Knowledge Matters Volume 3 Issue 5

Volume 3 Issue 5 December 2009 Welcome to Knowledge Matters Seasons greeting and welcome to this super-bumper fun-filled festive edition of Knowledge Matters.

It certainly has been a busy year with 2010 promising to be full of exciting developments and opportunities. The past two months have been particularly busy for the team, in part due preparations for the SHA Assurance visit in November and the assessment of the 200 Regional Innovation Fund bids that have been received. Final decisions on the initial bids to receive funding will be made in early January - watch out for further details next time.

Working with the Healthier people, excellent care clinical pathway leads, good progress has been made in the specification of metrics and associated analysis. For some pathways, measurement is challenging and a significant amount of further work is required to agree relevant metrics and agree the best way to capture the required data. This will be a key priority for the team moving into next year.

It is great to see that good progress is being made by other regions in the establishment of Quality Observatories. An effective network has now been established to facilitate the sharing of tools, products and expertise across the country. If you have a chance, I suggest that you take a look at the Quality Observatory website which provides a link to Quality Observatories in every region http://www.qualityobservatory.nhs.uk/ I would like to take this opportunity to thank the many contributors to Knowledge Matters during 2009—your contributions are greatly appreciated and I hope will continue for another year.

Thanks also to all readers of Knowledge Matters and users of our website. Your feedback is as ever always really useful—please do continue to contact the team and let us know how we can best support you to improve the care received by patients across Kent, Surrey and Sussex! Merry Christmas and happy reading!

Inside This Issue : A3: Ask an Analyst

Establishing the Evidence

2 What kind of analyst are you?

8

Opportunity Locator

3 Better Care, Better Value Indicators

10 Skills Builder - using the NHS Postcoding File

16

Healthier people, excellent care— measuring our progress

5 NHS Informatics Graduate Management Training Scheme

11 Reducing harm from alcohol

18

12 News, Fun Fact, Quick Quiz, plus more!

19

In the Post Bag…….

http://nww.sec.nhs.uk/QualiityObservatory

14

Page 2

Establishing the evidence The Quality Framework Team, Department of Health Duncan Palmer

Tim Muir

Mark Dinsdale Richard Taunt

If the NHS is to continue delivering high quality care it will need to make savings of up to £20 billion over three years.

Quality needs to remain the organising principle of the NHS at the same time as efficiency savings are made. And evidence of how NHS staff are already improving in these areas is being made available on a new NHS Evidence specialist collection, ‘NHS Evidence – quality and productivity’.

This is the result of Phase One of the Establishing the Evidence project, which has been led by the Department of Health with close involvement from NHS Medical Director (Professor Sir Bruce Keogh) and National Director for Improvement and Efficiency (Jim Easton). Significant input has been provided from the NHS, Royal Colleges, NHS Institute for Innovation and Improvement and other national expert organisations and groups.

A project team has now been established to take the project forward. It includes the NHS Institute, NICE, The King’s Fund, Health Foundation, NHS Improvement, SHA Medical Directors and national clinical directors. These groups will update and evolve the website, and report their progress to Bruce and Jim ‘NHS Evidence – quality and productivity’ contains 69 examples from across the NHS of interventions that improve quality and productivity. The intention is that this library grows as more well evidenced examples of practice which improves quality and productivity are identified and assessed by the team. Currently, six examples from within the library have been identified as potential high impact changes, and are labelled as ‘recommended’.

The six interventions are: •

atrial fibrillation – detection and optimal therapy in primary care

•

fractured neck of femur: rapid improvement programme

•

stroke pathway – delivering through improvement

•

electronic blood transfusion systems

•

enhanced recovery for elective surgery

•

The Productive Ward.

The aim of the collection – which is a local resource and not mandatory – is to provoke thoughts, ideas and discussions about changes that can be made locally in the NHS. The examples are the result of a wide-reaching process involving a large number of national stakeholders, National Clinical Directors, and all ten SHAs. Over 200 examples were sent in from over 80 different contributors, and these examples went through a filtering and analytical assurance process before arriving at the final 69 published examples.

To find out more:

•

visit the NHS Evidence website (www.evidence.nhs.uk/qualityandproductivity)

•

you can contact the Team directly (firstname.surname@dh.gsi.gov.uk )

We’re really excited that it’s Christmas.

Seasons greetings to all Knowledge Matters readers!

Page 3

Opportunity Locator Sophie O’Brien, NHS Institute for Innovation and Improvement

The Opportunity Locator is an on-line tool provided by the NHS Institute for Innovation and Improvement to support the commissioning priorities of local health communities. This data tool has been designed to provide PCTs with relevant and useful data in an easily accessible format to support the 'care closer to home' agenda.

The purpose of the Opportunity Locator tool is to stimulate ideas on where commissioners should focus their attention in re-designing and shifting services away from the traditional setting of the hospital and out towards community based care.

The potential to shift care from a hospital setting into the community can be viewed by how many attendances a PCT has the opportunity to shift into the community, based on the performance of the top 10%, 25% or 50%, and by financial shift. The financial shift view uses tariff values to convert the attendance shift into the financial value of care that can be shifted into the community.

