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DATE: 25 July 2013

Title Review of the use of Business Intelligence systems

Recommended action for the Governing Body

That the Governing Body: Consider the options as laid out in the report & Approve the recommended Option 3; Agree the use of resources freed up from Option 3 to acquire a risk stratification tool, as discussed on pages 4-5 of the report; and for the CCG to discuss with GPs the opportunity to use the balance of freed up resource for further practice support to develop QIPP linked to the quality agenda and provide additional benchmarking information in line with that already started by the Information Analyst.

Executive Summary

The CCG currently commissions two Business Intelligence Systems, from Mede and South London CSU (SLCSU). The CCG always had the intention of reviewing this duplication during 2013/14, but the restrictions placed on CCGs’ access to Personal Confidential data (PCD) has escalated the need for a review. The report explains the history and current situation regarding the Mede and SLCSU contracts and gives four options on resolution, recommending option 3 - Allow the Mede contract to conclude on the expiry date and use the freed up resources for risk stratification and further GP support. The CCG needs to acquire a risk stratification tool to fulfil its role to NHS England on the risk profiling DES included within the Kitemark for 2013/14. The paper recommends utilising resources freed up from the recommended option to do so.

Which objective does this paper support?

Patients: Improve the health and wellbeing of people in Bexley in partnership with our key stakeholders

X

People: Empower our staff to make BCCG the most successful CCG in (south) London

X

ENCLOSURE: H Agenda Item: 73/13

Governing Body (Public) Meeting

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Pounds: Delivering on all of our statutory duties and become an effective, efficient and economical organisation

X

Process: Commission safe, sustainable and equitable services in line with the operating framework and which improves outcomes and patient experience

X

Organisational implications

Key Risks (corporate and/or clinical) N/A

Equality and Diversity

N/A

Patient impact

N/A

Financial

The CCG is currently paying for two Business Intelligence systems. This is not value for money. Additionally, the CCG needs to acquire a risk stratification tool as laid out in the report. This is expected to cost between £50k & £100k.

Legal Issues

The use of Patient / Personal Confidential data for invoice validation and risk stratification is not currently a valid legal purpose for CCGs.

NHS constitution

N/A

Consultation (Public, member or other)

The use of information systems has been discussed at each of the locality meetings.

Audit (Considered / Approved by Other Committees / Groups)

Review of systems and options have been considered at each of the three Bexley locality meetings.

Communications Plan N/A

Author Theresa Osborne, Chief Financial Officer

Clinical Lead Dr Sid. Deshmukh Information Lead

Executive Sponsor Theresa Osborne Chief Financial Officer

Date 5th July 2013

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Review of the use of Business Intelligence systems within Bexley CCG Introduction Bexley CCG currently commissions business intelligence support from Mede and as part of the core services provided by South London Commissioning Support Unit (SLCSU). The CCG had always intended to review this duplication of provision during 2013/14 but restrictions placed on CCGs’ ability to access Personal Confidential Data (PCD) has escalated the need for a review. History Bexley Care Trust introduced Mede Analytics (Mede) into the organisation several years ago. The Care Trust and GPs spent significant time developing the system with Mede. There is no evidence of a a procurement or selection process being followed. The Mede contract was originally agreed on the basis of a one month rolling contract but was later changed to a six month contract. The current contract expires on 30th September 2013. We therefore need to evidence market testing going forwards regardless of any review. The Mede system provides desk top access to GPs to assist in Practice Based Commissioning and invoice validation, including GP attribution. The data was loaded onto Mede by the Care Trust Information Analyst from Secondary User System (SUS) extracts which took significant manpower. Until March 2013, the Care Trust provided in-house support to write reports for GPs to access, through the system, to look at comparative data and benchmarking. During 2012/13, in preparation for the abolition of PCTs and introduction of CCGs, discussions were held with Clusters for support services through Commissioning Support Units (CSUs). CCGs accepted the local CSU’s core offer, although the purchase of other (enhanced) services were discretionary. As Business Intelligence Services (BI) are closely linked to acute provision, SLCSU included this as part of the core service offering to CCGs. The South London CCGs are contractually committed to this service until Autumn 2014. Current Position Personal Confidential data (PCD) The Health and Social Care Act 2012 (HCA) provides a model where the expectation is that PCD will be managed centrally (for the purposes other than direct care) in order to protect confidentiality. Under this new legislation it is not anticipated that CCGs will need PCD but that their business intelligence (indicators and aggregate information) will flow from CSUs to the CCGs. These flows should be underpinned by appropriate information sharing agreements which clarify the purpose for which the data can be used. The CCG has consequently reviewed all of its data flows with respect to PCD and taken measures to ensure that it is compliant with these new regulations. However in so doing, some areas of CCG activity that used to be driven through the use of PCD has had to be stopped and this is having repercussions on the CCG’s ability to support the GP Practices in the same way as before. This includes Mede support.

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There is a possibility of the CCG becoming an Accredited Safe Haven (ASH) which could overcome the issues described above however currently the process for applying to become an ASH is undeveloped and guidance is being sought from the Health & Social Care Information Centre (HSCIC). It is thought that a collaborative approach to applying for ASH status may be taken with Bromley, Lewisham and Greenwich CCGs. Mede Analytics As a result of the restrictions placed on CCGs, in respect of the ability to access PCD, no data has been uploaded by the CCG’s Information Analyst on Mede since 1st April. The data held in the system is therefore now out of date and will get older as the year continues, reducing its use. The CCG’s inability to access PCD also prevents the support previously given, on writing reports & supporting GPs on Mede, from continuing in the same way. GPs access to PCD is also limited in that they are now only permitted to look at PCD for clinical reasons. Only pseudonimised data can be used for service redesign and data validation. An audit has been undertaken of the use of the system which has shown that access over April and May is already in decline. Information received from Mede Analytics supports this as shown in the chart below.

