
Other Local PartnershipsOther Local
PartnershipsIntegrated
CommissioningIntegrated
CommissioningHealth & Wellbeing
BoardsHealth & Wellbeing
Boards
Non-HealthLocal Authority Business Intelligence
Public HealthLocal Authority Business
Intelligence
CCG Local Commissioning Intelligence
CCG NHS CB National CommissioningIntelligence
There are a number of local groups which
need local Intelligence
There are a number of local groups which
need local Intelligence
CCGs are accountable for commissioning
services on the basis of the best available
evidence
CCGs are accountable for commissioning
services on the basis of the best available
evidence
Local Authorities are accountable for
providing a Public Health advice service &
other intelligence to support other wider LA
agendas
Local Authorities are accountable for
providing a Public Health advice service &
other intelligence to support other wider LA
agendas
How LAs and CCGs will use intelligence to commission services
35
We need:oStreamlined data flows, store data once and use many timesoIncreased sharing of data to enable greater understanding of the whole system
What will it do for CCGs?o Greater understanding of the
potential and scope of intelligenceo Facilitate understanding of whole
system & evidence interdependencies
Overarching Question
An example question
Data and Tools
ServicesOverarching concepts
The CIM Model is a consolidated view of the different types of commissioning intelligence requirements needed to support evidence based commissioning decisions.
It takes account of feedback from a large scale engagement exercise including innovative practice from across the country
CCG intelligence requirements - The Commissioning Intelligence Model
36
Joint Intelligence Programme Work
37
Intelligence for
Commissioner
Intelligence for
Commissioner
Public Health England I&I
Public Health England I&I
Local Authority Core Offer
Local Authority Core Offer
Commissioning Support
Development
Commissioning Support
Development
Types of Services
Tools/Data
Types of Services
Tools/Data
Tools/Data
Tools/Data
Types of Services
Tools/DataTypes of ServicesTypes of Services
Tools/Data
Tools/Data
Types of Services
Types of Services
The Commissioning Intelligence Model
What questions
do we need to answer?
Q8.01: Are our strategic objectives aligned across the health economy inc
social care?Provenance: HB
Q8.02: What will be the impact of demographic and
disease pattern change?Provenance: WS270911
Q8.03: How can we make QIPP savings of £XXXm?
Provenance: HB
Types of Services Tools/Data
Q2.09: What is the impact of patient choice
on Provider volumes?Provenance: CCG
Q3.08: What is the projected liability for our
referred population? Provenance: WS021211
Q5.06: Can we distinguish between Provider 'pull' and Primary Care 'Push'
Provenance: CCG
Q5.07: Are Providers sending datasets to agreed standards and frequency? (If not, are there sanctions
in place?)Provenance: V13
Q6.05: Do we need to procure services from
alternative providers, or work in partnership with other stakeholders to be
more efficient for provision and procurement?
Provenance: MT/HB/WSS290911
Q7.05: Have we improved outcomes?
Provenance: HB
Q7.06: Have we reduced inequalities?
Provenance: HB
Q8.04: How will changes in technologies
(IT, drugs etc) impact us?
Provenance: HB
Q8.05: Given our budget, how can we decide how
much to invest/disinvest in services?
Provenance: HB
Q8.06: What activity should we contract for to
deliver the service changes / cost efficiencies
needed?Provenance: HB
Q7.08: Did we meet our targets and can we sustain them?
Provenance: HB
Q7.07: How did our patients rate their experience of our
services?Provenance: HB
Q6.06: How do we compare with evidence and
guidance for process, outcomes and patient
experience?Provenance: HB
Q6.03: Would 'Scenario A' improve patient flows and
productivity more than 'Scenario B'?
Provenance: AF
Q6.02: What will be the combined impact, in cost
and activity, of a whole set of service changes and productivity measures?
Provenance: AF
Q7.02: Can I isolate the 'cause and effect' of an
individual initiative?Provenance: AF
Q7.01: When a service change is implemented, what was the outcome, cost and quality for this and to other services?
Provenance: AF/HB/WS290911
Q7.03: What's the combined impact of all our interventions for
patients, the services & health economy?
Provenance: AF/WS290911
Q5.01: What is the current performance
against plan?Provenance: AF
Q5.02: What elements of the billed activity can we
challenge?Provenance: AF
Q5.03: Are providers delivering on service-improvement, quality
(cquins) patient experience and waiting-times targets?