The Outpatient indicators show the shift potential if Outpatient appointments were in line with the top performing 10% 25% or 50%

Emergency shows the shift potential if emergency admissions (due to conditions which are deemed treatable in the community) were in line with the top performing 10% 25% or 50%

Intermediate Care measures the number of excess bed days beyond the long stay trim point

The emergency, intermediate care and outpatients indicators can be broken down by specialty, provider and GP practice by clicking on the bars on the main graph when using the tool. This shows commissioners the areas where there may be an opportunity to shift care away from hospital and into the community, and, when used in conjunction with local knowledge, can be used to aid policy decisions.

The tool currently contains data for the following periods: -2006/07, 2007/08, 2008/09 and 2009/2010 Q1. The tool will be updated quarterly with further quarterly data as the information becomes available.

To find out more:

•

visit the Opportunity Locator website (www.institute.nhs.uk/opportunitylocator)

•

you can me for a guided tour (Sophie.obrien@institute.nhs.uk)

Page 4

Measuring our progress

By Rachel Harrington, Head of Healthier people, excellent care As many of you will be aware Healthier people, excellent care (HPEC) is our vision for improving health and care for the residents of Kent, Surrey and Sussex over the coming decade. Within it we set out 45 pledges that we believe will make a critical difference to the health and care of local people and the means by which we will achieve our goals.

Clinicians, experts from social care, and the voluntary sector worked in eight clinical pathway groups. They identified good practice throughout the region, examined gaps or barriers and described what needed to happen locally and nationally to deliver optimal care.

Healthier people, excellent care, Is giving us the chance to share, The vision that we’ve laid bare, Providing services clean and fair, Helping people to be aware Of all the efforts to repair Ailments from brain to derrière.

8 pathways are ensconced in there,

More than 100,000 staff, service users and organisations were informed about or involved in developing the vision and more than 2,500 people and groups provided feedback or took part in consultation events.

Take a moment to prepare, Then read on if you dare…

This summer after the appointment of a new medical director, we also appointed 9 senior clinicians from across our region to provide clinical leadership to each of the pathways.

These clinicians have been working with their networks and programme boards and with the quality observatory in developing measures for each of their pledges, so that we can measure our progress against the pledges. This all sounds pretty straightforward? Well yes and no!

This article takes four of the HPEC pledges and shows how the ease of measuring ranges from the relatively straightforward to the far more challenging, indeed the majority of the pledges seem to fall into the latter category.

Here are some examples where the pledges are relatively straightforward to measure.

18 weeks is the top duration Waiting for an operation, With careful planning over time We want to get it down to nine.

As the pathway you traverse, Every consultant, GP, nurse, And other workers you will see Shall treat you with expediency.

All women will receive their cervical screening test results within two weeks.

This information is collected through GP practice systems and will also be part of vital signs collection.

In 2008/09 SEC primary care trusts (PCT’s) achieved 27.8% of results returned within 2 weeks.

Surrey PCT achieved the highest in the patch of 44.6% of results returned within 2 weeks.

The England average was 21.4%.

Regionally 80.8% of results were returned within 4 weeks compared to the England average of 65.5%.

We still have a lot of work to do to meet this pledge but we are able to target and focus our efforts in the most appropriate way.

Page 5 Healthcare associated infection (HCAI’s) By 2011 there will be less than 2000 cases of Clostridium Difficile (C. difficile) a year across NHS South East Coast.

Cum ulative count of all cases against lim its (2009/10 only) Natio nal limit

Stretch limit

A ctual

4000 3500

We are able to gather this data easily. Trust staff are able to input into the health protection agency (HPA) system as a C. difficile infection occurs. The quality observatory then simply collates the information.

3000 2500 2000

For this year (2009-2010) we have set a stretch target of 2,382.

1500

We are on course to reach and exceed our stretch target (with a current forecast outturn of 1,949 cases).

1000 500 0

Hopefully this will mean that we will meet this pledge a year early and in a position to consider setting even more challenging limits for next year.

We will now look at a couple of our pledges that are little more challenging!

Some health problems come and go, Many more stay and cause years of woe, These conditions need a plan, Unique to each woman and man.

Support from every health and social source,

By 2010, all patients with a long term condition will be offered a care plan. By 2011, 90% of those with complex long term conditions will be identified and able to manage their own personalised and negotiated care plan. Case manager support will be provided when necessary.

To live as normal and join the workforce.

Nationally there is an annual GP patient survey, which currently measures the percentage of respondents with a long standing health problem who ‘have a care plan and those that feel that this has improved care’ What it doesn’t tell us is: •

those people with complex long term conditions,

•

it won’t tell us those that have been offered a plan and refused,

•

and most importantly it doesn’t tell us whether it was personalised and negotiated.

The annual survey selects people randomly. In the last survey, we had 153,654 patients identified themselves with a long term conditions ( LTC’s) this is around 6% of the estimated numbers of people with an LTC in South East Coast.

Unfortunately these small numbers mean we become less certain that the information is representative of the whole picture.

As we can’t explicitly measure this pledge we need to look for indicators of success.

One way to do this is to triangulate data from multiple sources; for example, the quadrant analysis below looks at the percentage of LTC patients with care plans agreed and the percentage of the LTC patients feeling supported to manage their condition (SEC PCTs are shown as red blocks) for all England PCTs. There is a clear relationship between the two however the range of variation shows that having a care plan in place is obviously not enough for some patients to feel supported in their self-management, suggesting that we need to do more to support these patients in addition to care planning.

