Knowledge Matters Volume 2 Issue 4

Knowledge Management Team, South East Coast Strategic Health Authority knowledge.management@southeastcoast.nhs.uk nww.sec.nhs.uk/knowledge

October 2008 Volume 2 Issue 4

INSIDE THIS ISSUE

Welcome to Knowledge Matters

2

Hello and welcome to another fact-packed edition of Knowledge Matters!

Clinical Quality Dashboard

3

18 Weeks Tools

4

PbR Benchmarker

5 6

Making links – Knowledge & Library Services Skills Builder –Funnel plots

8

The Improvement System

10

A3: Ask an Analyst

11 12 13 14

World Class Commissioning KM Page from the Patch The 4 C’s……..

Simulation & Modelling the RIGHT Way Clinical Metrics Development Update

15 News and updates 16 Quick Quiz

By Samantha Riley

I’d like to start by welcoming a new member to the team. Charlene AtcherleySteers joined the team on 13th October as Performance Analyst having graduated this year from the University of Kent. We hope to learn from Charlene and Nia’s recent experience of joining the NHS with ‘fresh eyes’ to inform the development of a formal induction and training programme for analytical staff. I hope that this will encourage local organisations to appoint individuals with a broad range of analytical backgrounds outside of the NHS. This year, a number or organisations within South East Coast have hosted graduate placements (including ourselves).

Next year, I am keen that we attract more graduate placements and will be contacting organisations over the coming weeks to explore opportunities that may be available.

I am pleased to announce that the Health Informatics Career Framework has now been launched. The framework has been designed to facilitate structured career progression for health informatics staff. Health Informatics covers a broad range of roles including knowledge management, information management, ICT staff, health records, and clinical coding. We will have an article on HICF in the December issue of Knowledge Matters, if you can’t wait until then here’s the link to the website http://www.hicf.org.uk/ Continuing the careers theme, applications are now being accepted for the Informatics Graduate Training Scheme. This scheme has been piloted in the north of England and is now being rolled out across the country. The Graduate Scheme covers two years and combines work experience over a series of placements with an education and development programme. The closing date for applications is 28th November 2008 and details can be found on the following website. http://www.nhsleadtheway.co.uk/ A range of new tools and dashboards have been developed over recent months.

We have articles on a number of these in this edition. In addition, the Programme Budget Comparison Tool has been updated to contain three years of data to enable more useful comparisons to be undertaken. This tool is available to download from the website and further details can be obtained from Simon Berry. Simon has also developed a Length of Stay HRG Benchmarking Tool (see page 15) which we hope will be useful to both Commissioners and Providers.

Fascinating Fact Did you know that 1,432 people have joined the Facebook group “Proud of the NHS at 60"?

You will I am sure be pleased to hear that we are in the process of constructing the 2008 Knowledge Matters Christmas Quiz. As always, there will be prizes to be won, so start swotting up on back issues of Knowledge Matters! We can’t have Damon taking the crown for a second year in a row!

As always, please do contact me if there is anything I can help with!

Samantha Riley

Knowledge Matters

Page 2

Clinical Quality Dashboard

By David Harries

Over the past few months, I have been working on the development of a clinical quality dashboard which attempts to provide an overview of the quality of clinical care across Acute Trusts in NHS South East Coast.

David Harries

The dashboard builds on and complements several strands of work currently underway within the SHA looking at a variety of clinical indicators for use by NHS South East Coast in order to inform the Board of clinical quality within the region. This includes work the Clinical Metrics Development Programme (focused on stroke and dementia) and the Safer, Smarter Nursing Metrics Programme (which you read about in the last issue of Knowledge Matters).

Whilst the Department of Health has collaborated with the Institute for Innovation and Improvement to develop a greater understanding of the potential use of clinical indicators, it has not, as yet, developed a national set of indicators for use by SHAs. The work carried out by South East Coast SHA is therefore highly developmental and is very much a pilot exercise in testing the appropriateness of such a dashboard.

To maintain the usability and visual impact of the dashboard we have selected only ten indicators. It is important to recognise that these are only a small selection of indicators which we are using to provide an overview of the quality of care provided by a Trust. It is important to both consider the context of these indicators and the wealth of additional indicators which could be reviewed when interpreting the data and making comparisons between Trusts.

The five domains of quality are: effectiveness, efficiency, safety, patient experience and timeliness. As a result, clinical indictors from each of these areas have been identified to encompass all of these aspects in an effort to give a rounded view of service quality in the South East Coast.

Clinical Quality Dashboard Select Trust from drop down list Estimated rate of MRSA bacteraemia reported per 10,000 admissions 250

12.0

Trust SHA YTD limit

10.0

300

Incidence of Catheter Associated UTIs per 10,000 Bed Days SHA

90% 80%

2.0

70%

200 1.5

150

60%

150

6.0

Hip Fracture repaired <48hrs (%) 100%

2.5 Trust

250

200

8.0

50% 1.0

100

40%

100

4.0

30% 50

0.5

50

2.0

20%

Trust

M

J

J

A

S

O

N

D

J

F

2005/06

2008-09

Estimated rate of C-Diff cases (aged 2+) per 1,000 ordinary admissions (attributable to Trust) 4.5

2006/07

SHA

2004/05

2007-08

12

2005/06

80

2006/07

2007/08

2004/05

2005/06

2006/07

2007/08

Patient satisfaction: Overall Score (HCC patient survey 2007)

Incidence of Pressure Ulcers per 10,000 Bed Days

Trust

6.0

60

Local Stretch National Limit

3.0

2005/06

England best

England worst

5.0

Trust (YTD)

3.5

2004/05

100

70

10

SHA

0% Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4

2006/07 2007/08

Rate of drugs, medicaments & biological substances causing adverse effects in therapeutic use per 10,000 episodes

Unplanned readmissions <28 days (%)*

Trust

4.0

Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2

AMJJASONDJFMAMJJASONDJFMAMJJASONDJFMAMJ

M

better ->

A

0.0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

0

0

Trust

10%

SHA 0.0

8

4.0

50

2.5 6

40

%

3.0

2.0

30 2.0

20 1.0 Trust

A M J

J

A S O N D J 2008-09

F M

0 AMJJASONDJFMAMJJASONDJFMAMJJASONDJFMAMJ 2005/06

2006/07

SHA

0

0.0 Q1Q2Q3 Q4 Q1 Q2 Q3Q4Q1Q2Q3Q4 Q1 Q2

2007-08

2004/05

2005/06

2006/07 2007/08

Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4 2004/05

2005/06

2006/07

2007/08

Q'tion 71

SHA

0

Q'tion 70

Trust

10

0.0

Q'tion 69

2 0.5

Q'tion 68

1.0

Q'tion 67

4

1.5

<-worse

An important caveat to note is that a number of these indicators are based on SUS data. We know that that there is variation in the accuracy of note taking by clinicians and subsequent coding by coding staff. It is not known how consistently and accurately coding maps the clinical notes. Increased depth of coding does not necessarily obviate this.

