Select Committee on Health Written Evidence


Evidence submitted by Dr Foster Intelligence (ISTC 57)

  I am writing in response to your current inquiry on independent sector treatment centres (ISTCs) and specifically on the issue of information about ISTC performance.

  By way of background, I have outlined the key activities of Dr Foster Intelligence included as an appendix to this letter.

  Since becoming operational, all Wave 1 ISTCs have been required to submit data monthly via the NHS Wide Clearing Service in the same way as NHS organisations. This is routine administrative data which records information about NHS patients including age, sex, diagnosis, method of admission, procedure, date of admission, date of discharge etc.

  Data quality is variable and there are a number of relevant issues to bear in mind about the data:

    —  Some providers have not been operational for very long and volumes are not yet at the necessary level for meaningful analysis. However, our performance benchmarking system takes this into account by using confidence intervals.

    —  Coding of activity is poor in some organisations.

    —  Most ISTC providers are multi site and therefore accurate site coding is very important.

    —  Where trusts have subcontracted waiting list initiatives to an ISTC the data may be recorded at trust level rather than by the ISTC.

    —  There are some providers such as those contracted via GSUP (contractual arrangements preceding wave one of the ISTC programme) which are not submitting information.

  However, some ISTC providers are submitting good, accurately coded information which does allow us to analyse their performance. The routine reports in our information system allow the benchmarking of providers with their peers in both the independent sector and the NHS against a number of measures, for example, day case rates, length of stay, readmissions and volumes. We can also report on data quality, in terms of the proportion of activity that goes uncoded.

  Included with this letter are two sample reports from ISTCs showing readmission rates and overall peformance indicators for two ISTC providers.

  It is our view that the Department of Health should work with ISTCs to ensure that they submit contract minimum datasets via NWCS and that payment is dependent on accurate coding to an HRG, as it is for NHS providers and will be for Wave 2 ISTCs. Data quality and timeliness should be a key and enforced feature of contractual arrangements.

  If required, we could supply the Committee with further analyses. We would also be very happy to brief you, the Committee or your research team on our information systems which could be a useful evidence base for this and future inquiries.

Tim Kelsey

Chairman, Management Board, Dr Foster Intelligence

12 April 2006





 
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