We want all our PCTs in the green quadrant!

We could enhance the information available further, either encouraging additional or slightly differently worded questions to the GP survey through feedback to the DH (with clinical support of course!) or adding more locally based surveys. In some areas GPs have also been looking at improving collection of information through their local enhanced service agreements.

Page 6 Are you going to have a baby?

Answer Yes or No – there is no maybe!

If Yes – you’re in the family way, Go see a midwife without delay.

They will follow you through the gestation, From early weeks unto parturition.

The best place to deliver we’ll help you choose,

By 2010 we will ensure that all mothers and babies receive high quality postnatal care, for example support with breastfeeding for at least 6 weeks

And will provide support through baby blues.

Looking at breastfeeding as the example given, we are able to retrieve data from a couple of key sources: •

The annual health check audit ,where notes are scrutinised for evidence of “supporting the initiation of breast feeding.”

•

Vital signs category B

•

Data from GP practices is recorded at the postnatal check up between 6-8 weeks after delivery. The mother is recorded as breast feeding wither fully, partially or not at all.

Prevalence; The number of children recorded as being breastfed at 6-8 weeks plus the number of children recorded as receiving both breast milk and infant formula as a percentage of the number of infants due for a 6–8 week check in each quarter.

Actual

The graphs and table below show the prevalence of breastfeeding at the postnatal review split between our primary care trusts.

Target

Eastern & Coastal Kent PCT

In summary What you will see is that it is often a basket of measures that will be needed to build up some depth and colour to the overall picture.

Breast Feeding Prevalence at 6-8 weeks Q2 08/09

Hastings & Rother PCT

80%

80%

80%

70%

70%

70%

70%

60%

60%

60%

60%

50%

50%

50%

50%

40%

40%

40%

40%

30%

30%

30%

20%

20%

30%

Once again combining and comparing this data gives us much better information than from just a single source. Subsequently understanding why some areas are doing better than others and targeting initiatives means that we have a far better opportunity to improve postnatal care for all mothers in our region.

Brighton & Hove City PCT

West Kent PCT

80%

20%

20%

10%

10%

0% Q2

Q3

Q4

2008-09

Q1

Q2

0%

0%

0% Q1

10%

10%

Q1

2009-10

Q2

Q3

Q4

2008-09

Medway

Q1

Q1

Q2

Q2

Q3

Q4

2008-09

2009-10

Surrey PCT

Q1

Q1

Q2

East Sussex Downs & Weald PCT

70%

60%

60%

50%

50%

50%

40%

40%

40%

40%

30%

30%

30%

30%

20%

20%

20%

20%

10%

10%

10%

Q1

Q2

Q3

2008-09

Q4

Q1

Q2

2009-10

Q2

Q3

Q4

2008-09

Q1

Q2

2009-10

Q2

2009-10

60% 50%

10% 0%

0% Q1

Q1

70%

70% 60%

0%

0%

Q4

80%

80%

70%

80%

Q3

West Sussex PCT

80%

Please note includes revisions submitted after the deadline for 200809. Therefore figures will differ from those published by DH.

Q2

2008-09

2009-10

Q1

Q2

Q3

Q4

2008-09

Q1

Q2

2009-10

Q1

Q2

Q3

Q4

2008-09

Q1

Q2

2009-10

Prevalence as % of those due to be screened Totally Breast Fed

Partially Breast Fed

Not Breast Feed

Not screened

Brighton & Hove City

61%

13%

22%

4%

East Sussex Downs & Weald

37%

12%

40%

11%

Eastern & Coastal Kent

26%

8%

50%

17%

Hastings & Rother

31%

10%

49%

10%

Medway

19%

9%

38%

34%

Surrey

34%

9%

26%

31%

West Kent

24%

14%

34%

29%

West Sussex

16%

6%

18%

60%

South East Coast SHA

28%

10%

32%

30%

To measure some of our pledges it may be necessary to put in place new methods of data collection, but it is clearly important that this doesn’t add burden to busy clinicians. The pathway boards and networks with the truly expert advice from our Quality Observatory are leading on the development of these metrics and we will keep you updated.

For more information on Healthier people, excellent care visit our website http://www.southeastcoast.nhs.uk/hpec or contact me directly—I would love to hear from you! rachel.harrington@southeastcoast.nhs.uk

Page 7

Kids are great! Kids are fun!

On life’s adventure they’ve just begun.

Give them time to bloom and grow Sometimes, though, they need protection From adult ways and temptation, Drink and Drugs and Sex will take their toll, Best to stick with rock ‘n’ roll.

Everyone wants to be fit and trim, That’s not too fat and not too slim.

Reducing hangovers, and stop choking: So less boozing and stop smoking.

Special clinics if you’re silly, And don’t wear a condom on your _____.

Do these things every day, To help you work and rest and play.

Can’t think straight? Not yourself?

Could be a problem of mental health.

Don’t be shy, it’s no shame, Many people feel the same.

There will be people you can see, Long –term or with urgency.

They can help take the strain, Emergency, Emergency – I’m feeling sick,

And get you back to work again.

Get a doctor, and make it quick.

Feeling broken, slightly wrecked?

Then speak to NHS Direct, See a pharmacist, or your GP, Call on an ambulance for urgency.

Need some medicine or leg in plaster?

With these services we’ll do it faster.

