As the end of the 2005-2010 Parliament approaches, and the political classes gear themselves up for the general election, each of the political parties’ health teams will be looking to prove that they have the big ideas to take the NHS forward in a period of tight public finance but escalating public expectation.
In this short series of opinion pieces, Health Mandate’s team of expert health policy consultants look at some of the big issues that will shape the political and the NHS landscape in the next parliament. Today’s piece sees Mike Birtwistle assess the prospects for an information revolution.
David Cameron wants an information revolution to help deliver excellence, efficiency and equity in healthcare. We are told to expect a white paper on the issue in the first few months of a Tory administration.
Labour actually announced its own information revolution for the NHS in 2004, although since then the Department of Health has shied away from using this language. The Liberal Democrats have so far not launched their own revolution. Instead they have called for ‘competitive localism,’ involving the open use of data to compare performance of local areas and drive improvements in services.
The political consensus about the need to better use health service information is nearly as strong as the consensus on the NHS itself. Yet what additional information do politicians want in the public domain? And should they be careful what they wish for?
The case for a revolution
Even setting aside the slightly excitable political rhetoric, it is clear that there is now a policy consensus about the importance of transparency on service performance. The use of information is seen as a neat way to reconcile a desire for greater local autonomy with the political necessity of maintaining common standards in a national health service. Politicians are understandably eager to devolve accountability for poor performance alongside the power to improve services. This is never more apparent than in the wake of the Mid Staffs scandal and a fierce row about the extent of malnutrition in hospitals.
The case for the greater use of data is compelling. It can enable patients to make informed choices, provide PCTs with the tools to make commissioning decisions based on quality and enable providers to introduce improvements based on the experience of others. It can also stimulate research into health service trends, uncovering areas of inequality.
Of course using health data also fits in with wider policy trends – open government, accountability, greater scrutiny of expenditure and enabling citizens to play a greater role in shaping public services are all politically potent concepts. Combine them with technological changes such as open sourcing and the use of data mash ups and it is easy to see why this particular revolution is politically attractive.
The information challenge
However, beyond the broad commitment to publish more information, it is less clear how this agenda will develop. Collecting health service data is expensive and releasing information in a way which enables meaningful analysis whilst protecting patient confidentiality is fraught with difficulty. All too often well intentioned attempts to promote transparency have foundered. In this sense, there is no reason to suspect that the next wave of information revolutionaries will have any more success than the last.
There are significant data already in the public domain, offering unprecedented opportunities to analyse and understand health service performance and how it might improve. From information on expenditure, to the use of drugs or the burden of ill health in primary care, we know more than we ever have done before. Yet it is not clear that NHS organisations – or indeed the stakeholders that seek to influence them – are making sufficient use of this information. Too many PCTs have yet to conduct meaningful analysis of why their spending on a particular programme area is high or low, or why the outcomes they achieve are better or worse than the national average.
Turning intelligence into action
Put simply, information has not consistently translated into intelligence, nor intelligence into action. The National Audit Office is already examining the power of health service information as a change lever. Expect the verdict to be that progress has been made, but that there remains a lot to be done. With a few notable exceptions, the promise of information has still to be fulfilled.
Given the difficulties in making available more information, don’t be surprised if the focus shifts (again) to making better use of existing data sources. The question will be how the
Department of Health seeks to stimulate this. The record of Arms Length Bodies in applying the data they collect is mixed at best. Expect a greater role for private sector providers.
Health Mandate has experienced firsthand the power that using information appropriately can have. From collating information on exceptional cases processes and successfully making the case for a change in the law through to our work on producing the first ever national analysis of PCT commissioning priorities, it is clear that the use of information – if done well – can change policy and transform NHS practice.
Clients are increasingly making use of our commissioning intelligence tracker (CommIT) to generate insights on how services can be improved and to successfully make the case for change. Collaborative efforts between the NHS, voluntary sector and others, for example through initiatives such as the National Cancer Intelligence Network, are already bearing fruit.
The paradox of information
Perhaps the model of a stakeholder-led revolution offers a more promising way forward than those in Westminster and Whitehall manning the barricades. It does, however, come with a risk for politicians in that they will be able to exercise less control. This may seem attractive in opposition but, as Labour has learned, can be a lot less comfortable when you hold the keys to Richmond House. A firefight over statistics may make for good election theatre, but the heat feels a lot less intense when you are not ultimately accountable.
Information which is poorly analysed can actually set back the development of health services, leading stakeholders to draw the wrong conclusions or commissioners to shy away from the correct, but difficult, decisions in the face of misdirected scrutiny. The disclosure of information which is then used inappropriately will only diminish the case for greater transparency.
The paradox of the information revolution is that making more information available to all will actually require greater expertise and specialisation, both in determining what data can be published and how it should be presented and then in contextualising it, analysing it and applying it to make a difference to health service delivery. Information is power. But only if you know how to use it.