Rate of complications of medical and surgical care per 10,000 episodes

Risk-adjusted mortality- all admissions

Q'tion 66

Although there are a number of caveats that need to be considered around the individual indicators, the dashboard should provide clues to the quality of care and focus attention on variations in outcome that may have otherwise remained undetected. It may also highlight potential examples of good practice.

In many cases this will vary between Trusts and can partially account for observed differences in rates etc.

Additionally, Trusts have different reporting cultures and recording of incidents such as drug errors will vary accordingly. It is important to therefore interpret any major differences between Trusts cautiously. Further information and local discussion is likely to be required prior to firm conclusions being drawn. The dashboard is intended to be used as a general indicator of quality for each Trust to prompt discussion â&#x20AC;&#x201C; the health warnings outlined in this article need to be taken on board when drawing conclusions from the data.

Further details of the caveats applicable to individual indicators which should be considered when interpreting the clinical dashboard are available within the note that accompanies the dashboard.

If you have any queries regarding the dashboard please do not hesitate to contact me (01293 778844 or david.harries@southeastcoast.nhs.uk). The Clinical Dashboard will be updated on a quarterly basis and is available to download from the Knowledge Management website: http://nww.sec.nhs.uk/knowledge Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Page 3

New 18 weeks tools

By Rebecca Owen

18 weeks continues to be one of the highest performance priorities for the NHS and for 2008/09.

With this in mind, three new 18 weeks dashboards have been developed to look at Commissioner and Provider performance both on a weekly and a monthly basis.

1. Monthly Commissioner Dashboard

Rebecca Owen

The monthly dashboard aims to look at not only overall 18 weeks performance but also the activity behind 18 weeks.

There are 2 dashboards within this: The Primary Measures dashboard looks at 18 weeks performance measures and includes charts on overall performance, T&O performance, incomplete pathways, data completeness, direct access Audiology performance and mean waiting times for diagnostics and 18 weeks. Actual performance is measured against Vital Signs plans or national targets. Data can be viewed for an individual PCT or at an overall South East Coast level and it is also possible to see a provider split within each PCT.

The Secondary Measures dashboard looks at the underlying activity measures including total waiting list size, activity levels for outpatient attendances and elective admissions, diagnostic activity and the ‘shape’ of the clock stops for each month (how many patients waited in each of 5 time-bands before treatment). This dashboard aims to look at activity trends to assess if 18 weeks is being achieved in a sustainable way.

2. Weekly PTL Dashboard The weekly dashboard uses data from the Weekly PTL return to produce a performance management tool for both the SHA and Commissioners. Key metrics from the PTL are charted over time (18 weeks performance, total PTL, total backlog and additions to backlog). Additionally, the charts show where organisations should be for their position to be sustainable – total backlog should be no more than 50% of the weekly ready reckoner, additions to backlog no more than 10% and patients already waiting 10-18 weeks no more than 1.5%.

Both Commissioner and Provider views of the data are shown and a Provider split is given within the Commissioner dashboard for each PCT – this shows all main providers, not just those within South East Coast. The dashboard is updated each Monday with data from Unify.

3. Diagnostics Dashboard The 0809 Diagnostics Dashboard collates information from all of the diagnostic returns and shows data from the quarterly diagnostic census, the monthly DM01, the monthly Audiology Direct Access return and the weekly Audiology PTL. With the exception of the Census, which is a Provider only return, both Provider and Commissioner views are shown.

The Diagnostic Census and DM01 charts look at patients waiting over 6 weeks for tests; the Audiology charts show 18 weeks performance (number of patients seen within 18 weeks).

All of these dashboards are available via the Knowledge Management website in the 18 weeks section within downloads. You will need to be a registered user and logged in to access these. If you have any queries about the dashboards, please do contact me (Rebecca.owen@southeastcoast.nhs.uk or 01293 778832) Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

Knowledge Matters

Page 4

A, 3: ASK AN ANALYST PbR Benchmarker

By Howard Davis, PbR Benchmarking Manager, Audit Commission As part of the PbR Data Assurance Framework the Audit Commission has developed a robust and sophisticated benchmarking methodology. This benchmarking has been developed into an online tool called the National Benchmarker which allows commissioners and providers to undertake their own investigations, encouraging selfmonitoring and helping Trusts to identify issues independently of clinical coding audits.

The benchmarker uses SUS data and is based around 42 separate data quality indicators. The analysis uses indirect standardisation and funnel plots to ensure the process of identifying outliers is as representative and equitable as possible. This is driven by a data warehouse containing over 1 billion records – representing the largest and most complex dataset ever compiled by the Commission.

The indicators focus on clinical coding and PbR specific issues, covering both admitted patient care (inpatients) and outpatient activity, and range from general tests to focused indicators. Key functionality is split into two tools: Scorecard Viewer • Each Trust has a scorecard that combines the results of our indicators to create a score for each HRG, HRG chapter and specialty at that trust; • A headline report allows quick access to areas of interest; • Drill into the scorecard to view each indicator’s performance; • Brand new functionality allows you to view the results in a technical or non-technical manner.

Data Explorer • Allows you to analyse any one of our 42 indicators over a two-year period to identify trends or unexpected changes at a selected Trust; • Presented in a manner that allows you to easily spot the outlier; • Drill into the data to investigate further, or use our context switching to move between indicators to identify any causal relationships.

The tool is updated on a regular basis and is currently updated to the end of May 2008.

Access to the National Benchmarker is free to the NHS. To gain access you need a log-in to the PbR Assurance Portal – once you have logged into the tool there are no restrictions on the analysis. To request a log-in go to www.auditcommission.gov.uk/pbr For more information contact Howard Davis, PbR Benchmarking Manager, at h-davis@auditcommission.gov.uk.

Want to see a demo of the system?

