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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