Written evidence from Intellect (COM 86)
INTRODUCTION
Intellect is the trade association for the IT,
telecoms and electronics industries in the UK. Its members account
for over 80% of these markets and include blue-chip multinationals
as well as early stage technology companies. These industries
together generate around 10% of UK GDP and 15% of UK trade. Intellect
is a not-for-profit and technology neutral organisation, which
provides a collective voice for its members and drives connections
with government and business to create a commercial environment
in which they can thrive.
Intellect's healthcare programme represents
and provides a collective voice for over 250 companies (from multinationals
to SMEs), many of whom are at the forefront of developing and
deploying solutions across the sector. The healthcare programme
works with policy makers, decision makers and industry to enable
the delivery of 21st century healthcare and offers high-level
networking with government, industry and key stakeholders.
www.intellectuk.org/healthcare
Intellect welcomes the opportunity to provide
the views of industry into the Health Select Committee's enquiry
into commissioning. Intellect believes that our industry's solutions
and cutting-edge ideas can support the development of a model
that is able to commission the services needed today, tomorrow
and in the future. In July Intellect published Care Commissioning
for England—an Intellect perspective on the challenges ahead
outlining how information and technology can be used to improve
the commissioning process. The paper identifies technology solutions—eg
data mining, reporting services, standardisation and integration—and
resource capacity—eg contract management and information
governance—as areas where information and technology will
play a decisive role. The Select Committee should consider this
paper and our response to the consultation questions as part of
their enquiry into commissioning.
Finally Intellect would be happy to discuss
our views and response in more detail with the department if desired.
HEALTH SELECT
COMMITTEE: ENQUIRY
INTO COMMISSIONING
Intellect has only responded to the questions
that we believe are relevant to the views of our industry.
CLINICAL ENGAGEMENT
IN COMMISSIONING
How will commissioners access the information
and clinical expertise required to make high quality decisions
about the shape of clinical services?
There is little doubt that one of the most valuable
assets of the NHS is the large volume of administrative and clinical
data to be found in information systems throughout the NHS. This
data is capable of providing the source for effective research,
planning and decision making in commissioning healthcare provision
at local and national level. At the moment, much of this information
is in isolated data stores in discrete organisations. While used
locally, its use is not optimised. For example, if this data were
made available as a web service to commissioners, this historical
data could be put to good use to detect patterns and trends and
also to enable funding for prospective care instead of the current
situation of contracts being funded by retrospective episodes
of care. Furthermore, specialist software developers and consultancies
are now beginning to harness advanced relational database management
tools that underpin their solutions to support more accurate costing
of services for providers, which again could be replicated and
used to support commissioning.
These are not "big ticket" new investments;
existing NHS focussed investments in both the front office and
back office are capable of being used to exploit and support predictive
analysis capabilities from day to day processes. For both public
health and commissioning, this knowledge will enable joint modelling
and improved forecasting in the future. Again, the opportunity
is in the supplier community helping making best use of what the
NHS already has in place.
Both the NHS and its supplier community are
beginning to develop new system solutions that will support commissioning
excellence. Some important investment is already in place through
the Secondary Uses Service as a trusted data source as well as
the promotion of Digital Dashboards through demonstrators. The
proposed NHS Interoperability Toolkit is likely to improve data
integration across solutions, through the adoption of published
standards.
The information that will support the current
and future generation of commissioners is already being recorded
across both health and social care by practitioners and administrative
staff as part of their daily professional practice. NHS investments
to date have delivered a national high speed broadband network,
a national core demographic data set and, above all, the nucleus
of an electronic care record across most of primary care and large
parts of secondary care. In social care, a similar pattern is
emerging. With information being recorded nearer to the point
of care, organisations are beginning to raise data quality standards
and providers are improving performance indicators.
How will commissioners address issues of clinical
practice variation?
In order to be effective GP-led commissioning
will need access to shared resources that can be quickly and economically
deployed. This will enable co-operatives and practices to commission
services in a transparent and robust manner.
A continuing drive for more and more disparate
information, able to be pulled together and analysed in many different
ways, means the capability for data sourcing, integration, compilation
and interpretation remain paramount to commissioners. Consequently,
information standards, security and quality also remain high priorities
going forward. Data standards are necessary to gain an oversight
of performance and effectiveness within delivery organisations.
If every service provider had different data standards you would
not be able to manage the delivery and monitor value for money.
How will GPs engage with their colleagues within
a consortium and how will consortia engage with the wider clinical
community?