Provenance: AF/WS290911Q5.04: What service lines are above or below plan -
why?Provenance: V13
Q5.05: Are providers overlooking agreements
on Threshold Management?
Provenance: V13
Q4.01: Where is there clinical / activity / cost /
outcome variation vs local , national, international, best
practice?Provenance: WS270911
Q4.02: Are we delivering national standards of care
for: patient experience, quality and outcomes?
Provenance: AF/WS290911
Q4.04: Do current pathways reflect
evidence-based good practice?
Provenance: AF
Q4.05: How do we compare for value for money, outcomes
and productivity against similar areas/ best practice
over time?Provenance: AF/WS290911
Q3.01: How much is my budget? How much am I spending compared to
plan?Provenance: AF/WS290911
Q3.02: How much do individual service- lines/ pathways cost compared
to budget?Provenance: AF
Q3.03: Is cost aligned to volume, quality and
outcome?Provenance: V13
Q3.04: Are we maximising value for
money? (e.g. community provision vs. acute care)
Provenance: V13
Q3.07: Where are the most severe cost
pressures?Provenance: AF
Q3.06: Is activity being priced at the correct
amount?Provenance: AF
Q2.01: Why have we got financial pressures?
Provenance: AF
Q2.02: How long are patients waiting for
treatment?Provenance: AF
Q2.03: Is demand really going up? By
how much?Provenance: AF
Q2.04: What are the current flows and pathways and are patients using the
right ones? Provenance: AF/WS290911
Q2.05: Where are the bottlenecks?
Provenance: AF
Q2.06: How much random variation in
activity do we observe?Provenance: AF
Q2.07: What is the demand today for urgent care, and who do I need to target to keep out of
hospital?Provenance: AF
Q1.01: How healthy/unhealthy is my
population relative to benchmarks?Provenance: AF/WS290911
Q1.02: What health conditions are changing
most?Provenance: AF/WS290911
Q1.03: Who is at greatest risk of disease/acute
admission to hospital?Provenance: V10
Q1.04: How is the local population going to change in future?
Provenance: AF
Q1.05: What diseases kill most people and which are the biggest burden?
Provenance: WS270911
Q1.06: Who are the sickest people and where
do they live?Provenance: AF
Q1.07: Who would benefit most from a disease
management programme?Provenance: AF
Q6.07: What are our drivers for
change and have we engaged with stakeholders (inc
Patients)Provenance: WS270911
Q2.10: To what degree are
patients able to make informed decisions about
their care?Provenance: CCG
1. How Healthy?Reducing health inequalities and improving health outcomes now
and in the future
8. What are our future plans?Reduce unmet need by
anticipating future priorities and improving decisions about
resource allocation, by ensuring planned services reflect changing
needs and demands of local population
2. What's really happening in this
system?Information available at right time and to the right person to protect
the vulnerable and ensure the right care is given to reduce duplication
and improve integration of care
7. What difference have we made?
Ensuring patient feedback is embedded in the cycle of
continuous improvement to improve patient experience
6. How could things be better?
Developing new pathways and/or decommissioning services to
improve safety, quality, effectiveness of care and
maximise financial benefit
3. How Much?Improved financial information
(including budgeting and planning) to ensure resource is given to
appropriate care provider for the treatment given and ultimately there is better transparency of
financial flows to support improved commissioning decisions
4. How do we Compare?
Challenge our current state through proactive benchmarking
and comparison in order to improve clinical outcomes
5. Are my providers
delivering what they agreed?
