NHS Data – which one are you, again?

© Matthew Collingwood Dreamstime.com

Last week’s news that the NHS has saved £6.1 million by removing about 95,000 ‘ghost patients’ from its GP lists sounds impressive, but it only exposes the tip of the iceberg.  Removing these outdated records from GP lists is a step in the right direction, but there are other pressing reasons why a concentrated clean-up of patient data is needed.

The quality of data supporting the NHS has been poorly controlled for years and now that healthcare information is beginning to be shared between care providers the true extent of the issue is set to be highlighted.   With NHS Trusts under relentless pressure to measure and publish quality outcome indicators and with the increased accountability that directly affects their budgets the need for clean, accurate and accessible data is more important than ever.

To enable health care providers to identify which patients they are actually treating the NHS maintains its Personal Demographics Service (PDS).  The PDS is where data on every recorded NHS patient is held; it’s used by hospitals and other care-providers as the most up-to-date repository of patient identity available.  However, matching the details a patient has given about who they are against the hospitals own database and then verifying with PDS is not always straight forward.

If patient A is recorded in one database as living on ‘Salisbury Road’, and on another database as living on ‘Salisbury Rd’ then to a computer you have a failed match and there is an error, whereas to a human user the records are clearly the same and perfectly usable.  However, where the flow of information is electronic, and interpretation performed by computers the situation becomes very much more polarised and a minor error can lead to the failure of the referral mechanism, resulting in a patient being unable to book treatment, or to unknowingly receive treatment under a separate identity.  Such situations are often propagated as treatment staff, having recognised registration problems, will often not have the authorisation to make the changes needed.

It is not surprising then that A&E departments find themselves treating unknown or non-NHS patients which results in the hospital not being able to claim back the cost from the Department of Health.  As part of the NHS Reforms hospitals will become reliant on their own income to fund treatment.  Without being able to verify who they are treating, hospitals will lose out to “ghost patients” and “health tourists” meaning they won’t be paid and won’t have the cash available to maintain their service levels. It is vital to address wider data quality issues now, before the Reform Bill changes the NHS beyond recognition.

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What’s wrong with Special?

All the Same

© Alexey Lisovoy | Dreamstime.com

I’m at a loss to explain it…why is this government working so hard to eliminate anything that is different?  Same old, same old, seems to be their template for the future.

Once we Britons were known for our originality, if not eccentricity, and we provided the World with thousands of innovative inventions that have shaped everyone’s lives.  We’ve always celebrated “the different”… be that people or things…and these islands have always been home to the special, the unusual and the anomalous.

Now “anomaly” is spoken of as equal to wrong or unfair…something that must be wiped out or at least ignored.  It is becoming “the norm” for Government to seek out and dispose of anomalies.  As evidence I cite:

The Pasty Tax – said to remove an anomaly in the application of VAT on hot food but which puts up the price of the workers’ lunch.

The Heritage Tax – the chancellor says this will avoid the anomaly of not having VAT on repairs to old buildings, but zero tax encourages the owners of listed buildings to keep them serviceable for the Nation.

The Abolition of the 50% tax rate – the chancellor believes that everyone should have the same top rate.

I suppose these instances have highlighted the current trend to make everything the same…and the Government would probably argue, make things fairer…but then a state where everyone is the same and there is nothing worth striving for is surely the life of a drone?

This is not a new situation, though…just look at the way we run junior school sports days (no winners or losers), allocate university places (by quota) and fill jobs (by quota).  We are on the road to everything of equal value…and with it…mediocrity.

NHS Bill – the devil’s in the detail

Last month I commented that the NHS Bill risked losing hearts and minds and drew some parallels with the way differences of opinion on NHS reforms have been handled in the past, that is, by just ignoring them. Well, the reality is now upon us and whether we like or not, the thing is signed.

Many of the arguments against the Bill have been deeply emotive with health sector groups denouncing the Bill with evangelistic fervour…an ideal scenario if you want to dilute and detract from the smaller voices warning that the Bill is privatising health care by the back door. If you’re wondering whether this is the case or whether I am just scaremongering, then maybe it’s worth considering that this Bill has been ushered hastily through at a time when surveys show record levels of satisfaction with the NHS.
Being a “business person”, you’d think I would see the sense in privatisation and in most markets I can, but how can directors of private companies put patients first when their statutory duty is to put shareholders first?

These questions are the ones that generate a most unhealthy response in me:

  • Once hospitals are forced to take the Foundation route, they become independent of government and subject to GATT rules (showing my age) and EU competition. What will happen to them should they start to fail?
  • What will happen to the supply contracts currently in place with NHS orgainisations that are being scrapped? We’re talking about everything from cleaning to catering to IT and building maintenance. Will they be novated?…or worse, who’s left to manage the suppliers?
  • Even before the bill was passed, we had an example in Hounslow where the new GP consortium has appointed a multi-billion dollar American company to vet patient referrals according to a set of rules. How is this improving patient choice?
  • What happens when GPs start running out of money to commission services? If I should suddenly get ill in March, would I have to wait until the new financial year in April until I get hospital treatment?
  • Where will the 1 million staff work whose jobs are set to be privatised by 2014?
    Most patients do not see GP practices as private sector organisations, but they are, and at least in the past we have had referrals to hospital staff to provide treatment for the patient independent of profit considerations.

This Bill will take that safeguard away…and personally I would rather be treated by an NHS not-for-profit organisation than a “multi-billion dollar American company”.