IT & TELECOMS
T Getting the right mix
To ensure that NHS funding is being allocated in the most effective way possible, experts at the NHS Information Centre devised a system so effective it has inspired similar systems throughout the world, reports Richard Mackillican
he NHS relies on a constant flow of information to improve services but has not always had such good mechanisms in place to capture and process data.
“Over a decade ago, there was international recognition that the funding allocations for healthcare via block contract were lacking, in that they failed to provide any form of transparency or inform measurement and quality indicators,” says Virginia Jordan, programme head for IC-PbR & Casemix at the NHS Information Centre.
“Here in England this led to the establishment of the Casemix Service, an impartial, independent body accountable to the NHS and Department of Health. The remit of the Casemix Service is to develop and enforce national standards which underpin the monitoring, measurement and improvement of performance at a local, regional and national level.”
“Other parts of the world also developed casemix classifications and several of the field leaders were subject to a Department of Health-commissioned review that recently reported the NHS Information Centre’s Healthcare Resource Group classification (HRG4) developed by the Casemix Service as ‘best in class’ when compared to the others.”
To design the system the Casemix team engaged with a wide range of key stakeholders throughout the health service and government.
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design and development of our products and services.
This translates into multiple benefits that providers of NHS care in England can realise from HRG4 in supporting the delivery of high quality patient care. We supply healthcare commissioner and provider organisations with a host of information and guidance to support national, regional and local benchmarking.”
The benefits of these information services include:
Virginia Jordan
“Casemix design actively involves the broadest range of stakeholders possible: the Department of Health, as well as NHS senior clinicians, finance and information colleagues. In addition, it engages with NHS Connecting for Health to ensure appropriate support of Casemix from the primary classification sets.”
“The design itself relies on the availability of national data flows, data definitions and data standards. None of these elements work in isolation; the Casemix Service manages a complex interface between each of them in order to develop and improve the service and maintain its position in the national and international arena.”
“A rigorous and effective casemix classification can make a real difference in the health service and be used to improve patient care.”
“The Casemix Service turns data (procedures, diagnoses) into information (HRGs) through the application of expert clinical and financial advice from our NHS colleagues and partners to the
• The ability to identify the patient care pathway
• Facilitation of service redesign and streamlining in accordance with national best practice
• Establishment of a link between care provided and clinical outcome
• A mechanism to support provider income to reflect the complexity of care provided
• A mechanism to assess commissioner value for money
In addition, the information also provides the Department of Health and other organisations at a national level with significant benefits, for example the ability to monitor activity trends over time on a consistent basis.
“Our information plays a vital role in the Treasury’s ability to identify what NHS spend delivers. It also provides a means for the Audit Commission to assess data quality of local information and provides assurance to the Department of Health and commissioners that systematic ‘gaming’ is not taking place on the part of provider organisations.
“Significantly, HRG4 provides
the flexibility to support future policies for healthcare funding by identifying the components of NHS service provision - via the separate identification of high cost activities - and enabling care to be linked to outcomes. This means that Casemix can help to bring greater efficiencies to the NHS organisations which make use of them.”
“Our products are pivotal in terms of supporting local understanding and benchmarking local practice in a number of areas, including identifying resources used to deliver care, and variances in the care delivered.”
“They also support the redesign of care pathways for appropriateness and outcomes of care to ensure high quality care is – and can be seen to be – delivered, and opportunities for improvement and efficiency identified. And of course our products are built to support Department of Health funding policy, which itself aims to reimburse the appropriate costs of care and deliver value for money.”
When a service is so vital to the success of the NHS organisations, it must be well received by the staff that use it and casemix services are no exception.
“The extent and degree of the positive response we receive is quite humbling really. Our annual roadshows are consistently fully booked, and user feedback captured at these events is overwhelmingly supportive and provides an essential source for future developments. Our users feel that they have ownership of the products and faith in their development.”
Sep/Oct 10
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