Reasons to be cheerful at the Midstaffs inquiry.

At the end of the seminar held at Leeds on information in the NHS the Chairman Robert Francis said that the day had cheered him up. I shared this feeling.

We heard from people who are actively using information technology now within the NHS to drive up the quality of care.  There is a quiet revolution in progress. 

We heard how in 2000 Information technology was still in its infancy. We heard about the long time lags between events and the eventual statistics, and the very variable quality of data. All this meant  meant that clinicians did not have any trust in the emerging early systems, of which HSMR is an example.  We heard about the problems of Clinicians accepting information that was provided to them by outside agencies, and how important it is for clinicians to feel they own the information.

We heard how the speed of the information revolution has been accelerating, over the last four to five years.

The people who presented papers to the seminar included Professor Martin Elliot form Great Ormond street and Dr Dave Rosser from University Hospitals Birmingham NHS Foundation trust. They are both part of organisations that have completely bought into the use of information.

Great Ormond street did this by closing an intensive care bed, to fund the project. The savings and quality improvements that they have made through good information have now made it possible for them to fund two intensive care beds.  

Birmingham has 16 analysts who work on giving the clinicians real time information. They allowing the clinicians to develop the indicators that they believe they need and help them use these systems to improve quality. This is paying off both in terms of quality of care and demand for their services.         

The work they are doing is remarkable.

The trail to the seminar that I heard on BBC Radio 4 Today
http://news.bbc.co.uk/today/hi/today/newsid_9618000/9618445.stm  told us that one of the things the Birmingham system can do is to issue prompts to ensure that nurses do not miss giving doses of medication to patients.  This is a remarkably common problem within the NHS. Giving antibiotics or insulin late does cost lives.

This system is particularly relevant to the Midstaffs story because the Gillian Astbury Case, is one of small number of symbolic cases that Cure the NHS have pursued. This is an all too common case of an elderly lady with dementia and diabetes who did not get the specialist diet that a dietician had prescribed, and died because she had not received insulin at the right intervals.  Failure to administer insulin on time is common throughout the NHS wherever hospitals are relying on paper based note systems.  Dr Rosser reckons that potentially 16,000 lives a year can be saved by using his prompt systems.

We also heard about decision support systems, which act as guides to help doctors and nurses through their decision making processes. When this was first implemented the analysts were surprised by the 400 occasions a day where the system was challenging the course of action that the clinician was planning to take, though they point out that this represents only 1.8% of the clinical decisions that are made. I in 10 people in hospital currently experience an adverse incident. These information systems have done the work to understand how many common errors are made, and to help eliminate them by supporting doctors and burses better.

Dr Rosser also told us about their system to cut MRSA.  If a swab tests positive then as soon as it is entered on the system the ward is alerted by an email message. Action to prevent spread of the infection can be started within seconds, rather than the 30 hours that was common when they used paper based systems. This saves lives.

Dr Rosser showed us a series of graphs where the information systems had alerted the hospital and clinical teams to opportunities for improvement. There are two key ingredient in making the system work. There are the statistics, and there are face to face round table meetings with staff on a regular basis when they look at the issues raised, challenge each other where there are weaknesses  and decide collectively on the action to be taken. The Birmingham graphs show a dramatic story of what happens when a problem is identified and the clinical teams take a concerted effort to make a significant change.  You get a “step change” where you can see the shape of the graph change radically. Whenever that happens it means many individual patients get a far better service.  

What makes me cheerful about all these developments is that it shows that getting information right can move us from a position where we a seeking to punish individuals for failings so far after the event that no one really knows what happened, to using information to support decision making, help people get it right first time, and allowing clinicians to drive a process of continuous improvement.

A good aspect of this is that it cannot possibly be seen as political. This is about harnessing the new potential of information systems and combining it with the real creativity of some of the brilliant analysts that we have within the NHS.  Everyone should support these developments.

There is a bit of politics though!  Birmingham has offered to release their system free, to get it in use throughout the country and start saving lives. The government wish it to be issued on a commercial basis.

The seminar papers will be available on the Midstaffs Inquiry website in the future.

NOT A GREAT WEEK IF YOU HAPPEN TO BE CALLED FOX, WERRITTY.. OR LANSLEY…

As I write this, there is really not much else contained within the political pages of the broadsheets this morning. I can hardly believe that we’re still reading the revelations that are spilling out and yet Fox  still remains in his job. Isn’t this embarrassing for the Conservative party..   and how will Cameron be judged for letting this matter carry on for so long ?  But why has it carried on for so long? 