This poem is coming to the end, Beyond this stanza it will not extend.

No more puns or dreadful rhymes To help it through these difficult times.

With dignity and in a place of choice The poem will slowly lose its voice.

Poetry by Adam Cook Are you feeling creative or inspired?

Thank you, reader, for staying near, The time has come the end is here.

Why not give Adam a run for his money!

Send us your creations and if we publish them we will send you a prize!

Page 8

What sort of analyst are you ?????

Answer the following questions and add up the number of A’s, B’s and C’s you get to find out what type of analyst you are….

Which of the following languages do you speak/would you like to speak? a.

Klingon, Huttese, Dalek

b.

C++, SQL, PASCAL

c.

French, German, Spanish

What’s the best thing that comes in a box? a.

The complete four seasons of Blake’s 7 on DVD

b.

CPU, hard drive, graphics card

c.

Quality street

Do you know the name of the Jet in X-Men a.

Yes, it was originally called X-Jet and now its SR7 Blackbird

b.

Yes – its SR-71 Blackbird

c.

No, I have a life!

What’s the best way to get an answer to something? a.

Why what do you want to know?

b.

Google it, then ask an analyst

c.

Ask an analyst

If I were a superhero I would be…. a.

Mr Fantastic

b.

Iron Man

c.

Batman

As of now you have been in front of this computer without getting up for? a.

More than 6 hours

b.

About 3 hours

c.

About an hour

Page 9 Have you ever had an argument about which operating system is better? a.

Yes and the answer is LINUX

b.

Yes

c.

No and I don’t plan on ever having one!

Have you ever taken something apart with the intention of fixing/re-building it to make it better, stronger, faster? a.

Yes I have taken apart my computer and now it is a robot!

b.

Yes and its working much better now

c.

No!

Which star trek race has exceptional hearing? a.

Ferengi

b.

Vulcan

c.

The ones with the bumpy foreheads

My favourite Windows keyboard shortcut is: a.

Windows Logo+R – Launches The ‘Run’ Dialog Box

b.

ALT+ESC – Cycles Through Programs Or Items In Chronological Order

c.

CTRL+Z – Undo As Many Times As The Specific Program Allows.

In your opinion what is the war to end all wars? a.

Marvel Superhero civil war

b.

Bluray vs HD DVD

c.

WWI

Mostly A’s - You are a Geeky/Nerdy analyst You are furious that all existing episodes of Doomwatch have not been released on DVD yet. You will spend Christmas Day noting down continuity errors in Doctor Who and writing a letter of complaint to the BBC. Mostly B’s - You are a techie analyst You wished you could have completed this survey online. Christmas will involve integrating new bits of hardware into your home entertainment system and downloading “APPZ” for your phone. You will thrash all the rest of your family on your new Wii / PS3 /xbox games Mostly C’s - Congratulations you’re a well balanced human being!

You will have a lovely Christmas with your loved ones, enjoying fine Christmas food and drink, joining in with games and falling asleep contentedly in front to the telly in the evening.

Page 10

Better Care, Better Value Indicators

By Mike Davidge, NHS Institute for Innovation and Improvement

The Better Care, Better Value (BCBV) indicators reveal the potential to make significant cash or resource savings whilst improving quality. The National Opportunity for 2009/10 based on the calculated Quarter 1 2009/10 upper quartile performance is between £2.3 and £2.4 billion for the NHS in England.

Changes this quarter Opportunity by indicator £3,000 £2,500

£ 110 6

£Million

£2,000 £1,500

£ 17

£73 £ 14 1 £ 19 7

£1,000

£ 10 5 £ 10 6 £392

£500

£238 £64

£ 15

£23

To ta lP ro du ct

ivi ty

O p Le po ng rtu ni th ty o D ay f S t a El C as y ec e ti v ra e te Pr eEm O p er N ge ew Did Be d N nc to o da y R Fo t At ys el lo t Ad w end U m s p is R si on at S Em u 1 io r er gi c 4 d ge al a va ys nc ri a y 1s Adm tion tA is s Li ppo ion p Pr id M i ntm s ot od en o R en n P ifi c ts a u in -a mp ti on ng s In io te hib ns i to r in s D ru gs

£0

We have recently made some significant changes to the Better Care Better Value Indicators the key change being the move from HRG 3.5 to HRG 4 for the calculation of the Opportunity Savings. While HRG version 4 covers more activity than HRG version 3.5, the absence of indicative or nonmandatory tariffs under HRG version 4 means that less activity will have a tariff against it. As a result, organisations may notice a drop in their productivity opportunity of around 10%. In order to help organisations understand the impact of the changes, we have run the metrics using HRG version 3.5 as well this quarter to allow comparison. The published data is the HRG version 4 dataset.

In addition we have made changes to the following individual indicator definitions.

Reducing Pre-Operative Stay The calculation for the pre-operative bed days is now reported as the pre-operative ‘length of stay’ value rather than a percentage of the overall bed days. This is calculated as pre-operative bed days divided by the number of hospital spells. The indicator has been split to show the elective and non-elective activity in separate tables.

Only the productivity opportunity for elective activity has been included in the national total. The non-elective activity is available through the Trust and SHA scorecards and also the Indicator Explorer tool as before. The reasons, and therefore the courses of action a Trust should take, are completely different for elective and non-elective activity. Importantly, it is not possible to be certain for non surgical specialties that a pre-operative stay is relevant. Patients may have been admitted for a different reason and the need for a surgical procedure only surfacing at some later date.