Metrics Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 All

Total Logins 122 187 133 207 63 19 731

GP Practice Logins 89 115 94 176 49 18 541

Others 33 72 39 31 14 1 190

% of Practice Logins 73% 61% 71% 85% 78% 95% 74%

Discussions have been held at the three Bexley Locality meetings regarding BI and use of Mede. GPs have confirmed that since the focus on Kitemark has shifted away from data validation that use has reduced. The consensus from all three localities was that without current data the system was no longer able to provide the service as commissioned. The current Mede contract expires on 30th September 2013 and requires one month’s notice. The current costs of Mede are c£200k per annum. South London Commissioning Support Unit (SLCSU) As stated above, the BI offering from SLCSU is part of the core CSU service. The BI product has been under development for some months and the CCG has undertaken significant work with the CSU to verify the information included. The information provided to the CCG is pseudonimised allowing the CCG to use the data received without risk of breaching rules around PCD. Although the system needs further development, current information is encouraging. The CCG’s Information Analyst is in the process of developing dashboards for GPs in Microsoft Access, from the pseudonimised data that can be accessed and manipulated using Excel Power Pivots, alleviating the necessity for a separate desktop system within GP practices. The current contract with SLCSU runs for 18 months from 1st April 2013. Risk Stratification The current risk stratification tool used by the CCG has been hampered by the restriction on PCD.

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Consequently, there is a need to find a replacement that can utilise pseudonimised data. As well as being important for Quality, Innovation, Productivity & Prevention (QIPP), this is required for part of the Kitemark relating to the risk profiling DES. This DES aims to encourage practices to undertake risk profiling and multidisciplinary care planning with their populations, at least on a quarterly basis, for the identification and case management of patients identified as seriously ill or at risk of emergency hospital admission. This enhanced service is new for 2013/2014 and the final design and administration has been delegated to the CCGs by NHS England (NHSE). It will be subject to review by NHSE for 2014/15. This element of the Kitemark is paid for directly by NHSE’s primary care team, but has been included to prevent duplication. Payment, at a rate of £0.74 per registered patient will be processed on receipt of satisfactory assurance from the CCG that practices have supplied the necessary audit information and are meeting the requirements. The agreement with NHSE includes demonstration that risk stratification is in place. The CCG is arranging for a number of providers, including SLCSU & Mede, to demonstrate their risk stratification systems and provide costs. A paper on options and costs will be taken to the Executive Management Committee on which a robust decision on which system to select will be made. Costs are expected to be between £50k-£100k. Options Option 1 Do Nothing The CCG could continue to pay for two BI systems during 2013/14. This was the original intention to allow both providers to discuss options and benefit from each other’s systems to present a joint approach for 2014/15 onwards. Although the CCG facilitated this some months ago, little progress appears to have been made. The changes in PCD have now accelerated the need to address the duplication. Furthermore this option will result in the need to find additional resources in 2013/14 to fund a risk stratification system as this option will not release any funding. There is also a need to review and market test the existing system for Mede regardless of any change. This option is not recommended. Option 2 Give notice on the core contract with SLCSU which includes BI services The CCG is currently committed to an 18 month contract with SLCSU which runs from April 2013 to September 2014. The core SLCSU contract includes BI but also a number of other services, including acute contracting, performance management, financial management, HR & financial governance. Six months’ notice would have to be given on the entire core which would leave the CCG in a position of needing to procure a number of services over the next six months. In addition to it being uncertain whether nationally this would be permitted at this time, the CCG does not currently have the resources to undertake this step. As the length of notice period on the SLCSU contract is 6 months, this option would not free up resources in 2013/14 to use for risk stratification. This option is not recommended.

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Option 3 Allow the Mede contract to conclude on the expiry date and use the freed up resources for risk stratification and further GP support The 6-month Mede contract expires on 30th September 2013 and requires 1 month’s notice. The CCG does not need two BI systems and currently cannot use the Mede system for the uses originally commissioned. This option will free up c£200k per annum (£100k for 2013/14) with which the costs of risk stratification (c£50k-£100k) can be taken. The remaining freed up resource would give an opportunity to provide further practice support to develop QIPP linked to the quality agenda and provide additional benchmarking information in line with that already started by the Information Analyst. This should be discussed within the CCG and with practices further to understand benefits that could accrue. This option is recommended. Option 4 Open procurement The CCG could take the step of giving notice on both current BI contracts and procure a new BI system. However, as with option 2, this option would also result in the necessity to procure a number of other services. The CCG does not have the resources to undertake such a procurement at this time and as the notice period on the SLCSU contract is 6 months, this option would not free up resources in 2013/14 to use for risk stratification. This option is not recommended. Conclusion / Recommendation The CCG is currently paying for two BI systems, provided by SLCSU & Mede. Due to restrictions on the use of PCD, Mede cannot currently be used for the original intentions. The BI product from SLCSU needs further development but current information is encouraging. The Information Analyst is in the process of developing dashboards for GPs that can be accessed with Microsoft products alleviating the necessity for a separate desktop system. As the current contract with Mede expires on 30th September 2013, it is recommended that the one month’s required notice is given on this contract. Selection will then be taken forward on a risk stratification tool following demonstrations from a range of providers, including SLCSU and Mede, and the provision of costs. Members are asked to: Consider the options as laid out in the report & Approve the recommended Option 3;

Agree the use of resources freed up from Option 3 to acquire a risk stratification tool, as discussed on pages 4-5 of the report; and for the CCG to discuss with GPs the opportunity to use the balance of freed up resource for further practice support to develop QIPP linked to the quality agenda and provide additional benchmarking information in line with that already started by the Information Analyst.