Improve commissioning decisions through better
information and information analysis
Q6.01: What would be the impact, in activity flows and costs, of making a proposed
change to a clinical pathway?Provenance: AF
Filename: Commissioning Intelligence Model V13.vsdVersion Date Comment1. Aug 11 Original from Andrew Fenton2. 15/9/11 Added comments from Ming Tang, Helen Brown and responses to the IFC
document3. 21/9/11 Added comments from Shahid Ali and benefits from Jo Butterfield4. 27/9/11 Tidied version for workshops5 28/9/11 With comments from London Workshop6. 14/10/11 Added comments from workshop and consultation feedback7. 19/10/11 After linking data to services (CH & HB)8. 28/11/11 Q8.3 to include QIPP9. 5/12/11 Amendments after CSO workshop on 2/12/1110. 9/12/11 Amendments after ref group review
D1.01: Population, migration, birth, mortality and morbidity statistics and projections (ONS, Exeter, QOF, Primary Care, SUS, Prevalence modelling tools, Census) (Provenance: AF/WS290911)
D1.02: Public Health Data Observatory / Local Information Systems / JSNA / Cancer Registry / Qualitative Data inc Voluntary & Third sector (Provenance: AF/HBWS290911)
D1.03: Risk Stratification tools and models : Patients at Risk of Readmission (PARR), Combined Predictive Model, Adjusted Clinical Groups. (Provenance: AF)
D1.04: Socio-demographic classification system (e.g. Mosaic, Health foundations - DH segmentation tool). (Provenance: AF/WS290911)
D1.05: Mapping and geo-spatial software (Provenance: AF)
D1.06: Deprivation indices (Index of Multiple Deprivation). (Provenance: AF)
D1.07: Access to and familiarity with wide range of Public Health data sources , Benchmarking and comparison tools (e.g. NHS Atlas of Variation, NCHOD, Local tools). (Provenance: CH181011)
D1.08: Dynamic ethnicity data analysis across all aspects of care. Wider equality indicators including disability , sexual orientation etc (Provenance: HB)
D1.09: Data on wider determinants, social service, HPA (Provenance: HB)
S1.01: Health needs / Joint Strategic Needs Assessment/ Impact assessments (data & analytical input) (Provenance: AF/WS290911)
S1.02: Risk profiling & prediction. (Provenance: AF)
S1.03: Demographic forecasting & disease trends. (Provenance: AF)
S1.05: Geographic analysis and mapping , socio-demographic analysis. (Provenance: AF/HB)
S1.06: Identification of at-risk groups (e.g. Communities (inc Travellers), Carers etc) (Provenance: Auth)
S1.07: Informing the public about keeping healthy , prevention resources (Provenance: HB/CH)S1.08: Research, surveys, audits, peer reviews (Provenance: HB/
WS290911)
S8.01: Demographic forecasting & disease trends (Provenance:
HB)
S8.04: Forecasting and future projections of expected activity. (Provenance: HB)
S8.05: Cost Benefits analysis of current activity vs . alternatives (Provenance: HB)
S8.06: Strategic secondary analysis of 'How Healthy' and 'How much?' (Provenance: HB)
D8.01: Programme budgeting (comparative spend on disease conditions) & marginal analysis, PBMA Atlas, SPOT, SHAPE (Provenance: HB)
D8.02: Health investment packs, QIPP (Provenance: HB)
D8.03: Pathway modelling inc ROI calculators , return on investment tools (Provenance: HB)
D8.04: Results and secondary analysis of other questions, design making support etc (Provenance: HB)
S2.01: Trend and statistical analysis (activity, cost, SPC) (Provenance: AF)
S2.02: Capacity and demand analysis, patient flow modelling, waiting times analysis (Provenance: AF)
S2.05: Analytics support to Clinical audit . (Provenance:
AF)
S2.07: Provide access to patient medical records (Provenance: HB)
D2.01: Near/real time information - activity & financial for A&E, OOHs, MIU, Acute and Community Admissions etc (Provenance: CH181011)
D2.02: SUS data, including acute activity & costs, referrals with clinical reason, CAB, 'Patient-Journey' analysis. (Provenance: CH181011)
D2.03: Current, historic and planned Provider Activity and Cost data-sets (SUS & Local Contract Mgmt Systems e.g. Maternity, Mental Health, Local Auth etc) (Provenance: V10)
D2.05: Waiting times/list data (Provenance: AF)
D2.06: Patient level datasets with updates inc : decisions made in secondary care – reasons for treatment/changes/referrals/delays /test results and outcomes (Provenance: HB)
S3.01: Service-level costing (e.g. by Specialty, HRG chapter, Diagnostic chapter) (Provenance: AF)
S3.02: Budget planning, development & forecasting (Provenance: AF/WS290911)
S3.03: Budget Reporting & Variance analysis (Provenance: AF)
S3.04: Price verification (provider costings) & reconciliation to contract, automated invoice validation (Provenance: AF/CCG)
