The New Healthcare
Economy:
Information Challenges
Toby Lambert, Director of Strategy and Policy
Neil Stutchbury, Knowledge Management Director
Regulatory mechanisms for
influencing integrated care
Toby Lambert
Director of Policy and Strategy
Health and Social Care Act 2012
Monitor
(incl. CCP)
Professional
regulators
Care Quality
Commission
Protection of the
public and patients
Department
of Health
NHS Trust
Development
Authority
NHS
Commissioning
Board
Monitor is changing
Monitor (pre 2012 Act)
Monitor (post 2012 Act)
Responsible
for FT
assessment,
governance and
financial
oversight
Main duty: to
protect and
promote the
interests of
people who use
health care
services
Monitor
is
changing
Monitor’s main duty will be to
protect and promote . . .
Section 61
(1) The main duty of
Monitor in exercising its
functions is to protect
and promote the
interests of people who
use health care
services by promoting
provision of health care
services which
a) Is economic,
efficient and
effective, and
b) Maintains or
improves the quality
of the services
(2) In carrying out its
main duty, Monitor
must have regard to the
likely future demand for
health care services
‘Protect’ implies a
minimum
standard that
Monitor enforces;
could be the
focus for FT
regulator
‘Promote’ implies
enhancing all
performance;
could be the
focus for sector
regulator
Interests of people who use healthcare
Interests are a measure of
value – outcomes that matter
to patients (i.e., quality) /
cost
Mission
‘Enabling providers and commissioners of NHS care
to deliver the best possible care for patients today
and tomorrow through publishing information,
using incentives and enforcement where necessary’
New provider licence obligations
In force from 1 April 2013 (FTs only)
General
Integrated
Care
Pricing
Choice and
Competition
Governance
for FTs
Continuity
of Services
Integrated care
Information
•
•
What works in integrated care?
What costs are incurred?
Incentives
•
•
What are the most appropriate currencies?
How do we structure prices?
•
How can regulators enforce integrated care?
Enforcement
Timeline
Risk Assessment
Framework
Department
of Health
consultations
HSCA
assent
Spring 2012
Opportunity for
Secretary of State
veto
January 2013
Summer 2012
Summer 2012
Provider licence
consultation
Guidance for
commissioners on
Commissioner
Requested Services
Late 2012
Enforcement
Guidance
October 2013
April 2013
FTs
licensed
Competition powers
go live
Other providers
licensed
First Monitor/ NHSCB
national tariff
Management of
risk pool to be
consulted on in 2013
Today
April 2014
Monitor's Information Strategy:
Harnessing technology to influence
beneficial patterns of care
• How Monitor’s existing responsibilities are
supported by information management
• Monitor’s new information strategy to support
the new duties on economic regulation
• How Monitor’s information strategy benefits
patient care
Neil Stutchbury
Knowledge Management Director
Assessments and Transactions
docs
Portal
NHS Trust
connect2:
Assessment
Board report
approval
connect2:
Licencing
Board meeting
Financial analysis
Benchmarking
Governance and quality assessment
Pipeline views
Issue licence
and set up FT
in connect2
Benefits to patients
Future developments
• Assurance that their trust meets the financial,
quality and governance standards they would
expect of a well run hospital
• Improve benchmarking using new data
warehouse and modelling tools
Provider Regulation
Quarterly &
annual plan
templates
Portal
connect2:
Compliance
+
SQL db
Board report
approval
Monitor
website
Board meeting
Foundation trust
Financial risk assessment
Governance and quality risk assessment
Regulatory opinion and actions
Publish quarterly
risk ratings and
annual plan
review
Benefits to patients
Future developments
• Foundation trusts continue to be well led and
meet quality and governance standards
• New financial and governance risk framework
for ensuring compliance to licence
• Failing trusts are identified early and corrective
steps applied quickly to prevent failure
Licencing
Download
licence
Portal
connect2:
Licencing
Went live
on 1/4/13
Foundation trust
Online
Application
Applies for licence
Goes live
before 1/4/14
Portal
Download licence
• Creates complete licence from FT
details and standard licence conditions
• Creates PDF and puts it in the portal
Registered
provider of
NHS funded
services
Benefits to patients
Future developments
• The legal framework which assures patients
that healthcare will be delivered in a way that
best represents their interests and is done so
economically, efficiently and effectively
• Joint licencing system with CQC for new
entrants will be live from 1/4/14
Pricing, Competition, Enforcement
• The Pricing function needs to create costing and pricing models which
accurately reflect how care is delivered. We will trial a new approach to
costing based on patient level costs (PLICS) for the 15/16 tariff
• The CCP transitioned into Monitor on 1 April 2013. It analyses local
health economics data to investigate claims of unfair competition, for
example GP referral patterns and the impact of commissioning
behaviour on travel times
• The Enforcement regime acts to protect essential services for patients
in the event of failure. To do so it needs to model the impact of different
service reconfigurations on the local economy and patient choice
This requires a fundamentally
different approach to data
analysis and management
Pricing, Competition, Enforcement
A big change in number of organisations and the sources
of information that Monitor will need
145 Licensees
Other Stakeholders
Other Stakeholders
500-700 Licensees
Non-Licensee
Healthcare Data Providers
(e.g. NHSCB, NICE, HSCIC, CQC)
20%
Data
5%
80%
20%
Provider Regulation
Data
Assessment
Compliance
FT Regulation
Other Data Providers
(e.g. ONS, OS, Open Data)
25%
50%
Assessment
Pricing
125 Staff
Previous
Role
New
Role
Economics
417 Staff
Competition
Pricing, Competition, Enforcement
A big change in the volume, type and sources of data,
and the way in which it will be used
Area
Now
Scale
The Future
Functions
Foundation Trust Regulation Assessment and Compliance
x3
(staff)
Assessment, Provider Regulation,
Pricing, Economics and Competition
Data sets
About 10 (Quarterly, APR, FTC,
Surveys, A&E, RTT etc.)