 

One thing that some of us may have forgotten is that Dr. Liam Fox was,  and still remains,  a strong Thatcherite.  The Conservative right hold him in great affection, and view Cameron  as a liberal Tory.  The Telegraph has never truly backed Cameron,  much preferring the Thatcherite politicians.   Therefore, before taking drastic action, Cameron really needs the cards to stack up against Fox and that is certainly what is happening this morning!   And to give Cameron the opportunity he has required, the Telegraph has come out with some force against Fox this morning.  Even that paper can’t stomach much more of Fox !  At the end of the day, the Telegraph will put the party first.  I wonder if Cameron will… 

Strange, though, how the Tories cling on, with all their might,  to what they hold with affection…  even to some detriment.  They never learn, such is their arrogance.

Anyone watching BBC Question Time last evening will have noticed how much cynicism, mistrust and dislike there was from the audience towards the Health Secretary, Andrew Lansley.  Not much affection there then… 

As the programme began, Lansley sat there with a smug expression on his face as if he might be thinking  “I got the bill through the Lords, nothing can touch me now”.  Well if that is what he was thinking, he couldn’t have been more wrong… 

Oh yes, the first question was about Fox & Werritty..  that will have put him in the comfort zone …  Then  bang ! The boxing gloves came out ! 

Not towards Fox & Werritty though – aimed at Lansley ! Well and truly.  The next 30 minutes were taken up by the audience asking serious and sincere questions about the potential collapse of the National Health Service.  If anyone was in any doubt whether the NHS is a beloved part of British life, then they will no longer be mistaken after watching that programme.   

From the Guardian this morning:

"NHS cuts protesters demand Lansley resignation at BBC filming – video

Protesters angry about reforms and cuts to the NHS last night marched on a university theatre, to demonstrate against the health secretary, Andrew Lansley's appearance on the BBC politics programme Question Time, which was being filmed there"  

Video link from Guardian here.

What remains to be seen is if this mistrust and cynicism continues.  As we see privatisation take over, profits come before patients,  I don’t think it will merely continue – I believe it will grow.

But the press just hasn’t touched the public mood in response to the changes that this government is intent on introducing.  And they wonder why fewer people are buying their rags?  When will these editors and newspaper owners realise that people don’t want lies and bias – they want the papers to reflect their views, their feelings…   To quote an old adage – it isn’t exactly rocket science is it ?    However, praise where praise is due – there has been some good investigative journalism this week regarding Fox & Werritty.  Maybe all is not lost after all.

 And as a result, perhaps, the fight for Fox to retain his position as Secretary of State for Defence may well be nearing the end, but there is no mistake that the fight for the soul of the NHS is near the end…  in fact I feel the fight might even just be about to commence! 

by Mags W.

How do you really know you have the right staffing levels at your hospital?

Calculating the right level of staff for a ward is not a simple matter. Midstaffs shows us some of the pitfalls that other Hospitals are falling into right now.

The Background.

Two things I have learned from the months of listening to evidence at the Mid Staffs Public inquiry are : that there is nothing easy about running the health service; and that we go through periods were thinking  about the NHS is focused on particular themes.  

The priorities of the last ten years were how to stop people dying on waiting lists, or on trolleys at A&E, and how to tackle alarming hospital infections.  Now that these problems are largely resolved we are thinking about quality in other ways.

As life expectancy has grown, we are now seeing many very old and very frail people in our wards, and the Mid Staffs story is in part about what happens when we have not fully grasped the size and complexity of this problem.

The current focus on staffing levels and staffing mix.

A major criticism of Stafford Hospital is that the Staffing levels and staffing mix were wrong.

Midstaffs is by no means alone in this, and the high profile statements from Peter Carter of the Royal College of Nursing show us this is a major national problem. The staffing levels that we have in the hospitals are not high enough to allow us to deal as well as nursing staff would like with the very frail and very dependent people that there are in many wards.

Peter Carter is provocative on this issue. He uses the press to forcefully make the point that hospitals are not doing a perfect job, and that they cannot do all that is needed. He suggests that families can and should play a part in providing some of the basic care including getting people mobilised and making sure they eat.  It was designed to get a reaction and it did.

