I am sorry there has been such a gap between
updates. Since the IFQO initiative began in spring 2008
activity in the three areas of interest (Mental Health Informatics,
Funding Mechanisms, and Quality) has continued to grow very fast
both centrally and in Trusts. It is impossible to keep track
of it all. Over the last three months my ‘IFQO lecture tour’
has ended and I have spent most of my IFQO time assisting various
committees. Avid followers of IFQO will notice that I have
not completed the planned ‘Putting it all Together’ paper. It
was too difficult, I was not sure if anyone would read it, and I
have been otherwise occupied:
Mental Health
Informatics:
Roll-out of Connecting for Health systems in
England seems to be proceeding better than before – Lorenzo
promising to get in place in its first acute trust at the
11th hour ( the Chief Information Officer having
promised it by November), and we are making steady progress.
But I have to point out that other solutions are available.
I was very pleased to assist in setting up a
new central organisational structure for Mental Health Informatics
(in England) which will start to operate over the next few
months. At DH level there is to be a MHI Board setting the
strategy and policy priorities, which will bring together the DH
Division/ Directorates for MH and Informatics, CFH, the Information
Centre, and representatives from the NHS Confederation and clinical
informatics. Working with the Board will be an expert group
of representatives, whose considerable task, it will be to advise
the Board and also take their own decisions on many issues where a
single national approach will be advantageous. The third part
of the new structure will be a wider network of all interested
people, supported by the IC. Mostly of course this will work
through electronic communication, but a first meeting is planned in
London for January next year (probably the 14th).
I would recommend all members of the Mental Health Informatics
Special Interest Group and other College members interested in
informatics, in any of its manifestations to join the network. I
hope that invitations will be circulated via the College.
I must say, I think this could be a great help
in streamlining the development and implementation of MHI at a
critical time, and other countries should also be able to benefit
from the English work at no cost.
Funding
Mechanisms:
England continues to expect Payment by
Results! The bulges are growing steadily all around the country
with teams busily training themselves in the skills of allocation
to Care Clusters and making maximum use of the data. We are
eagerly awaiting the arrival of the results of the pilot projects
on ‘HoNOS-PBR’ and ‘Costings’ that will inform the application to
the Information Standards Board at the end of the year. Without
which of course there can be no Data Standards Change Notice in
March and no PBR for MH as planned. There are no warning signs that
I have seen to suggest there is any serious problem afoot. It
would be worth keeping an eye on the DH website for MH PBR.
Other related news is that work is beginning
in DH teams on improving MH ‘co-morbidity’ codings in acute
hospital care; linking quality measures to finance more
effectively; and making sure that IT support for Care Clusters will
be in place as soon as possible.
Quote of the month: ‘if we were not doing
Care Clusters for PBR we would do them anyway because they are the
only way of making sense of what is being done in our
teams’
It may be worth mentioning that there was a
call for evidence for an Inquiry by the Health Committee at
Westminster on Commissioning to which the College responded to
recently (The response is available on the College Website).
The other countries of course are no longer
playing the internal market game but financing providers directly.
There is however, a comparable movement in each jurisdiction
towards an information based approach, using Integrated Care
Pathways (ICPs, Scotland) or developing Intelligent Targets (Wales)
as a means of splitting the caseload into analysable groups so that
Health Boards can reward good performance (see below).
Quality and
Outcomes:
This is very much centre stage in England as a
result of Lord Darzi’s emphasis and its cross party emphasis on the
political agenda in the face of the economic downturn. Although
centrally there are of course several different teams involved,
which makes it hard to interpret what is going on, at a local level
it is the introduction of Quality Accounts that will be the focus
of attention. QAs will be prepared and published alongside
financial accounts in MH provider organisations in 2010. A
consultation is in progress on the detail of how QAs will work, to
which the College will of course reply. QAs will include national
indicators as well as locally selected indices in prioritised areas
for improvement. There are pros and cons for using very
specific single indicators in QAs, versus broader composite quality
assessments of services such as the College CCQI has been
developing for some time. Narrow targets, coupled to
financial incentives, could skew funding distribution away from
other areas that are just as deserving if there are not enough
balancing measures. It makes sense (doesn’t it?) to try to use
indicators that will map to Care Clusters, so that we will know
which groups of problems are receiving good, bad, or indifferent
care.
In Scotland, ICPs provide the groupings for
which the Quality Improvement Service (QIS) will set
standards. The other countries might be able to benefit from
the work put into choosing the indicators (over a two year period,
I gather).
In Wales the development of specific pathways
for different patient groups, and associated quality measures for
the National Reporting Framework and Local Delivery Plans, is still
in progress; but target indicator requirements for the service as a
whole are in operation and must be set against their financial
reports by each organisation.
IFQO plans:
This initiative was only planned to continue
until the end of the year. With the great expansion of
expertise and engagement in all three areas, and in all four
jurisdictions, there is an obvious argument for a change in
approach by the College. I will be discussing this with the College
officers. It seems that there is a need for support, training
and mutual exchange of knowledge between members, as well as
external representation of College interests, and the opportunity
for the College (or CRTU) to engage in specific projects where an
authoritative professional body could add particular value.
Dr Martin Elphick
Specialist advisor for Information
based funding quality and outcomes
8th October 2009