A demonstration of the PbR Benchmarker has been arranged for Monday 17th November between 11am and 2pm. The venue is the Surrey and Sussex Room at the offices of NHS South East Coast at Horley. Places need to be booked by emailing knowledge.management@southeastcoast.nhs.uk PCTs and Trusts are welcome to attend. Places are limited so book your place now! Bring along a sandwich as unfortunately lunch cannot be provided.

Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Page 5

Making Links – Library & Knowledge Services Louise Goswami, Head of Library & Knowledge Services Development, South East Coast SHA Louise Goswami

The Kent Surrey and Sussex Library and Knowledge Services Development Team (KSS LKSDT) aims to improve the quality of patient care by ensuring that the whole NHS workforce has access to appropriate knowledge resources and the skills to use them.

The Team works with the South East Coast SHA and the KSS Deanery to lead the future vision and strategic development of library and knowledge services. This ensures that they respond to and meet the knowledge, skills and resource needs implicit in current and future National Health Service (NHS) policy and objectives.

The LKSDT: • • • • •

Provide strategic and professional leadership to the SHA and library staff and services; Ensure the necessary infrastructure is in place to underpin collaborative practices; Uphold standards to minimise fragmentation and inequality of services; Offer impartial professional advice on library and knowledge services development to NHS organisations in Kent, Surrey and Sussex; Provide and manage an appropriate and cost effective mix of electronic and paper resources.

KSS LKSDT leads a managed network of collaborative healthcare libraries that are multi-organisational and multidisciplinary. A single Trust library service typically supports all staff in its surrounding health economy, including Primary Care Trusts (PCTs), Mental Health Trusts and Ambulance Trusts.

Library and Knowledge Services empower: • Clinical governance; • Evidence based patient care; • Workforce development; • Commissioning and health policy decision making; • Lifelong learning; • Research and development; • NHS knowledge management.

Here’s the link to find your local Library Service: http://www.library.nhs.uk/mylibrary/default.aspx Library and Knowledge Services have a key role to play in supporting the World Class Commissioning agenda.

The National Library for Health have developed the Commissioning Specialist Library (CSL), which aims to be a one-stop shop, providing timely and efficient access to high quality information resources for all those involved in commissioning for health and wellbeing. http://www.library.nhs.uk/commissioning/ Locally Library and Knowledge Services have been actively involved in the work of the WCC Knowledge Management Competency. They can work with PCTs to support commissioning in a variety of ways: • • • • •

Develop a knowledge management strategy; Undertake literature searches for evidence and best practice; Provide a comprehensive enquiry service; Provide current awareness services; Enable PCT staff by providing a programme of Information Skills training which covers all aspects of information retrieval and critical appraisal. Staff will be equipped with the skills to: • Identify resources to find high quality, reliable health information; • Locate and retrieve evidence; • Critically appraise health research.

For further information and support please contact me - I’m here to help you! (louise.goswami@nhs.net) Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

Page 6

Knowledge Matters

Skills Builder – Funnel Plots Lots of you will have seen funnel plots and thought ‘wow – that looks great!’, but do you really understand how to interpret a funnel plot? If not, hopefully this article will enlighten you!

Funnel plots are a tool that comes under the banner of statistical process control (SPC). All types of SPC charts are plots of data relating to the system or process to be investigated, with a target value (often a mean) and control limits superimposed. A funnel plot is no different but the method of its construction means that it has a characteristic shape, which looks like a funnel turned on its side (see fig 1.). The main difference between a funnel plot and the familiar run chart is that it is used to assess variation between areas at a single point in time, rather than variation in a single process over time.

Funnel plots can be useful for comparing and benchmarking organisational performance at a given point in time, without resorting to ranking techniques or league tables, which can be contentious at the best of times! The technique could equally be used for comparisons between individual hospitals, local authority area or even individual GP practices or surgeons. In ‘Delivering Quality & Value. Focus on: productivity and efficiency’ the use of funnel plots was highlighted as a comparative tool for areas such as standardised admissions ratios for low priority procedures. The technique is also widely used in public health data analyses, for example looking at standardised mortality rates, screening coverage and readmissions.

The types of data most suited to funnel plot analysis are those that involve rates and ratios (e.g. disease prevalence rates or standardised mortality rates), proportions (e.g. percentages) and counts (e.g. count of admissions). Funnel plots are created by plotting an indicator (e.g. % cervical screening coverage) against a measure of its precision (e.g. size of eligible population) so if you want time series analysis, then an alternative approach would be best.

As an example, imagine we are trying to assess which organisations have the best and worst mortality rates for lung cancer. What can other organisations learn from the best and what factors might be affecting the worst? A funnel plot seems like a good idea, but what stops us from ranking the organisations based on their number of deaths? Well, firstly, a larger organisation will inevitably have a higher number of deaths, from any cause, because it will have a larger population to be affected. Secondly, there are factors such as deprivation, age profile and other points of demography that need to be considered, before the provision of treatment or preventative healthcare within an organisation with regards lung cancer can be questioned. The expected number of deaths (available from NCHOD) takes these factors into account and by comparing the actual number of deaths with the number of deaths expected we can see whether or not the count of deaths in each organisation is considered ‘normal’ rather than ‘exceptional’. By calculating the percentage variance of observed deaths relative to expected numbers and plotting each data point against the number of expected deaths, in conjunction with an ‘average’ of 0% (thus reflecting expected deaths) and control limits then the funnel plot looks like that in figure 1. The outer line of this particular funnel is 3 standard deviations. This means that it would be expected for approximately 99.8% of organisations to fall within this funnel.

There are two points to remember when interpreting a funnel plot: 1. Points inside the ‘funnel’ are considered to be subject only to natural or common-cause variation; 2. Points outside the ‘funnel’ are considered to be indicative of special cause variation.

These terms are common to all SPC charts. Common-cause variation means that the variation is within what we define as normal boundaries. The premise is simply that everyone is different but only a few are very different.

These ‘very different’ points are subject to special-cause variation, that is, that there is something unusual influencing the process or system that is being investigated which is probably worth following up.

Looking at the lung cancer deaths funnel plot detailed above we can see wide variation between organisations.

Figure 2 shows the funnel plot again with commentary indicating the major points of interest.

Generally speaking, most organisations are within the 3sd (standard deviation) ‘funnel’ and are therefore perfectly ‘normal’ and subject only to common-cause variation. The organisations of interest are those above and below the ‘funnel’. With this data, those points below the funnel indicate a lower number of deaths when compared to the expected, and those above, a higher number.

Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Page 7

Lung Cancer Mortality in Under 75s, 2004-06 +100%

Observed Deaths Relative to Expected

+ 80%

+ 60%

+ 40%

Data Average 2SD limits

+ 20%

3SD limits

0%

– 20%

– 40%

– 60% 0

100

200

300

400

500

600

700

Expected Deaths Source: Compendium of Clinical and Health Indicators, December 2007

Figure 1: Example funnel plot showing lung cancer mortality in the under 75s, 2004-2006.

Source: APHO Lung Cancer Mortality in Under 75s, 2004-06

Observed Deaths Relative to Expected

+100%

Cluster of points with exceptionally high number of deaths. Special cause variation.

Data

+ 80%

Average

+ 60%

2SD limits 3SD limits

+ 40% + 20%

Outliers. Is the data correct?

Try removing these from the analysis, are there are changes in the overall picture?

0%

Cluster of points close to the 3sd limits; are these worth investigating?

– 20% – 40% – 60% 0

100

200

300

400

500

600

700

Expected Deaths Source: Com pendium of Clinical and Health Indicators, Decem ber 2007

Majority of PCTs within the 3sd ‘funnel’, with a definite trend below the average. All these PCTs are subject to common-cause variation.

Cluster of points with low number of deaths, below the 3sd line. Special cause variation. Still tightly clustered and quite close to the line, are these worth further investigation? These are the PCTs from which good

Figure 2: interpreting the lung cancer deaths funnel plot.

This approach is a bit simplistic; there are clusters close to the 3sd lines and these might be just the extremes of common-cause variation. Therefore, a judgment call is required as to whether or not such points require further investigation. This brings home the message that tools such a funnel plot are just that; tools. They can aid decision making but are not a substitute for fully understanding the system or process being investigated.

Plotting a funnel plot can be tricky: check out http://www.apho.org.uk for some really excellent guides and templates in their Technical Briefing Series.

Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

Page 8

Knowledge Matters

The Improvement System – what is it?

Jill Turner, Director, NHS Improvement Jill Turner

NHS Improvement is a newly formed national improvement programme working with clinical networks and NHS organisations to transform, deliver and sustain improvements across the entire pathway of care in cancer, cardiac, diagnostics and stroke services.

Formed in April 2008 after a national review, NHS Improvement has brought together over eight years practical service improvement experience from the Cancer Services Collaborative ‘Improvement Partnership’, Diagnostics Service Improvement Programme, NHS Heart Improvement Programme, the longest running Improvement programmes within the NHS. The NHS Improvement System (www.improvement.nhs.uk/improvementsystem) is being developed by NHS Improvement to support service improvement work in cancer, cardiac, diagnostics and stroke. Virtually all of the tools provided are generic and will be of use to anybody involved with improvement work NHS Improvement has integrated and is now developing further the former reporting systems from the constituent programmes: • Cancer – BRIT; • Cardiac – RAPPORT; • Diagnostics; • (Stroke & Audiology – new).

A nationally unique system for reporting, monitoring and sharing knowledge to support service improvement across a range of specialties has now been created - NHS Improvement System Plans & Proposals In conjunction with NHS Improvement website www.improvement.nhs.uk, the System is the “shop window” for NHS Improvement and is now being developed further to meet the current and future service improvement requirements of provider teams, acute Trusts operational services, PCT commissioners and SHAs. Content As part of its project functionality, the system: • Acts as a central repository for project plans, reports etc; • Provides a place to store any measures and analysis used within the project; • Provides a place to record and share within the team, project development and logs; • Has the ability to share both locally and nationally and within and across multiple organisations, as the work progresses, any wider service improvement ideas and stories.

Once you have registered as a user of NHS Improvement and received your sign on details, you have access to a range of tools to help you in your improvement efforts.

In addition to gaining access to a wealth of tools, it is also possible to sign up for regular updates and newsletters from the areas that you are interested in.

A selection of the tools that you can gain access to appear on the opposite page. If you would like to learn more about using the tools, why not come to our demonstration session on Monday 17th November.

Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Page 9

Data Dashboards Interactive data dashboards showing 18 week referral to treatment and data completeness measures are available on the website. In addition, information on diagnostic performance analysed by Commissioner, SHA, Network and provider is also available. Note that this is a developing resource which will link 18 week data to improvement stories ensuring its value added and complementing rather than duplicating information available via NHS Comparators.

The Demand & Capacity Module • Allows you to record demand, activity, backlog and capacity data; • Can be used daily or weekly as an operational or retrospective tool; • Provides a visual and dynamic interactive dashboard monitoring tool; • Enables you to view a weekly summary of all departmental procedures and activities; • Provides a backlog monitoring and management tool; • Uses integrated SPC tools and a variety of other charting features to help you identify variation; • Automatically calculates the recommended capacity levels; • Helps you monitor your lost appointments; • Can be used by a novice and expert with the online support; • Is fully complementary with other service improvement methodologies.

Statistical Process Control Tool (SPC) To monitor, control and improve process performance over time by studying variation and its source.

How does the tool help?

• Focuses attention on detecting and monitoring process variation over time; • Distinguishes special from common causes of variation as a guide to management action; • Provides a tool for ongoing monitoring and control of a process; • Helps improve a process to perform consistently and predictably for high quality lower cost and higher effective capacity.

Access to the Improvement System • NHS Improvement System is available to all staff with an “nhs” email address – in particular those working within service improvement, commissioning and development; • The secure system is accessed via a personal user ID and password; • Access for SHA Users will be arranged by NHS Improvement (details to be confirmed).

Users are provided with different levels of access to the system in accordance with their specific requirements, for example Commissioners do not routinely have access to detailed project management reports unless the team choose to share this information.

Further information Contact: Maggie Herbert, Systems Development Manager maggie.herbert@improvement.nhs.uk Email: Tel: 07789 552984

Contact: Jill Turner, Director NHS Improvement Email: jill.turner@improvement.nhs.uk Tel: 07900 223345

Want to see a demo of the system?

A demonstration of the Improvement System has been arranged on Monday 17th November between 1.30pm and 4pm.

The venue is the Board Room at the offices of NHS South East Coast at Horley. Staff from provider units (acute and primary care), clinical networks, clinicians and PCTs are all welcome to attend. Places need to be booked by e-mailing knowledge.management@southeastcoast.nhs.uk Places are limited so book your place now!

Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

Knowledge Matters

Page 10

A3: ASK AN ANALYST – If you have a question for the team please e-mail: Knowledge.management@southeastcoast.nhs.uk Q - I’m trying to calculate someone’s age accurately in Excel but there doesn’t seem to be a function built in, how can I do this?

A - The easiest way is to use a little known and well hidden formula called DATEDIF, it doesn’t even appear in the usual list of formulae! The syntax of this is as follows – =DATEDIF(Date 1, Date 2, Interval) Date 1 – the first date in your calculation, this should be the earliest date Date 2 – the second date in your calculation, this should be the most recent date Interval – a text string in double quotes defining what you want the formula to return, for example “y” would return the number of complete calendar years between the two dates. The various strings you can use are as follows d m y md yd ym

Days Number of complete calendar months Number of complete calendar years Number of days between the dates as if they were of the same month and year Number of days between the dates as if they were the same year Number of complete calendar months between the dates as if they were the same year

For example with the following values in A1 and B1 – 1

A 15/09/75

Formula =DATEDIF(A1,B1,”y”) =DATEDIF(A1,B1,”m”) =DATEDIF(A1,B1,”d”) =DATEDIF(A1,B1,”yd”) =DATEDIF(A1,B1,”ym”)

B 01/04/08 Value 32 390 11887 199 – so 199 days from 15/09 to 1/04 6 – so 6 whole months between 15/09 and 1/04

HAVE YOU GOT A HANDY TIP YOU’D LIKE TO SHARE ???

YOU COULD WIN A PRIZE…..

To calculate a person’s current age you would replace B1 in the above formulae with NOW() which returns the current date. =DATEDIF(A1,NOW(),”y”)

Many thanks to Carl Burns, Head of Knowledge Management at Brighton and Hove City PCT for this useful tip!

Q - When working with documents in Microsoft Word, I constantly find myself wasting a lot of time with rigorous formatting and messing around with margins to try to fit one document onto one page when one or two lines spills onto the next page. I am sure that there must be a simpler way of doing this – can you please help?

A - Sure there is! If you create a document and a few lines flow over onto next page, here is a quick fix.

1. From the main menu click ‘File’ then ‘Print Preview’.

2. Click on the ‘Shrink to Fit’ button up the tool bar.

It really is that simple!!!

Use this above simple way of removing that last irritating blank page in documents that you print and save trees at the same time!

Peter Nyaga

Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Page 11

- Knowledge Management Update Samantha Riley, Head of Knowledge Management In the last edition of Knowledge Matters, you heard from Sue Braysher about the work being undertaken jointly with South East Coast PCTs and Humana to assess the current capability around Knowledge Management and subsequently develop a strategy to fill any gaps that may exist.

The first South East Coast wide workshop with Humana was held on 2nd October at the David Salomons Centre in Tunbridge Wells. There were nearly 60 delegates from commissioning, public health, knowledge and library services and local health informatics services. John Wilderspin, sponsor for the Knowledge Management work stream, was also present for the whole day.

Local PCT events with Humana are planned over the next few weeks and the intention is that PCT self assessments will have taken place by 21st November. The second South East Coast wide workshop is scheduled for 9th December (again at the Salomons Centre). This will provide an opportunity to gain feedback on themes identified through the self assessments, identify quick wins and development required during 2009 and agree a joint vision for the future.

An agenda will be circulated by the second week of November.

All presentations from the 1st workshop are available to download from the Knowledge Management website http://nww.sec.nhs.uk/knowledge/index.php?option=com_docman&task=cat_view&gid=209&Itemid=116 As you will have read in a previous issue, there are a number of additional Knowledge Management work streams underway across South East Coast. Anne-Marie Morgan from West Kent PCT is leading on identifying and mapping tools and resources to each element of the commissioning cycle.

Anne-Marie has already identified over 75 tools! This list will be circulated to each PCT for additional tools and resources to be added in. In addition, you will all have the opportunity to comment on which tools and resources are useful to you and therefore recommended to others. If you would like to contact Anne-Marie, here’s her e-mail address. She would love to hear from you! Anne-marie@wkpct.nhs.uk Wendy Dearing from the Sussex HIS is leading on the ‘skills development for Information Specialists’ work stream. This work stream aims to scope the core training required for each AfC role; make an assessment of local training needs; agree mechanisms for the delivery of training; and develop training and development plans. The first meeting of Wendy’s sub group is scheduled for 31st October. If you are interested in participating in this work stream, please contact Wendy directly (wendy.dearing@sussexhis.nhs.uk).

It’s not just about having highly skilled analysts. A key requirement if PCTs are to become World Class Commissioners is the need for staff throughout the organisation to be able to specify their knowledge management requirements and then understand and interpret information.

With this in mind, we have a work stream focused on ‘developing the intelligent knowledge management user’. Sue Braysher is leading on this challenging area and is currently thinking through how we can best support this critical subject. Sue would be delighted to hear from you if you have ideas on activities we can undertake to support the development of intelligent users: Sue.braysher@westsussexpct.nhs.uk All South East Coast PCTs were well represented (40 delegates in total) at the first workshop of the Turning Data into Information for Improvement programme being run by the NHS Institute.

A range of support materials and resources have been uploaded to the Institute’s website http://www.institute.nhs.uk/world_class_commissioning/data_into_information/the_journey_so_far.html which will help PCTs progress their projects prior to the next workshop in January.

These documents are also available to download from the Knowledge Management website and a discussion forum has also been set up to promote discussion and sharing. We are keen to support PCTs with this important programme and have suggested some joint work focussed on two specific challenges – smoking cessation and childhood obesity. In addition, one to one support can be provided to PCTs within South East Coast. Please contact Katherine Cheema (katherine.cheema@southeastcoast.nhs.uk or 01293 778885) Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

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Page 12

The 4 C’s…

Capability, Capacity, Competences and C for … Sussex (by the sea) HIS!

By Wendy Dearing

Sussex HIS recognises the important contribution training and continued development for staff makes to the organisation’s success in supporting the delivery of an efficient and effective healthcare service. As Executive Lead for the Department of Business Process, Development and Management, I believe that investment in staff development is vital to the retention of existing employees and their skills, plus a significant benefit in terms of recruitment and retention.

Acknowledging the importance of learning and development, we have developed a range of ways in which staff can learn.