There have also been a series of high profile statements about the fact that increasing amounts of care are being provided not by trained nurses, working within a professional code, but by untrained and unregulated care staff, who may or may not be able to do what they are expected to do.

Why Midstaffs got into a tangle with Staffing.

The Mid Staffs Public Inquiry has been wrestling for weeks with the question of staffing levels and staffing mix. What all the witnesses have said is that you cannot set staffing levels. There is no hard and fast measure, no formula a manager can refer to, you have to work out what is right for each ward.

 David Nicholson, in his evidence finally threw some light on why the levels were probably wrong at Stafford, and why the managers did not at first see the problem.

The hospital had, as all hospitals now have to do, to work out how to balance their books. David Nicolson explained this had happened when the big story run by all the media is that we were spending too much on the NHS, and it was therefore essential to cut back any unnecessary spending. This meant rationalising the work that hospitals did. Stafford were perhaps ahead of the game in believing that the right thing was to have less beds, and to keep people in for less time, so they reduced the number of beds and reduced the number of nurses in line with this. So far so good!   

But …. This only works if you actually have less people coming in and you are able to move people out faster.  Achieving this means that there has to be a fully co-ordinated approach with the GPs and primary care, in treating more people at home, and with Social care in having transitional care or residential care beds to pass patients on through the system.  These things did not happen.

The result of this is not good. The same number of people kept on coming through A&E. The beds filled up so that some patients end up in an assessment unit, for which the hospital had insufficient trained staff. More people are passing through the beds in the wards, causing increased pressure on admin, cleaning and nursing, and because many of the care homes in the area had recently closed you end up with bed blocking with a build up of the most highly demanding patients who are simply unable to be discharged to their own homes.  My guess, though I do not have access to any records to prove this point, is that the level of nursing and care needs of the patients within the ward increased dramatically.

This is like boiling a frog. Maybe in the first few weeks people would have been coping, but the effects of this are cumulative. It would have been steadily more pressured, and once managers had understood the problem it then took months to get the approvals to recruit more staff.

What do you count? Beds or Patients?

David Nicholson explained it simply.  The Hospital management thought in terms of nurse to bed ratio which looked pretty much as it always had been.   The changes to have a higher level of care assistants to nurses would also have looked justifiable, because the case load did have many people with low nursing needs but high care needs.  The measure that he says the hospital should have used is the Nurse to Patient ratio, which would have told a different story.

This, as an indicator of how many staff you might need, (and the Vacancy factor which attempts to tell you how many staff you have - I could not get my head around this!), are not straightforward, and the fact that the managers, the board, the govenors, and anyone else with an interest in the hospital could not see the problem should come as no surprise. David Nicholson himself said he would have been hard put to see it.

Like everything else that I have seen about the Mid Staffs story, this is not a story of callous disregard for the welfare of patients, it is about something that did not work out the way it was intended to do.  

Why we urgently need to learn these lessons now.

The reasons why it is important to tell this story are apparent if you look at David Nicholson’s vision for the future of the NHS. What the management of  Midstaffs were trying to do, is something that many other hospitals are trying to do right now.  Everyone is looking for Cost improvement programs. Where are they going to find them?

Look at the intention.

·         Keep costs to a minimum.

·         Do not use more wards than you need.

·         Do not carry surplus staff.

·         Employ care staff to carry out caring functions.  

·         Put in the community support to keep patients at home under primary care.

·         Discharge patients to their homes or to other care facilities unless they need acute care.  

All of that sounds like good practice, and it is exactly what Midstaffs probably tried to do.

For any hospitals that are working on their cost improvement programs the only safe lesson to take from Stafford is that you have to assume for any action that you take that there may be unintended consequences. You have to actively monitor the effects of any change you make on staff and patients.  If your staff are telling you they are feeling the heat, you had better believe them.   

Why the Royal College of Surgeons report is a good news story.

I woke to the radio telling me what appears on the face of it another terrible story about the NHS. The Royal College of surgeons report on the Higher Risk Surgical Patients has been issued and shows the real possibility that substantial numbers of seriously ill patients, who perhaps could have been saved, may have been dying.

The report is here http://www.rcseng.ac.uk/publications/docs/higher-risk-surgical-patient/

First let me give some well deserved praise to the BBC Radio 4 Today Program. This is a story which lends itself to the kind of sensational reporting that I as a close observer of how the Mid Staffs story am all too familiar with.  Today gave the story time. They gave it two separate slots  http://news.bbc.co.uk/today/hi/today/newsid_9602000/9602878.stm and http://news.bbc.co.uk/today/hi/today/newsid_9602000/9602924.stm

They attempted to get behind the alarming headline figures and explain that this is about very seriously ill patients whose low risk of survival might possibly have been improved by better organisation of the way in which the hospitals work.