Ultimately, successfully implementing the radical
change identified in Liberating the NHS White Paper will
be determined by the willingness of the broad range of professionals,
operating in and across health and social care settings, to adopt
the relevant systems and processes. Practitioners are increasingly
beginning to work in joint, multidisciplinary teams and embrace
new ways of working. In order to do this successfully they need
to trust the information that has been gathered and recorded by
others, and there is growing awareness that care pathways need
to be underpinned by information pathways. Healthcare professionals
need to be confident that technology is there to support them
and that their decisions and actions are based on the full information
available.
Health and social care ICT can be an enabler
in both the definition of effective commissioned services and
their subsequent delivery. Joint care pathways provide clear points
of handover of responsibility and support continuity of care across
agencies and services within them, optimising the mix of skills
and specialisations. ICT is uniquely able to support these best
practice models which should be developed and more widely adopted.
However, engaging a broad mix of practitioners in programme and
project design is especially important. This ensures that the
focus is on the intended benefits for care providers, administrators
and citizens, and that the outcomes are realistic and achievable.
It gives confidence that patient data is secure, and improves
the level of support planned for the change. The changing model
for health and social care service provision requires significant
levels of culture change. New ways of working take time and attention
to change long-term behaviours and they are only embraced if you
involve practitioners in the design process.
What commissioners need to support service planning
and provision, contract negotiation and monitoring is data integration.
For commissioners, the ideal would be provision of or access to
data that resides in provider organisations, directly or indirectly,
and is anonymised. Today's modern database technologies can be
web-based and configured to report information in near real-time;
the benefit is that this knowledge can be shared by commissioners
and providers by presenting a unified view of these data.
In order to plan and commission innovative care
models, commissioners will need to model the possible options
and determine all the impacts of the approach they wish to take.
Predictive analysis techniques that can be enabled through spreadsheets,
geospatial aware software and specialist modelling solutions will
enable local scenario modelling of new services and pathways by
both commissioners and provider being able to jointly understand
current as well as future requirements. This is a major challenge
for the provision of data, from a variety of sources, to underpin
such varied modelling requirements. Quality, efficiency and effectiveness
of data is more than likely to be required.
INTEGRATION OF
HEALTH AND
SOCIAL CARE
How will any new structures promote the integration
of health and social care?
Knowledge and resources are needed to support
the analysis of health and social care services, and to supply
software and interpretive services to model both needs and the
impact of any envisaged configuration of services. In this way,
commissioners will be able to develop integrated commissioning
strategies on a secure evidence base and at lower risk. Such modelling
is especially important in an environment where it is necessary
to decommission services in order to release resources for new
ones.
There are a range of tools, underpinned by ICT
solutions, that can provide more visibility of information and
support for commissioners. Three such examples are noted below:
— Joined up IT systems allows professionals
to access and share information in a controlled way across organisational
boundaries, allowing for a joined-up view of the needs of the
citizens. The good news is that big-bang investment in ICT is
not required; in many cases the key components are already in
place and are integrated or integration-ready.
— Easier access to service information—service
directories should be created with the ability for users to comment
and provide reviews and comments on the services they receive.
— Improved market management—there
needs to be greater collaboration and sharing of information on
future demand, closer working relationships with existing suppliers
should be encouraged, and pilot programmes could be launched to
support new entrants and create business incubators and services
for future social enterprises.
Once commissioners have articulated intentions
better value can be obtained by defining appropriate contract
currencies and meaningful Key Performance Indicators (KPIs). It
is important that providers have adequate incentives to deliver
the outcomes, especially where outcomes cannot be directly attributed
to one provider. Providers will need new kinds of incentives designed
to collaborate directly or indirectly with other organisations
to create the required seamless care.
RESOURCE ALLOCATION
What arrangements are proposed for risk sharing
between commissioners?
Most typically associated with support for medical
decision making within operational computer care records systems,
population-based risk stratification is going to go beyond the
individual to support macro-level care planning, particularly
for chronic conditions. Risk stratification solutions will need
robust clinical evidence bases to form their rules sets and also
rely heavily on getting access to useable clinical data fed from
a wide variety of operational systems, including telehealth data.
This data will improve the existing evidence base and evolve current
preventative disease management campaigns such as diabetes, cancer
and other lifestyle programmes associated with smoking and over
eating for example, keeping as many people as possible away from
hospital-based care.
In all of this work, aggregated information
is at a premium, and will increasingly have commercial as well
as public health significance. This will require specialists in
information governance and security to be active in the design
of processes and security tools that enable sensitive personal
information to be reused for commissioning, without compromising
confidentiality and ensuring data quality does not reduce as data
is used further from its point of origin.
October 2010
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