Managing Variation in Referral Rates The indicator “Managing Referral Rates” has been retired and a replacement indicator “Managing variation in 1st Attendances” has been introduced. This indicator includes 1st Attendances only, DNAs are no longer included in the calculation. This change was felt necessary because DNA activity is not consistently reported in the Commissioning Dataset and we have previously used a ‘work around’ in the indicator calculation. This was justified initially because it was felt that the reporting of DNA activity would improve over time. This has not proved to be the case and therefore we have decided to remove the ‘workaround’.

Converting the potential into reality However, the key issue for the NHS is what has to be done to actually realise the benefits. For this reason we are introducing the ‘Converting the potential into reality’ guides - one is aimed at NHS commissioners and the other is for provider organisations. The guides contain ten steps that organisations can take to use the BCBV indicators to maximum effect to improve quality and increase productivity.

The guides can be downloaded from the Better Care Better Value Indicator web site at www.productivity.nhs.uk or at http://www.institute.nhs.uk/ quality_and_value/high_volume_care/better_care_better_value_indicators.html

Page 11

NHS Informatics Graduate Management Training Scheme

By David Graham, Informatics Graduate Trainee So what does being a management trainee feel like? For me I would say that in the early days I felt like a fish out of water.

Only two and a half months ago I didn’t know my PCT’s from my PBR’s. I thought a QIPP was a witty saying, DIPC was a teletubby, and all the NHS consisted of was hospitals and GP surgeries. How wrong I was! So how did I get to this position?

Around a year ago, I had just finished studying for a degree in computer science. Although I enjoyed my degree, I had realised that I didn’t want to have a job where I sat in front of a computer writing line after line of code. So I was looking at various jobs and graduate schemes online, and came across the NHS Graduate Training Scheme which looked both exciting and challenging. The Scheme is two years long and is aimed at taking graduates with the potential to be future leaders within the NHS. It is currently split into four streams, consisting of General, Finance, H.R. and Informatics. It involves external education, for a recognised qualification, training provided by the NHS, participating in a learning set and undertaking placements, where we spend time at an NHS organisation, and work on various projects, in order to gain skills that will enable us to be effective leaders for the future.

The assessment process to obtain a place on the scheme is pretty challenging – consisting of interviews, a range of tests and at the final stage an assessment centre. The skills looked for aren't solely based on technical proficiency. Most important are the skills required to deal with the complexity of the NHS agenda and the inter- and intra-organisational relationships. The scheme looks to recruit individuals with highly developed communication and problem structuring skills and abilities related to transformational change management. You also need to be analytical, flexible, creative and innovative.

The minimum requirement to apply to the scheme is a 2:2 degree in any subject. Some degree equivalents are also acceptable. Candidates need to be able to demonstrate academic achievement but the success of the scheme relies on attracting a diverse range of people. For that reason the rigorous recruitment process focuses on the leadership capability for the NHS of candidates, not their degree classification.

For me the scheme commenced in July with my orientation. This involved spending lots of time shadowing frontline staff and meeting senior leaders within different organisations related to healthcare. Here’s a flavour of some of the activities I undertook : - spending time on wards, shadowing doctors and nurses, a shift with an ambulance crew, spending a day with the Department of Health Quality Framework team, spending the morning in the office of David Nicholson (Chief Executive of the NHS), attending the world class commissioning analytical fair, visiting Guys and St. Thomas’ I.C.U. and watching surgery. My time in the operating theatre particularly stands out in my mind – at least I didn’t faint!

After my two month orientation ended, the real work began! My first placement (which lasts for nine months) is with the Quality Observatory. I have not undertaken any data analysis before, but the Quality Observatory seems like a perfect place to learn. I am going to be working on a variety of projects - the first of which is looking at blood culture policy, and how this may affect the results of blood culture tests. This strikes me as a really exciting piece of work and I will have the opportunity to present my findings to the Directors of Infection Performance Control (DIPC, turns out it isn’t a teletubby!!)

Hopefully this piece of work will make a real difference, and enable Trusts to change their policies for the better.

Life as a graduate trainee is really busy (I haven’t even mentioned the university study I do as part of the scheme during my own time) but it is very rewarding, and I get to be involved in so much and see so much that I otherwise wouldn’t, that I am so grateful to be on a scheme like this.

Coming back to the question at the beginning, do I really feel like a fish out of water. Well I did at first, but as I have begun to work on projects, spent time with Directors (who turned out to be ordinary people, similar to me) I’ve began to feel more comfortable.

Anyway, I hope this gives an insight into the training scheme and what the first few months of the scheme has offered me.

If you are keen on a challenging but extremely rewarding role, I would encourage you to find out more about the scheme.

Further information on the scheme can be obtained from the following website http://www.nhsgraduates.co.uk Applications can be made between September and December for intake the following year. If you would like to know more, or are interested in being a trainee, then please do contact me (david.graham@southeastcoast.nhs.uk) and I will do my best to answer your questions.

Thanks for reading and have a great Christmas!

Page 12

In the Post Bag…...

Dear Quality

Observatory,

Thank you fo r the help that you gave me last year – it really hel ped improve our service. T his around the ou year I have concerns tbreak of Rei ndeer ‘flu and am worri ed about how to make sure that business continuity is maintained at this our bu siest time of y ear.