They avoided blaming the problem on junior doctors, and allowed it to be seen in the context of how hospitals work and the priorities the NHS has needed to follow over the last decade.  

There have been enormous improvements in elective surgery over the last 10 years, largely as a result of getting huge waiting times down,  but this might have happened in part at the expense of the Accident and Emergency systems, which are now showing signs of stress, as the report shows, throughout the country.  It is clear that as surgical techniques have improved the possibility of helping people who would have been seen as beyond help some years back is now real, and should be acted on to give people the best chance of survival.  

One particular thing I would praise the BBC for is that in the second interview they had two specialists being interviewed together. This completely changed the dynamic of the interview and allowed a much more balanced picture to emerge. Well done BBC. Please do this again!

The papers were perhaps less nuanced Here are a few reports.

http://www.dailymail.co.uk/health/article-2042963/Tens-1000s-surgical-patients-die-needlessly-poor-NHS-care.html

http://www.telegraph.co.uk/health/elderhealth/8795146/Emergency-NHS-surgery-for-elderly-at-point-of-neglect.html

 http://www.guardian.co.uk/society/2011/sep/29/nhs-health?CMP=twt_gu

My personal feeling is that this report is some of the best news I have heard on the health service for some time.

Viewed from the perspective of Mid staffs It certainly put the most worrying problems that the #midstaffsinquiry has mentioned into a very different perspective.  The problems that did occur in Midstaffs A&E need to be viewed as problems of the whole care pathway in the hospital, but also to be seen as something that is common across the country as a whole.

I have been watching with interest as the Care Quality Commission develop their Specific Mortality Alert system and I think this is what has made it possible for the Royal College of Surgeons to begin to pin point the problems that are occurring. If so this is a positive story for the amazing strides being made with NHS information systems.

It is clear listening to the #midstaffsinquiry that many specialists have close links with specialists in different parts of the world and are actively looking to how performance can match the best the world can offer. So this is a positive story of international co-operation.

The Midstaffs story has been a nightmare for anyone from Stafford, where we found ourselves at the heart of a confusing media storm, but it has had positive effects. The Public Inquiry has done much to show where there were real causes for concern, and even if the general public does not yet know this, many within the NHS know that many of the problems that occurred in Stafford are common throughout the NHS. So this is a positive story of an NHS ready to be much more self aware.

The big positive effect of Midstaffs will I think be that Clinicians will assert themselves. They will  see the point of raising concerns themselves, and demanding the support they need to take the right actions.  

The RSC report is of course a tragedy for all those very ill patients that could not be saved, but it is a moment of real hope for a very positive future.     

Could there be any common ground on the Health Bill?

When the eminently reasonable Stephen Dorrell spoke at the #healthdebate at Labours conference I was glad that he was given well deserved applause. He was doing something that far more politicians should do; Venturing into enemy territory, speaking directly to people and searching for common ground. 

He made the point that we often hear from Conservative speakers that the Health Bill continues policies that were already in place. Until last week I might have dismissed this, but as I have listened to the witnesses from the Department of Health at the #midstaffsinquiry  I think he may well have a point.

The Mid Staffs Inquiry has been an astonishing experience; A rare opportunity to see and begin to understand the complexity of the NHS; A chance for all the different organisations that make up this vital part of our countries life to re-evaluate what they are, what they do, and how they relate to the other parts of the system.  It has also laid out for us where things went wrong in what the chairman is now tentatively describing as a whole system failure, and pointed to the changes we may need to make.  

I do not think there will ever be a clear cut agreement about what actually went wrong at Stafford, though the Inquiry will remove many of the false certainties, but Stafford can show us the way forward for the NHS.

The inquiry has been an exercise in trying to find the truth, and that is not at all easy. What we hear as the general public is always filtered. The press and the media give us fragments of stories, and fragments of what politicians say.  The politicians use the media to try to sell the policies that they are attempting to drive through the wheels of government.

The press do what the press do. They present issues in terms of debate and conflict; This side, that side; Dramatic changes in direction.  The battles that turn it all into soap opera; matters of personality, people we love, people we hate. 

