MIAA's Managing Director, Chris Harrop explores how healthcare data demands stepping beyond the obvious, exploring systemic issues, and embracing collaboration.

A few years ago, before Covid, I delivered a presentation to a group of Directors of Finance on how data and the triangulation of well known data sources, could lead to opportunities to optimise patient care and to generate financial savings.

The metaphor I used related to picking blackberries. I’ve always been a keen blackberry picker (maybe it’s the Yorkshireman/Accountant in me that just loves something for nothing) but the key thing is this; You don’t get the best blackberries if you stay in your comfort zone and only pick the ones you can easily see or reach. No, to the get the best blackberries, you have to get in amongst the blackberry bush, you’ve got to risk getting scratched and getting dirty and most importantly, you’ve got to get as many views and different perspectives to optimise your haul!

The example I used back then in 2018 was in relation to Gastro data published in both Model Hospital and Right Care data sets. Viewed in isolation, the Model Hospital data could easily be used to demonstrate how efficient and cost effective a secondary care service is (e.g. high patient throughput, low unit costs), however, when viewed in conjunction with Right Care data, a different hypothesis might be formed – is a high level of referral to hospital and high throughput a good thing? Shouldn’t we be looking at a whole system solution to address root causes, lifestyle issues and more effective out of hospitals options for care/treatment? This led to us supporting some of our local places by implementing a place-based approach to savings and efficiency planning.

Fast forward to today and the efficiency/cost effectiveness challenges have multiplied since pre-Covid days and will not abate anytime soon.

Our work in MIAA has led us to being involved for several years in All Age Continuing Health Care (AACHC) and in particular, Fast Track packages of care. Once again, this has required us to get in and amongst the data and the focus of this article is to share our thoughts and ideas on how current data sets might be used/reviewed to better effect and some ideas regarding additional data sets that colleagues in every system would find useful to optimise care and to ensure improved cost effectiveness.

1.   Understand referrals into Fast Track

In our experience, referral rates and numbers can differ significantly Place to Place, ICB to ICB. Typically, though, these referrals will originate in the main from either an acute hospital or a community nursing service. All referrals must be reviewed and either accepted or rejected within a 48-hr period and in almost all cases, the referral is accepted by the CHC team.

In some of the ICB regions we work in, Fast Track cases are costing the ICB in excess of £1m per week, yet in neighbouring regions, the figures are half that. We should all be curious to understand what the reasons and drivers of Fast Track demand really are, what can be done differently, and how can this be sustained as it appears to be in other ICB regions. This requires all parts of the Place to work together to understand, own the problem collectively and work on more sustainable pathways to optimise care and value for money.

2.    Report the number and proactively influence overdue Fast Track reviews

This is not currently a mandatory KPI and often isn’t reported in ICBs. In our experience, most ICBs have Fast Track cases that have not been effectively reviewed at or before 12 weeks from inception. In many cases, we have found that half of the reviews found that the person was ineligible for a Fast Track package and their care was not optimised.

3.    Compare Fast Track caseload numbers vs Fast Track referrals

If referral rates are flat or growing slowly, yet the total volume of Fast Track cases is not reducing, this raises questions regarding the review process and whether we could be more proactive in managing our Fast Track cases.

4.   Compare the cost of Fast Track packages

This should be undertaken both within an ICB (between each Place) and with other ICBs/Places. Not all Fast Track costs are the same and this could help in understanding the service contracts that are in place and how these are being set and managed to ensure value is optimised and the package of care remains the right one for the person.

5.   Understand the ongoing impact of Fast Track Reviews to the rest of the Place

As an integrated system, we need to fully understand the impact of every action we take on our system partners. In this scenario, we must understand if there is an impact for local authorities or other health services in transitioning people from a Fast Track package to something different.

In summary, there are a wealth of data publicly available and published frequently regarding AACHC, but viewed in isolation, these data may not unlock the key to some of the thorny (blackberry reference once again!), challenges we face.

The questions to ask in your own organisations are:-

• Are we considering all data? (even if these don’t form part of NHSEs suite of published indicators.)
• Are we confident that we have robust systems in place to track all our Fast Track patients over time as a hospital provider would in respect of Referral to Treatment targets?.
• Are we confident that we have the right skills and capacity to effectively manage the commercial contracts that are associated with Fast Track cases? (in some regions, this can amount to almost £70m per annum and requires the appropriate time, resources and focus to ensure effective control.)

At MIAA, we are passionate about our role in helping improve services, improve patient care and in making sure we optimise value for money.

If this article has raised any questions or you’d like to discuss this subject further, please get in touch. We are keen to speak with organisations that would like to work with us by sharing their data and helping us co-produce and deliver sustainable changes.