These include academic studies, skill-based training, knowledge management through reading, distance and e-learning and work based learning including coaching and mentoring. We very much view personal development as a life long process and are always looking to develop new mechanisms to support and develop our employees. Here’s a flavour of some of these opportunities that may be of interest to the wider informatics community within South East Coast: “The right people with the right skills in the right place at the right time”- a Skills Matrix and Career Pathways Teams within the HIS are currently assessing their current skill base against the Skills Framework for the Information Age (SFIA), a model which has been designed for the informatics industry in conjunction with the KSF. Use of this information will assist us with resource management, risk analysis, training needs identification, recruitment and development. As part of the SHA’s Knowledge Management World Class Commissioning work stream (within which I lead on specialist skills development), we are currently looking at the feasibility of testing out the SFIA model with a broader range of informatics staff within Trusts and PCTs. Contact me if you would like further details of the model and our plans.

Apprenticeship Programmes including the Cadet Programme One of the great successes of the Sussex HIS is the implementation of the Cadet Programme. Working in partnership with a local 6th form college, we offer structured work placements and mentoring to students undertaking GNVQ’s in IT and Business Administration. We are proud to be home growing staff! A number of ex-cadets are now working for us and one of last year’s cadets was entered into a national Advanced Hardware & Software Competition where he won a gold medal.

He says…

“I won a Gold Medal in this competition and came first in the country! Yesterday I attended a high-profile awards ceremony and took a few pictures. I think it was because of my apprenticeship here with the NHS that I gained the knowledge necessary to win this.”

The Microsoft Skills Academy The Sussex HIS has been nominated as the Microsoft Skills Academy host on behalf of the South East Coast SHA. The academy will offer a diverse range of IT training, professional development and certifications. The Microsoft Academy Program offers two levels of certification – Specialist and Expert. In addition there are a range of less advanced courses including a range of basic skills sessions for complete beginners or improvers. Learning can be undertaken at home or work or by booking an e-learning slot or via classroom based courses. For more detailed information have a look at this website http://www.microsoft.com/learning/mcp/OfficeSpecialist/default.mspx In addition, a limited number of free e-learning courses can be accessed direct from the Microsoft NHS Resource Centre http://www.microsoft.com/uk/nhs If you would like to find out more about the opportunities that are available to you, please contact Dee Romain (dee.romain@sussexhis.nhs.uk) Back in May, I was proud to receive the ASSIST award for the person making the most significant contribution to developing health informatics staff.

Receiving the award was a great honour and reinforced the importance of developing the work force. I believe that by developing staff within the HIS, we contribute to the delivery of high quality health services to patients across Sussex. In addition, there is a real impact on staff recruitment and retention and the effectiveness of our own workforce. Here’s a quote from one of our team: “ I think that the training and education opportunities made available to anyone who works for the Sussex HIS, not only this NVQ but the other courses offered, are a credit to the company and a big part of why I joined the team in the first place.”

Brian Derry, ASSIST Chair and Wendy Dearing

If you would like to learn more about any of the activities described here, please do contact me wendy.dearing@sussexhis.nhs.uk

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Page 13

Simulation & modelling the RIGHT way Peter Taylor, Manager for the Research Into Global Healthcare Tools (RIGHT) Programme Research Into Global Healthcare Tools (RIGHT) is a collaborative research partnership that aims to give healthcare service planners and managers easier access to a wide range of proven modelling and simulation techniques. Led by Brunel University, RIGHT also includes the universities of Cambridge, Cardiff, Cranfield, Oxford Brookes, Southampton and Ulster, as well as partners from Industry, Government and the NHS. Since 2007, RIGHT has been working alongside a number of NHS bodies that includes six Hospital Trusts, two Strategic Health Authorities, and three multi-agency networks. Together with input from other stakeholders, these parties have shared the process of developing a prototype ‘toolkit’ that can help experts and novices alike, identify the suitability of various simulation and modelling approaches in helping to solve real life problems at all levels of healthcare provision, from setting policy to delivering front line services. The resulting toolkit includes a workbook that helps users choose simulation and modelling methods that match their resources and constraints, and an interactive computer based application that uses graphic displays to show users how closely specific modelling techniques suit their particular circumstances.

RIGHT’s ambitious timescale (two years in which to identify a business requirement, assemble a toolkit and then assess its feasibility) has led to some pioneering research approaches. The first of these involved devising a way of rapidly reviewing the many thousands of academic papers on modelling and management methods that cover a diverse range of sectors from military applications to manufacturing.

Challenging as it was, that was the easy bit! Next came the test of finding ways to engage with NHS planners and clinicians in an unobtrusive manner that combined their day jobs with the aims of the research programme.

This has worked very successfully in some areas, but needless to say, has proved harder in others. As you would expect, learning from less successful experiences has been every bit as valuable as learning from the ones that have gone well.

Throughout the eighteen months that RIGHT has been running, the research team has enjoyed a particularly strong relationship with NHS South East Coast, whether in holding workshops to tackle the thorny issues of sustaining effective performance against targets, or through participating in events such as this year’s World Class Commissioning Analytical Fair. Understanding and incorporating the Strategic Health Authority perspective is an important element in ensuring that the design requirement for RIGHT’s multi-layer modelling toolkit is correct.

Over the coming months, RIGHT and NHS South East Coast are set to work together even more closely, particularly on plans to make RIGHT’s prototype toolkit available through the Knowledge Management website, alongside the tools that are currently available to service planners. This will create a welcome opportunity to involve a larger number of NHS users in the process of designing RIGHT tools through feedback. In addition, the SHA and RIGHT will be working closely to try and apply modelling techniques to real problems that are facing the NHS. To start with, we will be exploring the complex area of emergency care, following an initial meeting focusing on this in early November.

RIGHT aims to end its preliminary (feasibility study) phase next spring. However, the programme team is currently working on plans for a follow up, five-year, phase of activity that will see the design, trials, refinement and, eventually, commercial marketing of further tools and methods. This second phase will also concentrate on consolidating RIGHT’s existing, as well as building new, links with the healthcare modelling community.

If you would like to know more about the RIGHT Programme, visit www.right.org.uk or e-mail right-info@brunel.ac.uk .