Data
volume
10GB, growing 5GB/year
x1,000
(bytes)
10TB, growing >1TB/year
Data types
Finance, quality, provider
x3
(topics)
Finance, quality, provider, cost, price,
activity, geography, population etc.
Usage
Standard and ad hoc reports
Excel Pivot tables
much
more
complex
Standard and ad hoc reports +
Complex multivariate statistics and
modelling and analysis
Partnerships
Monitor collects information from
FTs, independent of IC, DH etc.
Providers
145
x5
(datasets)
+8
(data
suppliers)
x4
(orgs)
About 50 (HES, SUS, PLICS, Ref Costs,
Quality indicators, MHMDS, PROMS,
GIS, ONS, etc.)
Increasing dependence on others, e.g.
HSCIC, NHS CB, CQC, NICE
500-700
Proposed Information Architecture
Data Quality feedback loop
from Monitor functions
Bespoke
Applications
Data from HSCIC
E.g. HES, PROMs, ESR,
MHMDS, CDS etc.
Data from other sources
E.g. Maps, Census etc.
Data
Validation
Data
Warehouse
Data from providers
E.g. finance, quality,
PLICS
data not meeting
quality criteria and
requiring rework,
and/or resubmission
Statistical
Modelling &
Analysis
Dashboard
Reporting
Regular
Reporting
The means to track and
manage data quality
Central repository of
managed data to
source regulatory
requirements
Cost / Pricing
Models
Impact
Assessment
Models
Competition
Models
Ad Hoc
Reporting
Provider
Regulation
Tools
Tools
Use of
Tools
Using a range of tools
for different uses
Applications, models,
analyses, reports for
each business function.
Common Information Model
• Over the next 3 years, the
strategy is to turn every box
on this model green
• We will need to work with
partners to do this, e.g. Health
and Social Care Information
Centre
Monitor can easily collect today
Data exists and is available with
the right contracts/IG etc
Data may exist but may not be
complete or easily available
Common Information Model
Roadmap
2013-14
2014-15
Pricing:
Competition:
• Cost model
• Pricing engine
• Impact ass’ment
• Incentives
• Referral patterns
• Travel times
• Local market analysis
• Patient choice
Supporting
information
and
technology
capabilities
Assessment and
Compliance:
• Benchmarking trust
performance
• Risk modelling
• Financial analysis
2015-16
Enforcement:
• Service reconfiguration
• Economic analysis
• Impact on patients
2014-15
Overall Information Strategy
Vision: Information-led healthcare regulation
Patients, public…
Providers
Strategic imperatives:
Website (gov.uk)
Portal interface
• Single entry / exit point for
data and information
• Unified data storage /
manipulation environment
Contacts
Enquiries, FOI…
Case management
Intranet
Document mgt
Collaboration
CRM (v4 to 2011)
SharePoint (2010 to 2013)
Data warehouse
Data validation
Modelling, stats, reports
SQL Server (‘08 to ‘12) and/or
Cloud + BI/modelling tools
Data suppliers eg HSCIC, Google, ONS
• Advanced modelling and
analysis of the data
• Expanding role of the KIM
Team (scale and capability)
• Mature internal governance
and controls
• Partnering with HSCIC,
NHSCB, CQC, NICE, NTDA
to access data and promote
quality and standards
Conclusion:
The Benefits to Patients
• Our mission is to protect and promote the interests of patients, for example:
– Confidence that hospitals are well run and meet acceptable quality and governance standards
– Preventing hospitals from failing by spotting issues early and remediating them
– Prices are set such that providers are incentivised to improve quality and efficiency
– Encouraging providers to link services together for the benefit of patients
– Enabling patients to exercise their right to choose how their healthcare needs are met
– The system will allow efficient services to replace poor or inefficient services
– Protecting essential services for patients and reconfiguring failed providers
• We cannot fulfil our regulatory responsibilities without accurate and timely information
• We are implementing a new information strategy for the benefit of patients