S3.05: Comparative Provider cost analysis (Provenance: AF)
D3.01: SUS reporting & analysis web-service, including Budget reports. (Provenance:
V10)
D3.02: Current and historic Provider Activity and Cost data-sets (SUS & Local Contract Mgmt systems) (Provenance: V10)
D3.03: Tariff / Pricing tables, PBR rules and algorithms (local and national), Prescribing costs (Provenance: CH181011)
D4.01: Age-sex-deprivation standardised comparative data at Practice level for commissioned activity (inc practice specialism). (Provenance: AF)
D4.02: Primary Care data extracts providing integrated analysis with Acute activity, e.g. prevalence rates vs. Admissions. (Provenance: AF)
D4.03: Comparative benchmarking tools (e.g. QOF Data sets, NHS Comparators, NHS Atlas of Variation, Better Care Better Value indicators ). (Provenance: CH181011)
D4.05: Benchmarked GP referrals analysis . (Provenance: AF/HB)
D4.06: Practice profiles (Needing national standards) (Provenance: HB)
S4.01: Practice level, regional, and national benchmarking of disease prevalence , activity, productivity and costs. (Provenance: AF)
S4.02: Analysis and presentation of productivity indicators by programme / project. (Provenance: AF)
S4.03: Clinical Pathway mapping and modelling and cost comparators (Provenance: AF/
WS290911)
S4.04: Providing evidence and information on comparative health outcomes . (Provenance: AF/WS290911)
S5.01: Analytical support to Contract monitoring & analysis (Provenance: AF)
S5.02: Provider activity validation & Data Quality review (Provenance: AF)
S5.03: Invoice validation, challenge (Provenance: CH181011)
S5.04: Provider level-analysis of ‘how much’ and ‘how good’? (Provenance: AF)
S5.05: Contract development (Provenance: MT)
S5.06: Performance Management and support for service improvement (inc Negative impacts and Data Management) (Provenance: MT)
Draft for Discussion Only
D5.01: Data warehouse integration and reconciliation of Activity/Cost and Provider contracting reports (Provenance: AF)
D5.02: Contract Monitoring reporting by Provider (Provenance: CH181011)
D6.01: Pathway data (Provenance: AF)
D6.02: Contract activity and cost (Provenance: AF/HB)
D6.03: Forecast analysis and planning projections (Provenance: AF/HB)
D6.04: Service structure audit and improvement support. (Provenance: AF/HB)
D6.05: Prescribing decision support data (Provenance: HB)
S6.01: Pathway & scenario modelling (inc Audit of Admission thresholds and service structure) (Provenance: AF)
S6.02: Contract modelling (Provenance: AF)
S6.03: System-wide activity & cost modelling (Provenance: AF)
S6.06: Review evidence base (e.g. National Comparators, NICE, etc) (Provenance: V13)
S7.01: Programme and project monitoring. (Provenance: AF)
S7.02: Providing comparative cost and activity monitoring (Provenance: AF)
S7.03: Metrics reporting. (Provenance: AF)
S7.04: Performance reporting. (Provenance: AF)
S7.05: Providing comparative outcome monitoring inc Patient and Public Data (Provenance: HB)
D7.01: Performance & Public Health metrics, frameworks and dashboards (Provenance: AF)
D7.02: Activity & cost baseline and tracking data (Provenance: AF)
D7.03: Impact analysis & evaluation using statistical tools (Provenance: AF)
D7.05: Public Health Observatory tools including survey tools (Provenance: HB)
S6.07: Capture & manage stakeholder feedback/outcomes (Provenance: WS290911)
D1.10: Predictive disease monitoring (Provenance: WS270911)
Q1.10: What are the preventable conditions
contributing to our premature mortality?
Provenance: WS270911
Q1.08: What causes patients most distress?
Provenance: WS270911
Q1.09: What proportion of disease is avoidable?
Provenance: WS270911
S1.09: Managing needs of Stakeholders (e.g. Care Home, Community, Health Education) (Provenance: WS290911)
S2.09: Indicators to track progress throughout pathways reasons/decisions for referrals, patient experience and outcomes. (Provenance: WS290911)
Q3.09: How much are we spending on inequalities?
Provenance: WS290911
D3.05: Robust timely referral activity (Provenance: WS290911)
D4.07: National Guidance, PROMS, Utilisation reviews (Provenance: CH181011)
D5.05: LA, Primary care and Voluntary/third sector (Provenance: WS270911)
S5.07: Utilisation reviews, PbR Audits, Clinical Decision Support (Provenance: WS290911)
D6.06: Capture & processing of patient experience and outcomes throughout pathways, inc PROMS (Provenance: WS270911)
Q7.09: What are the benefits of the
changes?Provenance: WS290911
Q8.07: Have we got the balance correct between
national, local and patient expectations?