Listening to the Ex ministers and to the Department of Health spokesmen I see that this is not the way it is.  Ministers are there to represent us.  In some cases, as with Andrew Lansley, and Michael Gove, they have arrived in position with their own set of passionately held dreams – a vision of the future they wish to create. When they get there, they always find that power is not all it is cracked up to be. Having a vision is one thing, turning it into reality is another.

The DoH as everyone who has listened to the evidence at the Midstaffs Inquiry has heard is packed with people who really do know their subject matter inside out. They understand the sheer difficulty of bringing about change in something as complex and interconnected as the NHS. They will bring to the minister’s sketchy vision the depth of knowledge that can make parts of it work, and they work with tact and diplomacy to modify or remove those parts that are potentially damaging.  It is the Civil Servants job to keep the spirit of their service alive from one minister to another and one government to another. They are there to help us.

It is in this complex dance between elected politicians and appointed civil servants that legislation is brought together, and as the tools for public consultation become stronger the public and potentially the press can play an increasingly strong part in helping legislation take shape. 

As a grass roots Labour party member my dislike of the Lansley plans was strong; Strong enough to get me marching for the first time in 30 years.  But now, having listened to both Andy Burnham and the civil servants I can see that there is much within the Lansley plans which are as he has claimed – a continuation.

·         The quality agenda is being driven in part by the embryonic new information systems which developed under the last government and are now reaching maturity. It is also driven in part by professional concerns about how best to improve standards.  This would have happened anyway.

·         The decentralising of responsibility and the integration of primary and secondary health care with social care is necessary to deal with the challenges of the future and was happening under Labour anyway. 

·         The impetus to help or force hospitals into governing both quality and finance better is necessary and would have happened anyway.

·         The emphasis on the patient voice is in part what Midstaffs has added into the equation. All parties theoretically agree that a stronger patient voice is needed but there is no agreement about how this can be effectively done. I suspect we will spend the next decade trying to work this out.

There is substantial common ground. There is no need for many of the changes to be presented as radical or new. They are simply stages on a journey.  There is no good reason why all parties cannot drop the rhetoric and co-operate on the areas I have outlined.

There is a stumbling block is this – The major structural changes, and increased competition which Andrew Lansley sees as essential , look from the viewpoint of the Midstaffs inquiry room to be both unnecessary and harmful.

There are two main theories on what happened at Midstaffs:

·         The orthodox version, espoused by the press, is that this was a major disaster which nobody saw because of faulty regulatory systems and the failure of communication between a series of organisations that had just undergone major structural re-organisations and were therefore in turmoil.   

·         The alternative version, which I share with many of those closest to the hospital and many of the regulators, is that there has been a significant distortion of the facts.  See http://pressreform.blogspot.com/2011/04/what-forms-our-perception-of-stafford.html , and that the problems at Stafford are both less serious and much more widespread than we have been told. These problems that do exist reflect the key challenges that Andrew Lansley has correctly identified for the NHS; Challenges that are set to increase over the next three decades.  Those people who are close to my way of thinking on Midstaffs  believe the turmoil caused by the series of structural re-organisations left the regulators in a weak position to deal adequately with the major moral panic that arose.  

 The one thing which unites most of the people watching from the public room at the Midstaffs Inquiry is that Stafford cannot and should not be taken as a justification for the changes Andrew Lansley wants to make. The Inquiry will not prove the case for structural change, and it may well prove why structural change is the wrong answer. Whatever it was that happened in Midstaffs is much more likely to happen at times of structural change and financial pressure.  We are creating the perfect breeding ground for future scandals right now.

If I had the opportunity to talk to Stephen Dorrell and Andrew Lansley this is what I would ask them to do. Put the Health bill on hold. Do the bare minimum to stabilise the system and to stop the haemorrhage of talent that has already taken so many people from the system.   Allow people to see the Midstaffs report and learn from it; Consult widely; Trust the Clinicians and the patients and set them free to devise the structures they require to do the job; Seek the common ground that does exist, and continue to build on this.  Then come back with a better and more consensual bill.

A quiet revolution at the NHS Information Centre

Tim Straughan came as a surprise to me.  I am not sure how after three years of following the Stafford Story that day 99 of the inquiry was the first time I heard of the NHS Information Centre. Probably because I have a blind spot for acronymns.

