PbR held back by NHS data failures

A new report into the progress of Payment by Results (PbR) has concluded that problems with the quality and timeliness of data remain significant barriers to the policy having more impact on NHS activity and efficiency.

The Audit Commission report, The Right Result,singles out the Secondary Uses Service (SUS), developed by NHS Connecting for Health and since handed over to the NHS Information Centre (IC), as failing to deliver the information PCTs need for PbR.

The report says: “Limitations in the infrastructure underpinning PbR, such as information systems… partly explain why PbR has not had more impact on activity and efficiency.” It also says there is much to be done to improve data quality.

NHS organisations are said to lack confidence in SUS and believe it unable to provide the support PCTs need for contract monitoring and payment under PbR. To compensate, many NHS trusts have developed local systems to give them the data they need.

Criticism is made of the timeliness and quality of data available to PCTs through SUS for monitoring contracts and making payments under them, said to “need significant improvement.”

The report says: “Without timely access to accurate data, the NHS will not be able to account for activity performed, ensure provider payments are accurate, or indeed commission the right services. However, providers and commissioners report that the poor performance of SUS has been an obstacle to timely and accurate data provision.”

The SUS system is based on automatically extracting activity data from trust systems into a national database, which is then meant to pump cleansed data back to NHS service providers and commissioners, with the data providing the basis for monitoring contracts and payments.

The Audit Commission reports that these criticisms are contested by the IC: “It argues that timeliness of data and its processing is the responsibility of providers and that criticism is being inappropriately attributed to SUS.” The IC argues that NHS bodies’ criticism of SUS is unfounded as local systems should still be used for contract management and billing.

The report states: “There are several perceived limitations with the Secondary Uses Service, the NHS’s primary data source for commissioning and payment purposes. These include unworkable deadlines and a perceived lack of national accountability, both of which need to be addressed.”

It recommends that the current failings of SUS in supporting PbR should be urgently reviewed and addressed “ensuring there is a clear vision for NHS data and organisations’ responsibilities that is shared by NHS Connecting for Health and the Information Centre for Health and Social Care, and that expectations of the NHS are consistent with this vision.”

For NHS acute providers, one of the central recommendations made is that they should: “Ensure that robust information and reporting systems are in place that meet all internal and external requirements within the minimum reporting deadline of 30 days following the end of the month, and that local information systems are in place to complement SUS as necessary.”

The Audit Commission report says that as well as improving SUS there must be investment in local information systems, with particular focus on systems to capture and report on community services and support the development of an appropriate payment mechanism.

The report concludes: “Regardless of where the limitations lie, there is a lack of clarity among NHS bodies about the accountability of NHS data provision, including data definitions, standards and the collection and ownership of SUS, and the respective roles of Connecting for Health (formerly NPfIT), the IC and the DH.

“While these bodies argue that the dichotomy between PbR policy and the technical aspects of SUS is not understood at the local level, the perception of NHS bodies at the frontline is that failings are attributable to SUS and accountability needs to be taken somewhere to improve the system.”