EHI interview: Andrew Fenton

Clinical commissioning groups should be looking to their commissioning support units to supply a “golden thread” of information and technology to support their work, the EHI Information for Commissioning conference will hear.

Andrew Fenton, associate director for commissioning support (Berkshire) at NHS Central Southern Commissioning Support Unit, will set out why and how he believes CSUs can deliver significant benefits for patient care and help CCGs meet their financial challenges.

He says that ‘golden thread’ can take in delivery of information technology aiding direct patient care, interoperability, dashboards, the use of anonymised data to procurement to support outcomes based commissioning plus methods to collect clinician and patient feedback.

He adds: “I am not suggesting that there is one single innovation that will make all the difference but CSUs can help local health systems put all these things into place if they haven’t already got them.”

Off to a difficult start

CSUs were created by the Department of Health to provide IT, data collection, warehousing and analysis services, HR and commissioning support to CCGs when primary care trusts were scrapped at the end of March this year.

The idea was that CSUs could provide a vehicle for retaining expertise that PCTs had built up and that CCGs might want to tap into.

However, they came with a proviso that CCGs would be able to choose whether to buy services from their local CSU, a more distant CSU, or not use a CSU at all – in which case, they might build up service in house or buy from another NHS organisation or the private sector.

The DH originally estimated that between 25 and 26 CSUs would be established, but the number has now fallen to 18, with a couple collapsing very close to their 1 April start date or almost immediately after it.

CSUs are hosted by NHS England but are expected to become free-standing organisations by 2016 through a period of ‘externalisation’.

At that point, they will be expected to compete in a wider market of commissioning support services the NHS CB wants to create, or to be taken over by other organisations.

Research by EHI Intelligence earlier this year found that the vast majority of CCGs are expected to use CSUs this year and that CSUs at least have the potential to become stable and influential players.

EHI Intelligence estimates that they will employ 8,700 staff and have a total budget of just under £670m.

Fenton believes that a first target for CSUs might be to deliver links between information systems. This would include messaging for discharge summaries, laboratory and radiology results, A&E attendance reports, and so on.

“It’s about improving the information flow and integrating it into primary care to strengthen the immediacy of information at that level,” he says.

Lots of projects underway

The next development that CCGs can expect from CSUs is work on interoperability. Fenton cites the just launched Oxfordshire Care Summary as an example of this kind of work.

Currently in its first phase, the summary provides a view of selected data from primary care, the acute sector and community and mental health for relevant health professionals; and has been designed to provide a scalable platform for other providers.

He adds: “A CSU may have the capability to do it themselves, even if it would involve additional funding outside the core service agreement.”

Another technology must-have that Fenton believes CSUs can provide for CCGs are urgent care dashboards that supply an almost real-time view of patient data.

“That information can inform the immediate actions of commissioners and be used by primary care providers in managing their patients.

Dashboards bring in acute and out-of-hours information and could eventually integrate data from [non-emergency care service] NHS 111 as well.”

From here, Fenton moves on to how CSUs can look at anonymised data and its use for benchmarking, forecasting and risk stratification. He argues that by harnessing these tools effectively CSUs can support CCGs on outcomes-based commissioning.

He adds: “CSUs can’t take the strategic decisions but they can facilitate them and provide support with areas such as working with the commercial sector and procurement.”

A good future within reach

Like many CSU staff, Fenton has come from a PCT; he was chief information officer with the NHS Buckinghamshire and Oxfordshire cluster.

He recognises that clinical commissioners might have concerns about CSUs being like PCTs and not sufficiently customer-focused. But he argues that CSUs can build on their history, while still striking new directions for the future.

“They will know the commissioning agenda locally – what the priorities are – and they can provide support to inform and develop those priorities, tailoring their specific focus to an individual CCG or a group of CCGs,” he argues.

For example, he says some CCGs might want to develop methods for collection of concerns about NHS services from clinicians; something that has become particularly pertinent in the wake of the Mid Staffordshire NHS Foundation Trust scandal, where early concerns about death rates and care became mired in arguments about data.

His CSU has worked with some of its CCGs customers to use Datix patient safety software to record concerns. The aim is not to use the information for the resolution of any individual incident, but to enable the identification of patterns of concerns; which might then be used in the contractual relationship for service improvement.

Fenton adds: “It is about crowd-sourcing the intelligence. Because the Datix software is web-based it provides quite a good system for gathering intelligence from local experiences.”

From the patient perspective, the NHS Buckinghamshire and Oxfordshire cluster has been using Talking Health web-based patient engagement tool, which is now being managed by Oxfordshire CCG.

The system has registered 2,500 users and single consultations have attracted more than 800 responses when previously the average would have been about 100.

Central Southern CSU is directly supporting Berkshire CCGs with the same patient engagement platform, using Inovem’s web-based Collaboration software.

Grasping the opportunities

Fenton recognises that the big challenge for NHS CSUs is to demonstrate that they can move beyond being the providers of backroom support for transactional services to delivering added value and impact to the role of clinical commissioning groups. It is a challenge he believes CSUs can deliver on.

Information for commissioning box: First line: Andrew Fenton will be speaking at Information for Commissioning, EHI’s new show devoted to the IT and information needs of clinical commissioners and their support organisations.

Andrew Fenton will be speaking at Information for Commissioning, EHI’s new show devoted to the IT and information needs of clinical commissioners and their support organisations.

To see the full programme and to book a place, visit the Information for Commissioning website. For information about exhibiting, contact Neil Hadland.