The NHS information system is an important part of the journey to better information about health care. This journey has been going on for many years, and it will continue under this government. It became very apparent that we will be hearing a great deal more of it as it takes the central role in bringing about the “Information revolution” which is one of the key pieces of the NHS reforms.

Take a look at their website http://www.ic.nhs.uk/ which is astonishing.

About us

The NHS Information Centre is England's central, authoritative source of health and social care information for frontline decision makers.

Our aim is to revolutionise the use of information to improve decision making, deliver better care and realise increased productivity.

I have plenty to say about the NHS reforms, most of it uncomplimentary, but where the plans for the NHS Information centre come in I think I feel reassured.

Mt Straughan is a quietly humorous and diplomatic man. He speaks with precision and economy.  He runs a 500 strong team that deals with the data collection, analysis, processing and dissemination of an astonishingly varied mass of data designed to help us see what is going on in the NHS and social care systems.

We do need an information revolution, and the Midstaffs story shows us many of the reasons why.

Midstaffs and information

Throughout the Mid Staffs Inquiry we have been repeatedly hearing about problems with access to information

·         There are people who had access to a piece of information but were missing out on another bit which might help complete the picture. 

·         Bits of information that people think have been hidden have attracted huge and unwarranted attention. This has created ideal breeding grounds for Conspiracy theories.

·         Information has been seriously misunderstood and misused.

·         There are question marks about the quality of quite a lot of data, and it is clear that staff collecting and inputting data do not always have the same understanding as the system designers.

·         There have not been enough trusted people to advise on the quality of information, and many decisions, some of them important ones, have been taken by people who do not understand the limitations of the data they are using.

·         There have been simmering rows and resentments between different statisticians with different ways of measuring things.

·         There has been a major problem with the use of information by the press, which must relate to both the way in which information is given to the press and media, the responsibilities they have to use information correctly, and the options we have for challenging them when they need to be challenged.

Statisticians and Clinicians

What we perhaps see, when we look at the way in which Statisticians and Clinicians interact is a kind of mutual incomprehension. The Statisticians that I have listened to within the course of the inquiry are people who care very deeply about the health service and know that they have something valuable to offer. They know that by helping people to challenge their thinking and see things differently that they can help to transform the delivery of health care. Clinicians are too often swamped by dealing with day to day pressures of looking after individual patients in an overstretched health service, and will often feel quite irritated with what looks like additional things that they are required to do.  

Both Clinicians and Statisticians would agree that the task is to improve safety and quality of care for patients but perceptions of what helps with this will vary.

The interface between statisticians and Clinicians is further complicated by political rows about the effectiveness and cost of the health service.  This often leads, as it did in Stafford, to statistical tools which were designed as an honest tool for assisting clinicians make better decisions, being abused as a political weapon to beat the NHS and the government of the time.  

Often the pressure to complete data inputting is financial or part of the regulatory burden. As the health service attempts to measure performance to ensure value for money then failing to complete paper work on time, or in the right way can have consequences.  The pressure to complete the task without the necessary understanding or attention to detail is a real issue.

The private sector issue

None of this is helped by the conflict between different information companies that has erupted in the case of Stafford Hospital where the views about the quality of the information are in direct conflict, or by the deep hostility that many people within the NHS instinctively feel towards the involvement of commercial companies.

Distrust of statistics used by the media and politicians.

Many people do have a natural scepticism about Statistical information. This is not surprising. A huge number of news stories and the kind of rows that routinely erupt in PMQs are based on Statistics, often wrongly used or wrongly presented, so trust in statistics is being routinely undermined.

The media love dramatic stories, and most journalists are come from an arts background and are not good at dealing with the intrinsic difficulties of probability data, so we get the “swine flu” scenario, with Jeremy Paxman demanding that the chief Statistician tell us how many millions of people are going to die.

Statistics used well can help the NHS save lives, and can help the public and politicians see that they do so.  Statistics that are misused can cause distress, and confusion. 

The Role of the NHS information Centre.

All of this forms a background to the role of the information centre.

We have seen a huge proliferation of different sorts of data, and huge arguments about the quality of data. We are, as Tim Straughan says, data rich and information poor. The mission of the NHS information centre is to cut through these arguments. To make data available to anyone who can make effective use of it.