Yours sincere ly, Elf O’Tority

Quality observ a NHS South E as

Head of Qual ity and Perfo rmance Operations D elivery Divisio n North Pole

HORLEY

tory

t Coast

Dear Mr O’Toroity, You are right to be concerned about the outbreak of the H0H0H0 variant of ‘flu (“Reindeer ‘flu”), this has the potential to make your work a lot harder this season.

The first thing that you need to do is contact your local Reindeer ‘flu lead, and see about getting your staff inoculated.

Vaccines are now available for key workers such as yours, and also for high risk individuals, such as the overweight elderly living in cold climates. This simple precaution should reduce risks of Reindeer ‘flu incidence dramatically.

However in terms of robust business continuity it would be unwise to rely on just vaccinations, planning for staff cover in terms of sickness.

Training and knowledge sharing is a key factor here, it is essential that at least one other team member can pick up another’s team role in the event of absence. This is even more important for specialised roles such as that undertaken by Mr Rudolf – it may even be worth recruiting a team member with similar qualities to be able to work as backup.

We understand that a full team of nine is used. As the chart to the left shows, when this configuration is used the team outperforms the optimal delivery norm every time.

However a team of just 8 including Mr Rudolf also performs at optimal levels. The more traditional team of eight without Mr Rudolf does not reach optimal, but does perform within tolerance levels. More worrying is that any team of less than eight (regardless of the presence of Mr. Rudolf), simply cannot perform the task. However employing additional bank & agency Moose can bring the team back up to acceptable levels of performance, however this can be costly, and under trained and lower qualified agency Moose can actually have a detrimental affect on perform-

Normal Team

With Bank & Agency Moose

Optimal Delivery Tolerance level

9 (inc. Rudolf)

8 (without Rudolf)

8 (inc Rudolf)

7

6 Regardless of Rudolf's presence

Team Size

5

Page 13 Timeliness of delivery is just one factor affected by Reindeer ‘flu. Quality of wrapping on presents can also be compromised, with more and more staff needing to wrap more and more parcels, this can easily lead to misfolded paper, badly cut edges, and missing ribbons and bows. The lack of these details is a good indicator of overall gift quality, and research has proven that sick and absentee staff has a marked affect on this.

100% 90% 80%

% Quality of wrapping

70% 60% 50% 40% 30% 20% 10% 0% 0%

10%

20%

30%

40%

50%

% Staff Sick

Alternative methods of sleigh propulsion are available:

60%

70%

Now may be the time to start implementing innovations in delivery and wrapping services, many of which will help in the event of a staffing level crisis brought about by the current virus (see below): -

And there are many attractive gift bags and boxes now available to reduce wrapping time.

Hope that this helps!

Please do contact us again next year if we can be of assistance!

Christmas Quiz!

As is the Tradition here is the fabulous Christmas Quiz http://www.surveymonkey.com/s/SECQO2009ChristmasQuiz As always a super prize for the winner !

Quality Observatory Christmas Celebrations 2009

Page 14

How do I filter a list on more than one criteria ?

Application: Microsoft Excel 2003 Dear Quality Observatory I have a spreadsheet a that contains rows of data.

Each row has a field (column J) that contains a “pathway flag” the field can have more than one pathway flag.

There are eight pathway flags that could be combined in any order as shown in the example on the left.

I want to be able to filter on any record that contains the Mental health flag regardless of where and how it is situated Is there any way I can get excel to do this for me?

-Hamna Yusaf Team Administrator Innovation Improvement and Research

Solution: Complexity 3/5 — Uses logic statement, string function and error handling Hi Hamna Within Excel 2003 there 2 possible solutions to your problem.

Solution 1: Rearrange your worksheet.

This is a common problem that occurs when people compile data without thinking about how it is going to be used When you were creating your spreadsheet the best thing to do would have been add each Pathway as a separate column and use a Y/N flag against the record to filter on E.G: Mental Health

Planned Care

Acute Care

Staying Healthy

Childrens

Record 1

Y

N

Y

N

N

Record 2

Y

Y

N

N

N

Pros: You do not have to rewrite the full flag name on each record as a result: The file size will be smaller Less chance of spelling errors!

Longer term this makes splitting grouping and reordering the data set easier Cons: You have already typed out the full data set! Time consuming to Re do the whole thing again

Page 15 Solution 2 : String formulas This method utilizes a set of building excel functions that are designed to process and manipulate text strings rather than numbers.

There are two functions that could be utilized for this both have exactly the same syntax and variables: Find(find_text,within_text,[start_number]) Search(find_text,within_text,[start_number]) find_text — This is what you are looking for e.g. (AT) within_text — this is where you are looking in e.g. (tabulATe) [start_number]) - (optional) this is the number of characters from the start (starts at 1) The functions returns the number of characters from the start of the string where it finds the search text e.g: find(“AT”,”tabulATe”) = 6 If there is NO match the formula will return a #Value! error Find() is case sensitive Search() is not case sensitive find(“AT”,”tabulATe”) = 6 find(“AT”,”tabulate”) = Error in value (#Value!) search(“AT”,”tabulate”) = 6

In this cell type the search text

=if(iserror(search($K$1,J3)),”N”,”Y”) In this situation we don’t need to know the exact position of the match only if there is (or is not) a match.