Provenance: WS270911
Q8.09: What barriers exist that prevent change
(e.g. org/cultural)?Provenance: WS290911
S8.07: Track and react to patient expectation (Provenance: HB)
O0.01 Interpretation, contextualisation, exploitation and stakeholder communicationO0.02 Data collected at patient levelO0.03 Holistic Analyses - Full System view rather than isolated segmentsO0.04 Flexible tariffsO0.05 Master Data Administration (inc Common currencies & agreed standardisation techniques)O0.06 Timeliness and quality of dataO0.07 Data definitions and standardsO0.08 Interoperability
Overarching Concepts
O0.09 Knowledge ManagementO0.10 Integrated ways of workingO0.11 Development of Metrics
S2.13: Track patient experience (Provenance: CH181011)
S2.12: Management of Urgent Care Monitoring /Dashboards (Provenance: CH181011)
D3.06: Referral templates with expected costs (Provenance: CH181011)
D3.07: Reference Cost Data (Provenance: CH181011)
S4.05: Statistical analysis of variation and correlations e.g. Statistical Process Control (Provenance: CH181011)
D5.06: Referral Data (Provenance: CH181011)
D5.07: CQUINS (Provenance: CH181011)
S5.08: Basic budget reporting (Provenance: CH181011)
S5.09: Contract validation, challenge (Provenance: CH181011)
S5.10: SUS validation with GP Practice Systems (Provenance: CH181011)
D6.07: Data outputs from all other dimensions (as appropriate) (Provenance:
CH181011)
D6.08: Stakeholder feedback including external sources such as Social Media and Public Enquiries (Provenance: V10)
D7.07: Data required for Programme Gov inc Benefits Mgmt, Plans etc (Provenance: CH181011)
D7.06: Data outputs from all other dimensions (as appropriate) (Provenance: CH181011)
S7.06: Production of Board level reports , presentations and profiles (Provenance: CH181011)
D8.06: DH Programme Budgeting tool / Spend and Outcome Tool (Provenance: CH181011)S8.09: Programme budgeting (comparative spend on
disease conditions) (Provenance: CH181011)
S8.08: Manage Programme Portfolio (Provenance: CH181011)
D8.05: Quality of life & well being measures e.g. QALYs (Provenance: CH181011)
D8.07: Patient expectation information (Provenance: CH181011)
Q8.10: Are our investments distributed across all sectors to best
meet the needs of our population?Provenance: CH181011
D2.07: External Sources such as Social Media (Provenance: WS021211)
O0.12 Simplify presentation appropriate to audience
D6.09: Staff surveys, appraisals, complaints, incidents and SUIs (Provenance:
V10)
D5.08: Insight into provider sustainability (Provenance: V10)
S6.08: Clinical governance and complaints handling (Provenance: V10)
D5.09: Patient Feedback (Provenance: V12)
D6.10: External information e.g. Market intelligence (Provenance: V13)
Q5.08: Do our provider contracts reflect patient
requirements?Provenance: V12
Q7.10: What is the impact of change on
other services & stakeholders?
Provenance: V12
Version Date Comment11. 14/12/11 Amendments to support Business Analysis Team12. 14/12/11 Further amendments after CSO workshop on 2/12/1113. 19/1/12 Text changes from Gavin McIntosh
All using The Commissioning
Intelligence Model
All using The Commissioning
Intelligence Model
Producing joint report
July 2012
Producing joint report
July 2012
Proposed Commissioning Intelligence Delivery Model
38
IC
DMIC x ~10
CSSX~25
CCGCCGsx~210 CCG
LAPHX~150
Safe haven
Safe haven
National Bodies incl: NHSCB ( 4 Regional Teams with 27 Local Area Teams (LATs))
PHE, Research, Commercial, CQC, Monitor & Public
National Data Feeds
Local & National Data Feeds
Small no CCGs doing own intelligence
DMICs may also provide datato wider stakeholders
Data Flows
Work is on-going to understand the data accountabilities and responsibilities for each type of organisation and how data will flow
A potential future view – Repeated Data Management
Data Management Integration Centres
CS
Ss
~2
5 Insight
Data Management
CCGs~270
Locally defined data e.g. diagnostics/tariffs
National data from e.g. IC/SUS/GPES
PH Insight
PH Data Management
PH Advocacy
PHE data e.g. Cancer, Drugs data & Summarised Reports
Locally defined data e.g. diagnostics/tariffs National data from e.g. IC/SUS/GPES
LA
~1
50
He
alt
h &
We
llb
ein
g B
oa
rds
Du
plicated
Du
plicated
Duplicated, potentially inconsistent, uneconomicDuplicated, potentially inconsistent, uneconomic
CSS Process to Date
Dec 11 – Mar 12 Apr 12 – Aug 12 Sep 12 – Apr 13
CP 2 CP 3 CSS fully launched
CP 1
National Scale offers - co-design
National Scale offers - co-design
Set up planning & Development for ‘scale CSS’
Set up planning & Development for ‘scale CSS’
Scale CSS SelectionAdditional TestsDevelopment Plans
Establish and embed ‘scale CSS’Establish and embed ‘scale CSS’
• Co-design group established
• Costing assumptions for CP2
• Transition model to be agreed
• Investment plan sign off
• Transition planning
• Gap analysis• Local agreements
& SLA development
• Implementation • Risk management • Monitoring & accreditation• System review
Scale CSS Technical accreditation programme
Program Stages
AssessmentSteps
Activities
CSS Development Timetable
41
Why do it – what problem are we trying to address?
1. Overcoming the variation and inconsistencies in how Commissioning data in the NHS is handled – STANDARDS
2. Dealing with variable efficiencies / value for money in NHS data management for commissioning support – COSTS
3. Ensuring a technical architecture that enables delivery of commissioning intelligence – BUSINESS FUNCTION
4. A technical architecture that is flexible and responsive to changing requirements over time - SUSTAINABILITY
Why do it – what problem are we trying to address?
ONS Storage, for
developmental local
datasets administered by
PH
Local Patient level dataset
storage, processing, validation,
linkage) administered by
DMIC
LA Public Healthprovision public
health advice
Access to patient level
data
ICNational Patient level
dataset storage, processing, validation,
linkage
Safehaven
Safehaven
Patient level data
Aggregate data & reports
Commissioning datasets
Public health datasets
Local Patient level agreed datasets……
PHE
Patient level data
CSS CSS
CSS
Emerging locally developed public health patient level datasets
DMIC
Screening
Cancer
Communicable diseases
Patient level data
LA
Surveys
Other National datasets
Wider determinants reports, profiles ….
Local Data Providers
National Data Providers
DRAFT Proposed data flows for Local Authority Public Health Teams (RESTRICTED early work in progress for discussion only)
Aggregate data, & reports
Aggregate data & reports,
DMIC Network (Draft restricted for discussion only)
TBC
CCG Embedded
London
South
TBC
North East and NY&YCollaborative
Yorkshire
GEM
NW
Best West
Central Southern
Birmingham and Black Country
TBC
Norfolk & Waveney
Arden
EssexTBC
Hertfordshire
Areas identified as TBC are likely to source business intelligence services through either B2B or outsourcing arrangements
For areas identified as TBC:• Essex and Hertfordshire are planning
to source services from MediAnalytics
• Norfolk and Waveney are planning to source services from Anglia Support Partnership
• Arden are in talks with Birmingham and Black Country about sourcing services through B2B arrangements
Potential Model
45
Why do it – what problem are we trying to address?PH Questions1. How will PH get access to data in the future?2. What infrastructure is required? N3?3. Will we be charged for this?4. How should we get started in working with our local CSS?
CSS / DMIC Questions?1. What are the requirements for PH?2. How will we fund activities not commissioned by CCGs?3. How will PH gain CCG approval for use of their data?4. What value add services would you be interested in?5. How can we make sure we make best use of available resources
within the local Health Economy?