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Page 14

Clinical Metrics Development – Progress Update

By Simon Berry and Adam Cook

Dementia The Dementia Metrics group last met on 5th September and reflected on the progress that had been Adam Cook made to date and discussed potential next steps. We agreed that a report should be sent to the SHA Management Board describing the work to date and recommending a range of actions. The report provides a summary of available data sets to describe the pathway and provides a range of analyses on activity, spend and prevalence (down to GP practice level) which we hope will be of interest to commissioners. The report is available to download from the Knowledge Management website in the Clinical Metrics Development Programme section of ‘downloads’.

As a result of feedback from the group, I have developed a secondary care dementia dashboard (again available from the website). This dashboard shows the impact upon secondary care (mental health and non mental health) of patients admitted with a diagnosis of dementia in one of the first three positions. The dashboard includes information on length of stay, discharge destination, the value of bed days attributable to dementia and provides a run chart showing the actual length of stay for the most recent 100 patients having been discharged. We hope that this information will prompt discussion within local health communities regarding the pathway of care, increase the number of patients on dementia registers and provide evidence to support the Dementia as one of the first three diagnoses in Secondary Care (2005/06 - 2008/09 Q1): development of additional primary and community Royal West Sussex based services for this group of patients.

Numbers of Diagnoses of Dementia by Discharge Destination

LoS Distribution 300 Primary Diagnosis

1st 3 Diagnoses

90

600

S72 70

50 40

200

400

60

30 I63

J18 50

20

300 150

10 200

40

0 30

100

100

£Cost PbR Tariff 07/08 (where no tariff estimated cost £300 per day)

2008/09 Q1

2007/08 Q4

2007/08 Q3

2007/08 Q2

2007/08 Q1

2006/07 Q4

2006/07 Q3

2006/07 Q2

2006/07 Q1

2005/06 Q4

2005/06 Q3

Most recent 100 Admissions with a diagnosis of Dementia (any position)

by LoS

£300,000.00

1st 3 Diagnoses

Primary Diagnosis

2005/06 Q2

S01

800 1st 3 Diagnoses

90

0

J22

2005/06 Q1

Pateint died

Non-NHS hospital

10

R54

Total Beddays used by patients with a dignosis of Dementia

Average LoS for Dementia Diagnoses 100

R55 20

Non-NHS/LA hospice

Non-NHS/LA Care Home

Non-NHS medium secure unit

NHS - male ward

NHS - care home

LA residential accommodation

NHS - general ward

NHS - maternity ward

Not Recorded

NHS - medium secure unit

da ys

1 da y 2 da 3-7 ys da ys w ee 2ks 3 w ee 3-4 ks w 1- ee ks 2 m ont 2h 3 m s o 3-4 nth m s o 4-5 nth m s on 5th 6 m s 6-1 ont h 2 m s on 1-2 ths ye 2-3 ars ye 3-4 ars ye 4-5 ars ye ar 5+ s ye ars

0

Usual place of residence

50

NHS - high security psychiatric

0

Temporary place of residence

G40

0

Others

80

60

M25 500

Numbers of Diagnoses of Dementia by Location of Diagnosis Primary

N39 70

Primary Diagnosis

250

1-2

I am now working on a dementia dashboard for commissioners and undertaking analysis to compare for each GP practice the number of patients admitted to hospital with a diagnosis of dementia compared to the number on dementia registers. If you would like more information on this work, would like to get involved in the dementia metrics group or have ideas on other clinical areas that we could focus on, please do get in touch.

Adam.cook@southeastcoast.nhs.uk

Top Ten Primary Dianoses (where primary Diagnosis not Dementia)

700 1st 3 Diagnoses

Primary Diagnosis

1st 3 Diagnoses

Primary Diagnosis

90 Patients Average LoS Lower Confidence Limit Upper Confidence Limit

700 £250,000.00

80

80

600 70

70

£200,000.00

500

60

60

400

50 40

£150,000.00

50 40

300 £100,000.00

30

30

200 20

20

£50,000.00

100

10

99

92

85

78

71

64

57

50

43

36

8

29

1

22

0 15

2008/09 Q1

2007/08 Q4

2007/08 Q3

2007/08 Q2

2007/08 Q1

2006/07 Q4

2006/07 Q3

2006/07 Q2

2006/07 Q1

2005/06 Q4

2005/06 Q3

2005/06 Q2

2005/06 Q1

2008/09 Q1

2007/08 Q4

2007/08 Q3

2007/08 Q2

2007/08 Q1

2006/07 Q4

2006/07 Q3

2006/07 Q2

2006/07 Q1

2005/06 Q4

2005/06 Q3

2005/06 Q2

0

£2005/06 Q1

2008/09 Q1

2007/08 Q4

2007/08 Q3

2007/08 Q2

2007/08 Q1

2006/07 Q4

2006/07 Q3

2006/07 Q2

2006/07 Q1

2005/06 Q4

2005/06 Q3

2005/06 Q2

2005/06 Q1

10 0

Stroke

The Stroke Metrics group met on 10th October and reviewed all of the analysis that has been undertaken to date.

We were really lucky to have Phil Duncan, National Improvement Lead for the Stroke Improvement Programme, attend the meeting and found his input really useful.

We agreed a set of metrics to populate a stroke dashboard which will be updated on a regular basis. The intention is to have two dashboards. The first dashboard will be provider based and provide the option to select hospital site as well as Trust where appropriate. Indicators to be included on this dashboard relate to activity, length of stay, mortality, time to scan, discharge destination, vital signs indicators and selected sentinel audit indicators. In addition there will be a commissioner based dashboard with some of the provider indicators cut in a different way as well as some additional indicators from QOF. We are now documenting the ‘stroke metrics story’ so far and Samantha will be sharing lessons learnt and local progress at the NHS Improvement Stroke Data and Audit Group meeting in November.

We have already had the opportunity to compare progress and learning with colleagues in our neighbouring SHA (South Central) who have been working on specifying a stroke pathway.

I’ll be providing a full article in next issue of Knowledge Matters, but if you can’t wait until then, please do contact me Simon.berry@southeastcoast.nhs.uk Simon Berry

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News SUS Data Quality Dashboard updated As a result of user feedback and suggestions for improvement, the Information Centre for Health and Social Care have updated the SUS Data Quality Dashboard. Updates include: • The dashboard reports on data items in Trusts’ Admitted Patient Care (APC - inpatient), Outpatient (OP) and A&E CDS types submitted to SUS in 2008/09 by the Month 3 inclusion date; • Creation of Commissioner Data Quality Dashboard - this uses the Commissioner code submitted to SUS by Providers as well as the existing provider version; • Revision of validation rules; • Updating of the help text for each data item, including examples of frequent errors, to enable organisations to more easily identify and resolve problems in their data New 18 Weeks Forum A new forum has been set up under 18 weeks on the Knowledge Management website. This is designed for providers and is an area to discuss any technical issues around 18 weeks reporting or 18 weeks guidance. If you have an issue it is likely that someone else across the patch will have had it too, so it’s worth posting here.