We can use the iserror() function to handle negative returns (does not find the search string) inside an if() statement as shown above to output a Y/N flag. This can be used with the excel auto filter to bring up the rows which contain the search text.

Pros: Quick to implement & you don’t have to rearrange the data Cons: If the Text is not spelt correctly it will not get picked up by the function.

Page 16

Using the NHS Postcoding File What is it?

The Office for National Statistics (ONS) supplies postcode-related data to the Organisation Data Service.

This Data Set relates Postcodes to their Geographical Location in Eastings and Northings (Geocoded Postcodes) allowing you to map them.

Surely I can do that with google, or yahoo, or multimap?

The NHS postcode file is so much more. It allows you to process batches of post codes for mapping rather than just one at a time.

The data set can relate postcodes to: •

Local government (county/Unitary Authority/district/wards)

•

Geographical information

•

Health Authorities / Health Boards

•

PCGs / PCTs / Local Health Groups

•

Includes Terminated/Discontinued Postcodes

This allows users to group up data to administrative boundaries.

Examples of use : •

Grouping patients accessing walk-in centres to the appropriate commissioning PCT.

•

Analysing access and usage of services by districts or wards

•

Create bespoke boundaries

Am I allowed to use it?

Read the terms and conditions of supply for yourself before using the file.

My interpretation is summarized as follows: There are no restrictions on the number of people that use the data.

The data can be stored and shared on a local network or through a multi-user system (i.e. a database) The data file can only be used within the NHS for the organisation’s business activities (you must not use it for personal or non-NHS uses) You must not transmit, re-publish or redistribute the data (i.e. e-mail it, copy it to CD and post it, put the files on a website, cut and paste the all or part of the file into a document) without written permission from the ONS. Where do I find it?

The file can be found on the organisational data service (ODS) section of the Connecting for Health (CFH) website http://nww.connectingforhealth.nhs.uk/ods/downloads/officenatstats

The is a whole collection of ONS data available for you to utilize including the complete Gridlink Postcode file as well as reduced (country) files as well as county/district/ward/LHB/GOR name and code listings.

Page 17

How do I use it?

There are a number of ways in which you can use the NHS Postcoding file.

The first step is to download the files you require (including any code to name lookup tables).

The files are supplied as CSV files.

Be careful as some of the files are greater than 65000 lines so import them into a database rather than attempting to use them with excel. (the GRIDALL.CSV file contains 2.4 million records) If you are not sure how to do this then it’s best to familiarize your self with Access first. there are some access guides on our website or book yourself a slot on one of our monthly development sessions with one of the team.

File > Get External Data > Import > file type = text The CSV file is comma separates with “ as text qualifiers.

The Text File does not contain header rows so the imported data file will be labelled “field 1-38”.

You will need to refer to the NHSPD User Guide (Annex A) for the ‘ALL fields’ record specification.

You will need to manually copy over the field names to make best use of the file Import in all the code to name lookup tables that you need using the same method.

Add relationships

between each of the lookup tables and the imported data.

Your database should now be ready to use!

There are two postcode fields in the data file : 7character (AB1∆1AA-ZE999ZZ)

8 character (AB1∆∆1AA-ZE99∆9ZZ) remember to use the one which matches the postcodes that you want to use .

E.G: RH7 7DE = 7Char RH6 7DE =8 Char

You can use the =LEN() function in excel to count the number of characters if you are not sure!

If you are going to use the eastings and northings to map points check the character length!

4 character Eastings and 5 character Northings are 100 metre resolution grid references (you may need to *100 to get the appropriate positioning) 5 character Eastings and 6 character Northings are 10 metre resolution grid references (you may need to *10 to get the appropriate positioning) 6 character Eastings and 7 character Northings are 1 metre resolution grid references

Page 18

Manifesto to reduce South East’s alcohol harm

As health professionals gear up to face the effects of people’s excessive drinking this Christmas, a new manifesto for the South East looks at how problems linked to drinking too much should be tackled.

The manifesto, launched on 18 December by the Big Drink Debate, outlines a vision to address alcohol-related health and social issues. It is based on findings from research and public debates which took place in the South East in autumn 2009 and encompasses the views of many professionals and members of the public. It highlights the need to: •

Support police forces in tackling anti-social behaviour and alcohol related crimes

•

Work to reduce family breakdown and domestic abuse linked to alcohol

•

Explore whether minimum prices and restrictions on cheap alcohol sales should be introduced

•

Make adult drinkers of all ages aware of health risks from drinking above guidelines, not just binge drinkers

•

Help employers advise staff on potential effects of their drinking

Professionals in the South East, along with others working in the alcohol field, can select which points the region should prioritise at www.bigdrinkdebateSE.org.uk/manifesto. Members of the public are also encouraged to state their preference. The manifesto will be open for people across the region to sign up to until 31 January.

The Big Drink Debate aims to develop a coordinated approach to tackling alcohol related issues across health, community safety, industry, retail and education sector professional networks and services in the South East. It is hoped that professionals will use the manifesto points receiving most support on the Big Drink Debate website to inform their work on alcohol.

Dr Yvonne Doyle, Regional Public Health Director for NHS South East Coast, which is behind the project, said: “During the festive season, the effects of alcohol are at the forefront of many professional’s minds. I call on your readers to register their support for the Big Drink Debate manifesto and to share it with colleagues. This is an important opportunity for professionals to contribute to the development of alcohol priorities for the South East.”

