As part of its much-vaunted efforts to incentivise public service consumers (that means you and me) to make better choices and demand higher standards – something MAC applauds – The Cabinet Office announced last week that sets of performance indicators would be available covering health, schools, courts and transport. This is a warm-up for the much hyped but oft-delayed Open Public Services White Paper which is to see the light of day this week.
The Prime Minister’s letter to Cabinet announcing this said “We recognise that transparency and open data can be a powerful tool to help reform public services, foster innovation and empower citizens.” This is something MAC fully supports.
Information revolution in NHS
For the NHS this means, the “information revolution” promised by Mr Lansley in his own “Liberating” white paper last July will move centre stage. We will be deluged with health performance data, including:
- Data on comparative clinical outcomes of GP practices in England to be published by December 2011, following the lead of the NHS in London which has agreed a set of 22 indicators with local GPs
- Prescribing data by GP practice to be published by December 2011, as per the Growth Review
- Complaints data by NHS hospital so that patients can see what issues have affected others and take better decisions about which hospital suits them. This commitment will be met by October 2011
- Clinical audit data, detailing the performance of publicly funded clinical teams in treating key healthcare conditions, will be published from April 2012. This service will be piloted in December 2011 using data from the latest National Lung Cancer Audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)
- Data on staff satisfaction and engagement by NHS provider (for example by hospital and mental health trust) will be published from December 2011
- Data on the quality of post-graduate medical education by provider will be published from April 2012.
There is a danger people may drown in this deluge, but provided we man the lifeboats and learn how to paddle quickly it could be a useful development. Citizens, patients, carers – in this climate of data liberation we now need a geek or two who is on our side to be our data mentor and guide. If you browse Gov 2.0 sites and start trying to get into the datasets, life gets very complex and the data difficult to work. Can we simplify things along the lines of the US initiative called ‘Blue Button’ – ‘press this button and get all the data you hold about me’. Have a look at the proceedings of the Gov 2.0 conference in 2010 and in particular at the session on healthcare.
We suggest as a starter project on data liberation and use, working on the NHS London set of 22 performance indicators for the capital’s GPs. Will this, as Mr Cameron hopes, “signal the decisive end of the old-fashioned, top-down, take-what-you’re-given model of public services”? We hope so, provided we take those paddling lessons to heart quickly.
London’s GP leaders have agreed these 22 standards, to be divided into both practice and consortium indicators.
1. One year cancer survival rates for breast cancer and lung cancer (consortia indicator)
2. Cancer prevalence (consortia indicator)
3. Cervical screening
4. GP recorded smoking (Whole population)
5. GP recorded smoking (Long-term conditions)
6. Atrial fibrillation prevalence (consortia indicator)
7. Immunisation uptake
8. Influenza immunisation uptake (both practice and consortia indicator)
9. Chronic obstructive pulmonary disease (COPD) prevalence
10. Asthma prevalence (consortia indicator)
11. Diabetes prevalence (consortia indicator)
12. Coronary heart disease prevalence (CHD)
13. Dementia prevalence (consortia indicator)
14. Monitoring safe, rational and cost effective prescribing in general practice
15. Emergency hospital admission rates for specific chronic conditions usually managed in primary care (consortia and practice indicator)
16. A&E attendances (consortia and practice indicator)
17. After consultation how well did you understand / feel better able to cope?
18. Satisfaction with overall care received at surgery
19. Patients changing practice without changing address
20. Ability to see a specific GP or Practice Nurse if wanted
21. Advanced appointments. Satisfaction with opening hours. Ease of getting through on the phone
22. Significant event reporting (one and three year targets) (consortia indicator)
Keeping a watchful eye on GPs
Responding to this announcement, Dr Howard Freeman, associate medical director for primary care for NHS London and a GP in Wandsworth, said this was right in principle in order “to keep GPs under the public’s ‘watchful eye’ . . . and to give as much useful information as possible to the public”.
We agree. We’ve been campaigning for the data vaults to be prised open for a long time, so naturally MAC is pleased with this development. But there is a caveat: it is easy to overload consumers with upfront comparative data and defeat the object of the exercise. “Blinding with data” is not far from “blinding with science”.
What really matters
According to the Kings Fund, fewer than 10 PCTs – when we still had them – made comparative information available up front on their websites so choosers and changers could at least get some sense of how practices compared on the top level things that matter to most users: namely
getting through on the phone
making appointments in advance
ability to see a GP in two working days
an overall ranking of other patients’ satisfaction with the practice plus
some key indicators like MMR and flu vaccine uptake.
Put access and choice at the top not the bottom
These indicators are in the NHS London template project (nos 18 and 21 – the immunisation ones are higher at nos 7&8). We think the access and choice indicators are what patients want to see first and they should come top of the list, not almost last.
This is what Wandsworth PCT did with their GP performance scorecard and they are to be commended for it. Otherwise these key indicators risk getting lost. Too much data up front will defeat the object of the exercise, but of course it should all be accessible for anyone who wants to see it.
Let people choose and change and vote with their feet about which practice they believe is right for them. Yes, of course, some people will not choose well, but that is their right and we must accept it in an open society. The poorly performing practices will also feel the heat. We need more of that.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.