Daily Sitreps The Daily Sitreps are due to be collected again and providers should submit these onto Unify2 by 10am. The week commencing 27th October will be dry run to check processes – only mock data need be submitted this week. Collection of the actual data starts on 3rd November. All guidance has now been published on Unify2.

NHS Digital Mapping Agreement The NHS Pilot Agreement with Ordnance Survey for digital mapping data formally expired at the end of September (following a six month period of grace). A new Digital Mapping Agreement operated by Dotted Eyes in now in place. What this means is that any NHS organisation that received digital mapping products under the expired Pilot Agreement must take out new licences if they wish to continue using Ordnance Survey digital mapping data. Further details are available regarding the process at http://www.ic.nhs.uk/statistics-and-datacollections/population-and-geography/nhs-digital-mappingagreement The SHA is arranging a meeting with Dotted Eyes in November, to discuss the options with regards to a future agreement. If any organisation has yet to sign up to the New Digital Mapping Agreement and is interested in finding out more then contact david.harries@southeastcoast.nhs.uk Vital Signs/ Operating Framework The new Operating Framework is due to be published end of October/ beginning of November. This should contain all of the Vital Signs technical guidance for next year. No new lines will be added to the Vital Signs, although plans will be collected for some lines that are currently deferred.

Page 15 Unify2 and Performance Reporting Group In a few weeks we will be setting up meeting dates for a local Unify2 and performance reporting group.

This will be a forum to discuss and share any issues around Unify2, performance, data returns in general, also to get an update on any national developments with Unify.

If you are interested in taking part in this please email: Knowledge.management@southeastcoast.nhs.uk We can also offer Unify2 training to small groups of people. If you would be interested in this please email the Knowledge Management team. This would provide you with an opportunity to get a general overview of Unify and go through any specific issues that you may have.

HCAI discussion forum A new HCAI information discussion forum has been set up on the Knowledge Management website. Any questions on MRSA screening returns, C.Diff attribution mechanisms, or national and local limits can be posted here, hopefully for some answers! The HCAI dashboard is also to be made available in the downloads section of the website under clinical information and patient safety.

Length of stay HRG benchmarking tool A new tool has been created allowing easy comparison for length of stay by HRG for Elective and Non Elective using 2006/07 HES data, between South East Coast Trusts and all other England Trusts. In addition it allows comparison with the top quartile, top decile, median and the mean. It is freely available for download from the KM website in the Downloads - Benchmarking Tools - Acute Trusts section, any questions please contact simon.berry@southeastcoast.nhs.uk

New Team Member Hello, I’m Charlene Atcherley-Steers and I have just taken up the role of Performance Analyst.

I will be working for Rebecca and with Nia. I graduated in July this year with a BSc in Computing and Business Administration from the University of Kent. After my final exam I went travelling around Europe for a month, which was a very enjoyable experience. When I got back I worked for an insurance company whilst I looked for a ‘proper’ job.

I was very happy when I was appointed to this role as I hope that I will be able to put all of the theory that I have learnt into practice as well as pick up new skills! I am looking forward to the challenge of the job, getting to know how the NHS works and meeting people who I will be working with.

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Page 16 Clinical Coding for Commissioners

Are you a commissioner of services? Do you understand the process of clinical coding and the implications of inaccurate coding?

The Coding and Classification service has developed a clinical coding course specifically aimed at Commissioners to help them gain an in-depth understanding of this complex area.

A session has been organised for Wednesday 3rd December between 9am and 4pm. The venue is the Surrey and Sussex Room at the offices of NHS South East Coast in Horley.

Places are strictly limited to a maximum of 12. To book a place or to find out more, please e-mail Samantha.riley@southeastcoast.nhs.uk

Last issue’s quick quiz So, are they improving or not? Well firstly, we don’t know what the indicator is so we can’t know which direction is ‘good’ or ‘bad’. Secondly, the data is aggregated on an annual basis so any real trends that we might learn from, in either direction are likely to be lost in the aggregation.

Finally, with the exception of 2007/08 the data is wholly within the set limits which suggest that any trend is purely due to common cause variation. In short, there is neither enough information, or compelling evidence to suggest any improvement in the mysterious indicator X!

Kiran’s Charity Challenge Since the last issue, Kiran has abseiled Guy’s Hospital Tower. The tower is over 450 foot tall and taller than the London Eye!! Kiran raised nearly £200 for the Myasthenia Gravis Association.

Ode to Romilly……

Romilly's was here a scant few weeks, E'en tho' it seemed like more.

Working with aplomb and grace, Regardless of the chore.

Romilly helped us immensely, With jobs both large & small, The analytical fair, the BADS tool, The Website and that's not all...

To see how things work in a Trust, She was sent to Canterbury, Then, to see the other side, She was off to West Kent PCT. Then across to MTW, To look at A&E, Examining the Cas. Cards, For data quality.

We wish Romilly well with her course, And for her future vocation, And hope she learned quite a lot About NHS information To Romilly, a Thank You, From Sam and all her crew, Good Luck and best wishes For all that you may do!

Advanced Training Courses

Knowledge matters is the newsletter of NHS South East Coast’s Knowledge Management Team, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: Knowledge Matters C/O Knowledge Management Team NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone: 01293 778899 E-mail: Knowledge.management@southeastcoast.nhs.uk

We have now finalised all of the details for the forthcoming Excel Advanced, Access VBA and Excel VBA courses that have been commissioned from Vizual Learning. Attendance at these courses is free, however organisations will be charged for non attendance. Details on how to register, course content and venues can now be found via the Knowledge Management website. Each training course takes place over two days.

Training will take place in IT training rooms in Eastbourne, Haywards Heath and Maidstone.

To request a place on one of the courses please e-mail us at: knowledge.management@southeastcoast.nhs.uk

Quick Quiz Why is Hallowe'en the same as Christmas?

Because 31OCT=25DEC

To contact a team member: firstname.surname@southeastcoast.nhs.uk

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