Discussion points :
Public Health Intelligence Transition: A Local Perspective
Neil Bendel
Head of Health Intelligence
Public Health Manchester
NW Public Health Evidence and Intelligence Workshop
Friday 3rd August 2012
Current context in North West
• 24 Primary Care Trusts (PCTs)• 39 Local Authorities• 36 Hospital Trusts, 2 Care Trusts, 1 Ambulance Trust• 3 data processing centres• 3 Health Protection Units (HPUs) • North West Cancer Intelligence Service (NWCIS)• North West Public Health Observatory (NWPHO)• Range of academic units
Future context in North West
• 33 Clinical Commissioning Groups (CCGs)• 39 Local Authorities• 36 Hospital Trusts, 2 Care Trusts, 1 Ambulance Trust• 4 Commissioning Support Services (CSS) • 1 Data Management Integration Centre (DMIC) • 3 Public Health England (PHE) Centres• Public Health England Evidence and Intelligence Team• Academic collaboratives, e.g. Health eResearch Centre (HeRC), Manchester
Academic Health Science Centre (MAHSC)
Threats and challenges
Technical Growing demand for increasingly large and complex pieces of analysis from CCGs and LAs
Loss of NHS data following move of public health teams to local authorities
Reliance on voluntary accreditation and industry-owned standards of good practice poses threat to data quality
Organisational Greater integration with local authorities may divert public health analysts to more generic areas of work
Budgetary constraints may lead to a more ‘protectionist’ attitude to information and intelligence
Professional Loss or scaling back of existing training routes for public health analysts
Loss of staff from existing organisations whilst new structures are in the process of being established
Greater Manchester response
• March 2011: Review of Public Health Intelligence system
• June 2011: Project Implementation Plan
• August 2011: AGMA Research Shared Services Review
• January 2012: SWOT analysis paper to DsPH
• February 2012: Public Health Intelligence/GM IM&T Shared Service Data Workshop
• April 2012: Public Health IM&T Transition Project initiated
Public Health IM&T Transition Project
• Reports to GM Public Health Transition Sub-board
– SRO Abdul Razzaq (DPH, NHS Trafford)
• Project Steering Group and Project Board established
– Public Health, LA ICT and CSS representation
• Project Outline produced. PID under construction
• Project Management support from Greater Manchester CSS
Agreed Project Outputs
• A Business Case and implementation plan that describes the activities and costs of the work to ensure that all LAs have access to N3 to deliver their public health responsibilities by 1st April 2013
• A detailed Service Catalogue that outlines the datasets held by the CSS that could will be supplied to LA Public Health teams
• A Data Sharing Protocol that outlines the terms and conditions under which public health teams in local authorities will be allowed access to NHS datasets held by the CSS
• An agreed Delivery Model that sets out how CSS will support LAs and what the costs, funding mechanisms and governance arrangements will be
• A Memorandum of Understanding that describes the professional relationship between public health analysts in local authorities and the specialist analytical teams within the CSS
Project Workstreams
• ICT and systems connectivity
– Review of current network connections undertaken– Will require ‘sense checking’ by LA ICT colleagues
• Data requirements
– Data requirements specification template being constructed
– Temporary Business Analyst role within GM Transition Team has been advertised
• Information Governance
– Links with GM IG Board being made
GM Public Health Intelligence data model
Universal data Localised data Local data
Data owned and held by public health
Locally agreed data flows: maternity data, teenage pregnancy, health improvement data etc
Data owned and held by PCTs and accessed by public health
Non cancer screening programmes Exeter/MConnect (GP populations)
SUS (hospital stats) Mental Health-minimum dataset QMAS (where will this sit in the new world?)
LES/DES Other locally agreed data flows/sets
Data owned and held by other parts of NHS and accessed by public health, usually via N3 connection
PCMD (Primary care mortality) BCSS (Bowel cancer screening) QOF Other N3 connected databases (LASCA, NCHOD, Cancer registry, NCMP etc.)
LES/DES NHS admin codes
Public Health Birth files
Public Health Mortality files
Chi
ld H
ealth
Sys
tem
s
Key issues across NW Region
• Access to Patient Identifiable Data (PID)• IT and Information Governance • Time lag between local transition plans and establishment of national/regional
structures, e.g. PHE E&I Teams, NW DMIC etc.• Intelligence provision in two-tier authorities – where does the responsibility lie?• Loss of NW footprint with establishment of new PHE North of England region
Support from PH England and NHS CB
• Support for LAs seeking to complete NHS IG Toolkit– NW Transition Alliance?
• National forum for sharing examples of best practice from other areas around public health intelligence transition, e.g. data sharing agreements between CCGs and LA
• Further clarification of financial framework around access to data for LA PH teams from CSS/DMIC
Round Table Discussions
• Each table to discuss one of the issues covered by the national update– Information management– Commissioning for Intelligence model– Public Health Advice (‘core offer’)– Evidence– PHE contribution
• 45 minutes per session• Each session run twice (12.00-12.45 and 1.00 to 1.45)
Questions for discussion
• Where are you now?• Where do you think you should be in the new world?• What are the obstacles in getting there?
Opportunity to share local experiences, problems and solutions and raise issues with national leads.
