Units of value

There is something about commissioning support units that sometimes puzzles Derek Felton. “If I go to a CSU and say: ‘I need help with unscheduled care’, I just don’t get it when they respond by asking me how much analytics I want. I want them to solve my problem.”

Felton, a former NHS director of information and now executive director at EY, argues that the first approach is about selling a standalone informatics service: the second is about directly addressing customers’ needs through an integrated commissioning solution.

Time to think differently

Felton, who will speak at EHI Live 2014 next month about the progress CSUs have made so far and their future prospects, uses an analogy to hammer home his contention. “You don’t order a conservatory and then get asked how many screws you will need and what length they should be.”

He argues that the distinction between being service-centric or customer-centric organisations is critical to the future viability of CSUs. Also, that for many organisations it marks a step up from primary care trust-days, when the informatics function was seen as a discrete discipline, generating formulaic reports on past activity.

To be successful, Felton argues that CSUs will need to combine informatics with functions such as finance, workforce and change management to offer clinical commissioning groups a complete and flexible solution to their problems.

Getting to understanding

His thinking appears to chime with that of Dr Amir Mehrkar, chief clinical information officer for information sharing with NHS South CSU, another speaker at EHI Live.

He describes his role as that of a mediator between the CSU and the IT leads at the eight Hampshire CCGs it works with; able to keep in close touch with the needs of the IT leads and to interpret and explain those needs to the CSU.

He says: “Any successful health IT company will have a medical director, so it makes sense for CSUs to have that internal clinical representation too.”

Sylvia Tute, chief information officer with NHS Central Southern CSU, also emphasises the importance of building a partnership with CCGs. She says her CSU has gone from a “tense” situation when commercial relationships were first negotiated to a much closer understanding.

“It really is a partnership and we have been very appreciative that our CCGs have worked that through with us and that we still continue to work on that.”

Andy Kinnear, director of informatics and business intelligence at South West Commissioning Support Unit, says his CSU is also starting to work in a more joined up way. He adds: “For example, we’ve created delivery teams for each of our major CCG customers.

“So on something like the acute commissioning challenge, we’ve got teams led by a delivery director and made up of other professionals – including contract managers and commissioners, people doing data processing and high end statisticians.

“In addition to that, they have some central functions they can draw on. Those teams are then wrapped around the problem rather than being isolated within their disciplines.”

Thinking fast and slow

Felton also contends that CSUs need to be more agile and to make greater use of lower-tech solutions to win CCG custom. He suggests, for instance, that they should employ analysts that can travel to a CCG and work with it immediately on a problem; rather than spending months investing in a data centre before work can begin.

He adds: “Organisations can have the most sophisticated data warehousing; but maybe that’s not agile enough to meet the demands of a portfolio of customers across the country.”

Dr Mehrkar agrees that some of the most powerful interventions a CSU can offer may be about bringing people together around a table and helping them to find rapid solutions. “A good CSU will break down barriers,” he says, rather than always starting with the more glamorous, long-term investment initiatives.

By way of a local example, he says a current, critical issue is that GP free text information does not flow freely between GP supplier systems and shared care records, such as the Hampshire Health Record that his area has been building since 2005.

He says: “GP data controllers must be given 100% complete control to decide how best to use that free text data to serve their parents.

“We must have suppliers engage quickly with shared care record suppliers and release this in weeks not months’ and years' time. CSUs have a critical role in leading that conversation, but we don't need months of discussion: turn it on and send it.”

Predict and supply

A third key element that Felton’s identifies as critical to a CSU’s success is the ability to identify the value for money of the information services they offer. He says the “holy grail of commissioning” is for CSUs to be able to help CCGs predict what return on investment will be delivered from alterations to the way care is provided.

Kinnear concurs and argues that the key performance indicators built into contracts between CCGs and CSUs are really “the least important measure” of value for money. Demand and capacity modelling that help CCGs to deliver strategic change are the real prizes.

Tute adds: “The NHS has never been very good at describing what it is that health intelligence did and looking at outcomes and outputs rather than input but we are taking steps and I think that is an area where the private sector can help us.”

Finally, Felton wants CSUs to deliver a service that is closely in tune with the priorities of individual CCGs rather than offering a one size fits all solution.

Put all this together, and Felton’s suggestions may seem quite daunting for CSUs trying to survive in a changing landscape. But he is optimistic that they are achievable, and that CSUs can secure a place for themselves.

 “Across a CSU they have the skills,” he says. “It just needs to be a partnership between the analysts and people who can interact and engage with customers and tell the stories.”