The aim of the information centre is very ambitious. It is there to gather as much information about the health service as possible in one single place. It will make it available for people to see in the most transparent way possible. The centre aims to cut out duplication, and will work with a range of people who can provide a service of analysing the data. Some will be within the NHS, many will be private sector firms or individuals. The uses to which this information will be put are only just beginning to be imagined. The users will make use of the data with clear understandings of the rules of use. Much of the information they produce will then come under the umbrella of the Information centre. Users are already being invited to set up their home pages within the Information centre website.

Tim Straughan talks about the need for greater confidence in information – The need to be free from political interference. There also need to be the possibility of sanctions against people who breach strict rules governing the use of official statistics. He mentioned that there has already been an occasion where a minister has misused figures on Knife crime which came from NHS sources, and has been given an official reprimand by the National Statistician. 

Given how much time and energy is wasted by exercised like having to fact check just about everything that is said in PMQs and ministerial questions, and the lack of public trust that this generates then I would personally welcome this. We need our politicians to be using good information. We need the press to be using good information, we need both of them to be able to check with authoritative sources, and we need there to be effective ways of challenging them and getting corrections made when they are wrong.

I am not expecting miracles here, but I think that the intention behind this information centre is genuinely to improve the quality of information that informs the public and informs political decision making.

Tim Straughan was asked about what data gets collected. He says that there is a remarkable degree of global agreement on what it is needed to collect.

In the Stafford Case we have got very bogged down in the issues surrounding one particular set of data, the HSMR system. Tim says that we are moving away from the idea that one figure can possibly tell the story, There needs to be ways of cross checking with a wide range of other information. He says the centre is working with 300 indicators that can show us a much more rounded and complete picture.

Health service managers and the public will have access to a dashboard of indicators that will both prevent simplistic observations and help us to see better.

The intention is to carry information about many things including :

·         Outcomes.

·         Complaints

·         Work force Data

·         HSMR

·         Prevention

·         Population health

·         Lifestyles

·         Primary Care

·         Community care

·         Social care.

Moving towards consensus.

The kind of issue that happened in Stafford with the eruption of a dispute between rival information companies is unfortunate, and the information has already played a significant role in bringing the parties together to more towards a mutually agreed system for the future.

Views on Dr Foster.

Tim tells us that there are very mixed views within the health service about the company. Some are firm believers in the system, others are not. Many people felt strongly that the publication of the League table without having made the methodology available, and gained universal acceptance of their methods was certainly premature, and probably inappropriate.

On the subject of transparency Tim can see both sides of the argument. He defends the DFI because He says that they did in fact believe that they had published their methodology in a transparent way, but he also accepts that people found in practice that there was not enough detail to permit people to replicate the results and so people were still not convinced.

Tim is very clearly determined to get people to work together. I believe that it is possible for him to do this. Many of the disagreements that have existed are down to extraneous factors outside the substance of the statistical material. When viewed calmly, and out of the glare of publicity that has bedevilled this issue people can see that this is the case. 

Tims view of the individuals he has met in relation to the Stafford case is a refreshingly generous one. He values the skills, the creativity and the integrity of the individuals involved.  He describes DFI people in particular as sparky people, pushing the boundaries of knowledge.  

One of the issues that did emerge about Dr Foster is that as they were working with the DoH to advise on statistics that they could not bid for the work that they wanted to do. There has been a separation of the DoH from DFI so now there is no longer a conflict of interest.

Francis report and SHMI

The problems between the different groups of statisticians became fully apparent during the first Francis inquiry. He recommended work to resolve that and that is why the NHS information centre brought the Statisticians together to thrash out the framework for the SHMI system.

The Concordat on HSMR

As a result of the work towards SHMI there is now a definitive statement on the limitations on HSMR and the assumptions that can be drawn from it. This clarifies that the use of the 400-1200 excess death figures for Stafford is inappropriate. This concordat which we saw briefly on the screen at the inquiry shows that most of the key players in the NHS, including Doctor Foster Intelligence have signed this.

The Future.

Tim is very proud and optimistic about what is being to develop information systems. It is clear from what we have heard from him and from Richard Hamblin that there is real potential for something remarkable.

Restoring Trust.

Robert Frances picked up on the issues of political interference with statistical information and the need to protect statistics against misuse.  He is suggesting that NHS statistics should be issued through the National Statistics office, and that there should be clear codes of practice to prevent misuse, with penalties for those who do.

The complicated and as yet little understood saga of Stafford and HSMR has been the trigger for beginning a remarkable information revolution.

The future should be very interesting indeed. 

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Diana Smith