The Big Drink Debate is being led by NHS South Central, NHS South East Coast and the Government Office for the South East. It follows a request from the Chief Medical Officer for the NHS to run Big Drink Debates to capture regional views on alcohol.

To register support for the manifesto, go to www.bigdrinkdebateSE.org.uk/manifesto, where a full Big Drink Debate report on the research and public debates is also available.

For more information, please contact Laura Buller or Harriet Pearce Willis on 020 7403 2230 or laura@forster.co.uk / harriet@forster.co.uk

Page 19

NEWS

heart disease.

NICE consults on new Quality Standards

The project is looking at what data already exists to measure uptake rates. It will also make proposals for how information on the adoption of these new technologies can be collected and published in the longer term. By April 2010, the initial project will create: A credible evidence base for measuring the adoption of these six technologies.

A process for collecting and publishing data on the adoption of these six technologies.

A standard process that can be applied to new technologies that have been approved for use in the NHS.

The National Institute for Health and Clinical Excellence (NICE) has launched a consultation on its draft quality standards for the treatment of dementia and stroke; once published the new standards will represent a benchmark to inform aspirations for high quality care across the NHS. The consultation began on 27 November and is part of a pilot programme of work, which will include further topics on venous thromboembolism prevention and specialist neonatal care which are due to be released as drafts in the New Year. The closing date for the consultation is 15th January 2010 at 5pm.

In addition to consulting on the quality standards, NICE are also keen to test the practical aspects of the standards and consider the appropriateness of the statements of quality and measures: how implementable they are; the validity of their content and whether there may be any unforeseen consequences as a result of putting them into practice.

Organisations interested in field testing the standards are required to complete a questionnaire and return to QualityStandards@nice.org.uk by 5pm on 15 January 2010.

Follow the link for further details http://www.nice.org.uk/ aboutnice/qualitystandards/qualitystandards.jsp Best Practice Tariffs The Department of Health will be providing Best Practice Tariffs in 2010/11 for four high-volume areas, all characterised by significant unexplained variation in practice and clear consensus of what clinical best practice constitutes. These clinical areas are: cataracts, fractured neck of femur, cholecystectomy, and stroke care. In addition to these four, a best practice tariff is also currently being investigated for renal dialysis.

The aim is to have tariffs that are structured and priced appropriately both to incentivise and adequately reimburse for the costs of high quality care. Further information can be obtained from the Department of Health website http:// www.dh.gov.uk/en/Managingyourorganisation/ Financeandplanning/NHSFinancialReforms/DH_105080 Clinical Innovation Metrics The NHS Information Centre is currently working on a project commissioned by the Department of Health to measure how innovative technologies are being adopted within the NHS. The six technologies being focussed on are: 1. Insulin pumps: for type1 diabetes patients.

2. Spinal cord stimulation: helping to alleviate chronic pain.

3. Positron emission tomography with computed tomography (PET-CT scans): benefitting cancer patients.

4. Intensity modulated radiotherapy: more precise radiation treatment for cancer patients.

5. Brain-type natriuretic peptide tests: to help diagnose heart attack and reduce the need for and echocardiogram.

6. Cardiac resynchronisation therapy: for patients with

Here’s the link for further information http://www.ic.nhs.uk/ services/in-development/clinical-innovation-metrics Unify 2 Enhancement project On the 8th December the Unify 2 enhancement project went live. There are a few changes to the system mainly in the View manage section of the website.

The Unify2 team have prepared user guides covering View Manage, DCT home page, non-DCT home page, Unify overview and Extraction Viewer, following the enhancements to the Unify2 website. These are available to download from the Unify 2 section of the Quality Observatory website nww.sec.nhs.uk/knowledge Vital signs refresh Following publication of the new Operating Framework, the technical guidance for the 2010/11 Vital Signs refresh has now been produced.

The South East Coast timetable for submission of Vital Signs plans is given below: By 20th January – PCTs and Trusts submit first cut of plans By 29th January – SHAs to have validated and signed off all plans February – Department of Health to feedback on plans submitted By 17th March – final cut of the Vital Signs plans to be submitted by PCTs and Trusts, following DH feedback By 26th March – final plans to be signed off by SHAs For further details please visit the Quality Observatory website nww.sec.nhs.uk/knowledge

Congratulations……. … to the new Mrs Rebecca Matthews (nee Owen) who got married to Robin in November. Most of the team attended the wedding at St Peter’s Church in Caverswall and then had a fantastic time dancing the night away in the dungeon at Caverswall Castle!

After two weeks on honeymoon in Norway, Rebecca returned to work refreshed and ready for a Vital Signs refresh (!)

Please note Rebecca’s new e-mail address: Rebecca.matthews@southeastcoast.nhs.uk

Seasons Greetings ……….

Quick Quiz!

From the Quality Observatory

Fascinating Fact Question: why are the Team wearing antlers ?

Answer: ‘Cos they were the best at googleing the answers at the SHA Away Day!

60 babies were born in South East Coast Trusts on Christmas Day last year.

Knowledge matters is the newsletter of NHS South East Coast’s Quality Observatory, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone:

01293 778899

E-mail: Quality.Observatory@southeastcoast.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk