Knowledge Matters Volume 6 Issue 3

Volume 6 Issue 3 August 2012 Welcome to Knowledge Matters Welcome to this special Olympics edition of Knowledge Matters!

Despite this being the holiday season, the team have continued to develop a range of new and exciting products for the South of England. First up is a high level respiratory dashboard. This contains key indicators for COPD and asthma, including prevalence, underlying achievement on the COPD/asthma QOF indicators, admissions, 30 day readmissions and bed days. Data is shown at CCG level across the South of England footprint (covering South East Coast, South Central and South West former SHA areas). This dashboard is in development and more indicators will be added shortly so keep reading future editions for updates.

The team has also developed a CCG practice level dashboard. This has already been produced for a number of CCGs across the South and (as it has been very cleverly designed) can easily be replicated for any CCG within less than a day. The dashboard contains cost and activity trend data viewable by practice, drillable down to specialty level and containing a benchmark for the CCG. Finally, a Health Visiting dashboard is available for organisations within South East Coast which contains a range of indicators related to both monitoring the numbers of health visitors and looking at the potential benefits in terms of outcomes as a result of increasing numbers.

This is currently being adapted for use across the South of England.

The next edition of Knowledge Matters will feature articles on all of these new products.

I’d like to finish with the good news that myself and Kate have had our second paper accepted for publication in the journal Clinical Risk. Clinical Risk considers patient safety and risk at both the organisational and the practitioner level. Our article focuses on the utilisation of a variety of patient safety data sets to support improvements in patient care. Hopefully this will be published soon so I’ll let you have the link next time!

Inside This Issue : Best Practice data in Primary Care

2

Skills Builder - Geographic Information Systems

8

Analysis Ancient and Modern

14

Draft mandate to NHS Commissioning Board Consultation

4

Torchbearer Special

10

Commissioning Outcomes Framework development

15

Effective Clinical Analysis Part 2

5

Ask an Analyst

12

Enhancing Quality and Recovery Programme

16

Making Connections – NICE

6

Meet the Observatory

13

News

18

twitter.com/SECSHAQO issuu.com/SECQO http://www.networks.nhs.uk/nhs-networks/sec-qo www.QualityObservatory.nhs.uk

2 Working with CCGs: best ‘practice’ for data in primary care

By Nikki Tizzard, QIPP Analyst Last year the newly-formed Surrey Heath Clinical Commissioning Group approached the Quality Observatory about provision of a bespoke analytical service. From the outset they saw the value of having data and analysis specific to their needs to support their development as an emerging CCG, and assist them in making informed decisions about commissioning care for their population. A full-time analyst was assigned to this task in September 2011 and began working with them to establish their information needs and develop solutions with them.

In general, as CCG leads and GPs have become more involved in the decision-making process it has been important for them to engage effectively with data. We’ve worked with Surrey Heath to develop a range of useful dashboards and analytical tools and tried to put a ‘friendly face’ on the data to help with understanding and interpreting some of the information.

One of the first things Surrey Heath asked for was a regular monthly ‘practice dashboard’ – a simple tool containing just a few key measures, designed to focus on trends and benchmarking rather than performance targets. The dashboard looks at activity and costs for emergency admissions, elective admissions (both ordinary and day cases), GP referrals and multiple attenders.

We’ve also been able to help with a number of projects that Surrey Heath have been working on, such as their Virtual Ward project which focuses on caring for patients with long term conditions outside of the hospital setting. We have designed a dashboard which monitors the impact this is having on acute admissions for each individual LTC including length of stay, excess bed days and multiple attenders. The dashboard looks not just at secondary care data but also patient experience and end of life care.

Surrey Heath have also undertaken a nursing home pilot project where additional support and staff training has been provided in some of the area’s nursing homes.

The dashboard we developed aims to evidence the impact this might have on secondary care admissions.

New indicators have recently been added to the Quality & Outcomes Framework which relate to referrals, emergency admissions and A&E attendances and we have worked with each of the practices in Surrey Heath to assist with achievement of these. We developed userfriendly tools to view trends and benchmark against others, and visited each practice to facilitate discussions, so that

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

3 good practice could then be shared across the group. These visits were followed up with provision of more detailed data where needed and then a group level summary was presented to the board. From this the group were able to review patient pathways and develop action plans for the future.

As you might imagine, this has been a learning experience for the CCG, the practices and us at the Quality Observatory.

Surrey Heath are an ‘intelligent customer’ who have been really good at providing clear concise guidelines around the information they need from us and it’s been very much a team effort.

We’re now developing products for other CCGs and have come to realise that one group may really like a particular format and another, well maybe not so much. While they are still likely to need the big ‘one size fits all’ data resources, each CCG can also benefit greatly from receiving regular information tailored to themselves and their practices.

Jointly we have found that if we want clinicians to engage with the data, it doesn’t help to swamp them with unnecessary information. We need to take the time to find out what format suits them best and provide the analysis and insight that goes with it (by and large, GPs are very busy people with patients to see and so they need to get to the important stuff quickly!). We need to be cautious when analysing numbers at practice level, as one or two patients can make a significant difference to the overall picture.

Relationships have been key and crucially we have provided a person, not just data and dashboards, and become part of their team. From our perspective, it’s been important to get to know the GPs and practice managers and where possible find out about the demographics and needs of their individual population. This would obviously be more of a challenge with larger CCGs but, in our opinion, very much worth the endeavour. We’ve also worked to establish good relationships with community nurses, colleagues at the PCT and information teams at local providers among others.

As intelligence providers we need to be able to deliver the right amount of high quality, timely information, in the right format, to those that will benefit from it. Combining that with the commissioning skills of the CCG, the clinical expertise of the GPs and community teams, and the hands-on experience of the practice staff will help ensure that patients receive the best, most efficient and cost-effective services.

If you would like any further information please do get in touch at quality.observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

4

Draft Mandate to NHS Commissioning Board Consultation

By Samantha Riley, Director of Information for Service Improvement How many of you have heard of the Mandate to the NHS Commissioning Board and know what it is?

The Health and Social Care Act that was recently passed reaffirms the principles of the NHS as a comprehensive health service for everyone, based on clinical need and not people’s ability to pay. It also creates legislation to support the Government’s vision for improving the NHS. In future, the Mandate will be the main way for the Government to say what it expects the NHS commissioning system to achieve—so the Mandate is therefore really important as it will be the key way in which the NHS Commissioning Board will be held to account.

The draft Mandate is now out to consultation with the intention of publishing the final Mandate in the autumn which will come into force from April 2013. This Mandate will set objectives from April 2013 to March 2015 and will set ambitions for improving outcomes over 5-10 years. There are a range of areas covered by the Mandate including improving outcomes, reducing inequalities, putting mental health on a par with physical health, securing shared decision making and integrating care around patients.

In this brief article I wanted to draw your attention to the suggested objectives associated with the ‘better healthcare outcomes’ section of the Mandate. These are sensibly aligned to the 5 domains of the NHS Outcomes Framework.

The draft Mandate does not include actual levels of ambition against the Outcomes Framework, however the intention is to publish these in the final Mandate. Responses to the consultation document will potentially influence these levels of ambition. So here are the proposed objectives: Domain 1 : Secure an additional X life years for the people of England, through the reduction of avoidable mortality, by 2015; X life years by 2018 and X life years by 2023.

Domain 2 : Increase the number of Quality Adjusted Life Years for people in England with long term conditions to X by 2015; X by 2018; and X by 2023 Domain 3 : Improve recovery from illness or injury through increasing the number of Quality Adjusted Life Years for NHS patients in England by X by 2015; X by 2018; and X by 2023 Domain 4 : i) Increase the proportion of NHS patients in England who would rate their experience as “good” (an additional X patients by 2015); ii) increase the proportion of patients who would recommend their hospital to a family member or friend as a high-quality place to receive treatment and care; iii) increase the proportion of doctors, nurses and other staff who would recommend their place of work to a family member or friend as a high-quality place to receive treatment and care; and iv) provide evidence that poor performance is being tackled where patients and/or staff say they would not recommend their hospital to family members or friends as a high-quality place to receive treatment and care Domain 5 : Improve patient safety, reducing Quality Adjusted Life Years lost to NHS patients in England through avoidable harm by X% by 2015; X% by 2018; and X% by 2023 Consultation closes on 26th September. The draft Mandate and associated documents can be found at the following website http://www.mandate.dh.gov.uk/ I would encourage you all to have a look at what will be a very important document for the coming years.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

5

Effective clinical analysis—avoiding the pitfalls Part 2

By Simon Berry, Specialist Information Analyst In the last edition of Knowledge Matters I described why here at the Quality Observatory our preferred source of data for regular analysis and local reporting is SUS. I outlined some of the issues with HES and will continue this theme in this article. I am not intending to ‘rubbish’ HES in these articles at all—but simply to highlight some of the drawbacks of HES and explain why in South East Coast our preferred data source is SUS. One of the difficulties that you may experience is accessing HES. Unless you purchase the national HES extracts, or are a Public Health Observatory you are restricted to accessing HES via business intelligence tool, Business Objects. Unfortunately this is incredibly restrictive and causes significant issues unless you are doing the most basic analyses. You are forced to use a series of pre-defined measures that cover some of the basic areas, however you have no control of the underlying criteria that are used to generate these measures. This, in combination with the inability to create your own measures and the restrictive nature of Business Objects, means that important measures, such as mortality rates for admitting conditions / operations and readmissions, are impossible to calculate. The use of a business intelligence tool also means that you are detached from the raw data and so you lose a level of understanding as to how the data works (which in my view is critical). In addition, HES via Business Objects is only available in discreet years, this makes time series analysis awkward and difficult and again renders readmissions impossible to calculate.

The next issue that I want to raise which many of you will be aware of is timeliness. As mentioned previously HES takes data from SUS post freeze date for data cleaning prior to publishing. This means that the data obtainable from HES is typically 2 to 3 months behind that which you can obtain directly from SUS, assuming you have been granted access to the provisional monthly HES extracts. This delay becomes extreme at year end as the final published year end position from HES is not released until reporting to central government has been carried out after parliament’s summer break. The result of this is that at the very earliest the final published HES for a particular year is not made available till the following October at the earliest, the latest I have seen it published is the following February, almost a year behind!

As also mentioned last time, any changes made by a trust post freeze date will not be accounted for until a refresh of that period is carried out in HES. This may not actually be in the next provisional monthly HES universe release and may only be reflected when the final year end refresh is taken.

The final issue that I would like to draw your attention to relates to accessing Consultant and GP Codes.

Unless you specifically apply to gain access to clear data with your justification approved by the relevant Information Governance Board, Consultant, GP Codes and Referrer codes are pseudonimised despite that level of access being available through SUS (even for SHA users).

All that being said HES has its place for national benchmarking as long as you are fully aware of its limitations and make users of your analysis fully aware. Some of these limitations can be worked around if you are able to avoid using Business Objects to access the data but this involves obtaining full HES data which comes at a significant cost for the majority of organisations.

These reasons are why, for local analysis and benchmarking, we prefer to use SUS as our data source and limit use of HES for certain specific national benchmarking analyses.

As ever if you have any queries or would like some advice, please do get in touch!

Simon.berry@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

6

Here’s a NICE app!

By Sanjay Tanday – External Communications Writer at NICE Finding the time to keep on top of all the latest clinical guidelines and drug recommendations can be a real challenge for busy NHS staff.

Ever increasing demands mean that you often need to access information on the go, and the growing popularity of smart phones is enabling people to surf the web wherever they are.

But finding trustworthy and high quality information online, and in one convenient place, to help inform clinical decision making is easier said than done.

Well now help is at hand in the form of two free new apps from NICE – the official NICE guidance app and the British National Formulary (BNF) app.

So let’s take a look at the NICE guidance app first, available on Android and iPhone smartphones.

The app allows quick and easy access to all of NICE's recommendations and advice, and has been developed in response to demand from users of NICE guidance.

Aimed at healthcare professionals, including doctors, nurses and medical students, the app allows users to search, browse and explore all of the guidance produced by NICE.

More than 760 pieces of NICE guidance are contained, such as clinical guidelines on COPD, hypertension and stroke, and the app is automatically updated whenever access to the internet is available.

Guidance is arranged by clinical or public health topic, and particular sections can be bookmarked for easy access, or sent via email.

Other features include receiving automatic updates and new guidance as soon as it is published on the NICE website, adjustable font size for readability, and the ability to ‘swipe' between chapters when looking at guidance.

The app will provide offline access to all of NICE's guidance products, including clinical guidelines, public health guidance, technology appraisals, interventional procedures guidance, medical technology and diagnostics guidance.

What’s more, users will also be able to bookmark sections for easy access, and email sections to themselves or colleagues.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

7 The second of our apps is the BNF app which is available for Android and iPhone users and can also run on the iPod touch.

We believe that it will transform the way people access the BNF - the most widely-used medicines information resource within the NHS.

It will enable users to browse and search full content from BNF, receive notifications when new editions and updates are available, bookmark content and even choose their preferred reading settings.

Once downloaded, the app can be run without an internet connection meaning that professionals can access the BNF wherever they are.

Users will need to enter their NHS Athens user name and password to activate the app and download the content.

Eligible health and care professionals in England who do not yet have an NHS Athens password can register for free online or directly from their Smartphone by following the instruction displayed in the Apple App Store and Google Play Store.

Social care staff in England who also meet the NHS Athens eligibility criteria can also download and access the content.

The NICE BNF app is the first of our medicines and prescribing apps. An app for the British National Formulary for Children (BNFC) is in the late stages of development and will be released soon.

To download the app on Android, users will require the minimum operating system: 2.3.3 and up. Iphone and Ipod touch users will require the minimum operating system: iOS 4.3 or later.

What people are saying about our apps: “The NICE app is really essential for all doctors. It is quick and easy to navigate. A fantastic resource!”

“Really good, comprehensive app. Ideal for clinicians. Quick and easy to navigate.”

“Never felt the urge to write a review until now, but this is an excellent free app. Phenomenally helpful.”

“Search is fast on the BNF app and the content is well laid out. Latest update is working great.”

“Fantastic free BNF app essential for all NHS prescribers in England.”

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

8

Preparing Ordnance Survey Code‐Point dataset for use with GIS

By David Harries, Public Health Anaylist In the not too distant past, the high cost of GIS software and expensive annual Ordnance Survey (OS) mapping licences were the main factors influencing the low uptake of Geographic Information System (GIS) in the NHS. Fortunately, through OS OpenData and Public Sector Mapping Agreement (PSMA)*, there are now a wealth of really useful and often vital OS datasets available which are open and freely available. Increased availability of more user friendly, free and open source GIS software means that it is now possible to experiment with GIS without the commitment to spend vast amounts of money on software and datasets. One such open source geospatial software is Quantum GIS (QGIS) which the Quality Observatory (QO) use.

Whilst most of the datasets available through the PSMA (and OS Open Data) are immediately ready to use in a GIS such as Shapefiles (*shp), Tagged Image File Format (*Tiff) or comma-separated format (*.csv), some processing and modification of the data can be beneficial to make it easier to import and use in your GIS. This edition of the Skills Builder will cover a couple of useful tips for cutting down on the time consuming and repetitive nature of loading multiple CSV files into your GIS or database application as well as formatting the data to ensure it is ready for geocoding your data.

The PSMA layer that the QO use most frequently is Code-Point which allows us to join data to the postcode unit level (geocoding). Code-Point is ideal if you need to locate/map postcodes rather than individual addresses within your GIS. CodePoint comes in a simple CSV format providing details of the Postcode, additional information such as PO boxes and the total number of addresses, both domestic and non-domestic, in each postcode unit as well as administrative information such as County, Unitary, Ward and NHS Health Authority. The dataset contains the OS easting and northing for every current postcode which can be added to your own postcode data to turn it into a mappable table.

Whilst CodePoint comes in ready to use format, the data when downloaded consists of separate csv for each postcode area (AB, AL, B, etc), which does mean that if you have data for more than one area, you will either have to repeat the process of importing into your GIS for each postcode area, or combine the separate files into a single file first.

Combining (concatenating) multiple CSV files One way to combine all the individual CSV files in to a single file by using a batch file (*.bat): 1. Copy the following text and paste it into a new Notepad document: copy *.csv outputfile.csv Note, outputfile.csv can be any user defined file name with the extension .csv, e.g. CodePoint.csv.

2. Save the Notepad document with the file extension .bat (e.g. Combine.bat) in the same directory as the CSV files.

3. Since no headers are included with the CSVs, a column header can be added to the first CSV file listed in the folder i.e. ab.csv so that the combined file contains headers to easily identify columns.

4. Close the .bat file, and navigate to the directory where it is saved. Double click on the .bat file (i.e. Combine.bat) and an MS-DOS window will appear, once the process is complete the MS-DOS screen will close automatically.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

9 5. Navigate to the location where all of the CSV files were originally downloaded and where the .bat file was created. You will notice that there is a new CSV file with the name you defined in the .bat file (i.e. CodePoint.csv).

Combing CodePoint datasets can create CSV files with millions of records, remember if you open it in Excel you may not see all the records.

CSV single-space postcodes using Microsoft Excel and Access Postcodes are held in CodePoint as a seven-character field. When used in an address, the inward code (incode) should be separated from the outward code (outcode) by a single space, within Code-Point data, there may be 0, 1 or 2 spaces between these elements of the postcode.

Geocoding using data with postcodes which are all single-space (or no space) will result in a number of failed matches, therefore it is beneficial to modify CodePoint first before importing into your GIS. There are two ways of doing this: Option 1: Open the CSV file with Excel so the data is displayed in columns. In a new blank column, click in the first cell of the new column (excluding the row column names). In the function line, enter in the following function command, where A1 is the column containing the postcode: =TRIM(LEFT(A1,LEN(A1)-3))&"<s>"&RIGHT(A1,3) <s> indicates a single space.

This should now produce a column containing postcodes with a single space.

Option 2: The same method can be employed in Access, using an update query rather than the function line. Import the combined Codepoint csv file as created above then simply create an update query using Trim(Left([PC],Len([PC])-3)) & " " & Right([PC],3) With the data now combined and modified to single-space postcodes itâ&#x20AC;&#x2122;s simply a case of importing into your chosen GIS. Here is an example of a successful Code-Point import when viewed in QGIS:

*NHS organisations are covered by the recently agreed Ordnance Survey public service mapping agreement (PSMA), which provides a single agreement for the public sector, allowing state sector organisations to use, free of charge, consistent geodata for which they previously had to pay.

Links: OS OpenData: http://www.ordnancesurvey.co.uk/oswebsite/products/os-opendata.html Public Sector Mapping Agreement (PSMA):http://www.ordnancesurvey.co.uk/oswebsite/public-sector/mapping-agreement/index.html Quantum GIS:http://www.qgis.org/

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

10 My torchbearing experience

by Adam Cook, Specialist Information Anaylst I only really started to believe that I would be carrying the Olympic flame, when a week before my run date the tracksuit and details finally arrived. Before then it just felt like a crazy dream that I had been nominated to carry the torch, (one of only 20 NHS places nationally) and had been successful! But thinking about my keenness for sport and active participation, maybe it was no surprise! On trying on the tracksuit, it was clearly designed for my athletic physique and on the run up to the ‘big day’ I was often seen parading throughout my house with the torch in preparation (see photo to right).

I went with my family that weekend to try and see where exactly in Redhill I would be running and it seemed a nice spot, pretty flat and with the training that I had put in the run wouldn’t present a problem at all.

On the actual day I was due to be the torchbearer at 3:31pm, but had to be at the collection point for 1:25 pm. Traffic conspired against me and I was running (excuse the pun) a little late, which had me considerably worried because all the documents stressed that if you were late then they would go without you. As it was I did get there just on time, and actually needn’t have worried as the collection point was also that day’s stop off point so I had plenty of time to mill about and chat with my fellow torchbearers.

About ten minutes before I was due to run I was dropped off at the start point, torch in hand, and at that moment became public property. People came over to touch the torch, and thrust small children in front of me to have their photos taken. There were so many cameras pointing at me at any one time that it was difficult to know which way to look, although I quite liked the feeling of being a celebrity! Samantha managed to get in and have her photo taken with me (she is the boss after all!)

After a short while one of the officials came over on a bicycle, took me to one side and explained about the exchange of flame known as “The Kiss”, and that the flame was coming! The passing of the flame seemed to last for a long while but was only a few seconds in reality. Once my torch was lit, it was a quick high-five with the previous bearer and then I was off.

I went at a light jog, (we had been advised that this was most exciting for the crowd, but also I’m not sure that I could have gone any faster!) The crowd were fantastic. My family were there, the Quality Observatory were out in force, plus several other work colleagues and a whole host of strangers cheering me on and keeping me going. The torch started to feel heavy about halfway through the 300m, and I could feel the heat from the flame, so I had to change hands, but I kept on smiling and waving. I only wish that I’d paid more attention to the road when I’d come the week before, it was all uphill and the last few metres were steeper than I’d anticipated, so I had to slow down to walk for the last 10 or so metres, for my changeover.

Once the flame was passed over I was bundled into a coach with previous torchbearers and we followed the flame for the rest of the route via Reigate, Dorking and Westcott, where we turned round and went back to Redhill. That coach ride was just as incredible, because there was cheering and waving wherever we went. I spent the whole hour and a half smiling and waving out of the window.

It was a crazy day – one that I’m pleased and proud to have had the opportunity to be part of. It truly was one of those once-in-a-lifetime moments that people talk about. I was on a real high for days and days, arms aching from carrying the torch and my jaw aching from grinning so much! And yes, for those of you who are wondering I have been known to arrive at work in my Olympic outfit with my torch. That certainly turns a few heads!

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

11 The Olympic Torch

By Suzanne Gregg

From all corners of this Isle they came Each holding the symbolic creation of the flame As they travelled around our Isle We gave thanks to those who made us smile A representative of each generation The old, the young and the less able It was to be their time to shine Indeed it was their special moment in time For the NHS SoE (East) in Horley It could not be more special, surely?

With beaming smile and torch held high It was Adam Cook our Quality Observatory super guy!

Torch and Torchbearer Facts: The torch has 8000 holes, one for every torchbearer.

It is triangular in shape to represent the 3 times London has held the Olympics, the 3 parts of the Olympic motto; Faster, Higher Stronger, and the 3-fold vision of London 2012; Sport, Education & Culture.

It weighs one Kilogram, and is 800mm high.

The flame is able to withstand and altitude of 4,500ft above sea level.

Each Torchbearer carried the torch for around 300m with the torch, and it took Adam 2 minutes and 40 seconds to cover the distance, at that rate it would take Adam over 6 hours to complete a marathon!

For each of the 70 days of the Torch Relay around 110 people carried the torch.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

12

Trouble Importing CSV files into a database Application: mySQL Dear Ask An Analyst, Each week I’m sent a spreadsheet of data which I format, save as a CSV file and import into a local database.

I’m now trying to import the CSV file into our local SQL database, but having a few problems. I keep getting an error message saying ‘SQL Error (1261): Row 16 doesn’t contain data for all columns’.

I get the same message even if I delete row 16 or change the order of the rows – any ideas? There are some blank columns in the import file, but the database is set up to accept null values for these, so this shouldn’t be an issue.

Solution:

Complexity 3/5 — Formatting CSV for SQL import

Lets have a look at an example file. As you can see all the cells are blank for the last column (Column 5).

If you copy and paste this data into a text editor (e.g. Notepad) it immediately shows that only the first 16 rows have been saved with the commas at the end of the row (i.e the header column and rows 2-16).

After this point the end comma delimiters are missing. This is what is causing issues when trying to import the file into your database, as after row 15, column 5 (the end column) doesn’t exist, thus causing your import to fail.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

13 The problem is caused when saving the original Excel file as a CSV file and the way blank columns are dealt with.

Excel saves text files in blocks of 16 rows, so if all of the cells in the last column in a 16 row block are empty, these rows will be treated as if the last column doesn’t exist for those rows. The reason why your import seems fine up to row 16, is the header row ensures that the last column is taken into account for these rows.

One simple way round it would be to make sure that there is something in all of the cells in the last column (e.g Column 5) of your Excel file, before saving as a CSV. A space is a good thing to use as the column will still appear and will ensure that each row is given its end column. After doing this you should now be able to import the file.

Meet the Observatory— Doctor Quality interviews Kate Cheema Hello Katherine or can I call you Kate?, Hello Dr Quality, lots of people call me Kate so that’s absolutely fine. It’s a privilege to meet you!

Not at all Kate, the privilege is mine! May I start by asking how long have you been working at the Quality Observatory?

I joined the team in March 2007 as a Performance Analyst and remember my first day very well. There was a formal induction programme, the first meeting of which was with Kiran Cheema described on my programme as ‘Workforce analyst and husband’!! At the end of 2008, I was appointed as one of the 3 Specialist Information Analysts which has involved a diverse portfolio supporting improvements in different aspects of clinical care.

Thanks Kate, and what academic background do you have?

My first degree was in Psychology with Physiology at the University of Southampton, and then when I was on maternity leave with my second child I completed a Masters degree in Research Methods.

And which specific areas of work have you currently got responsibility for at the QO? Quite a number, I’ll focus on some key ones rather than list them all! I undertake a significant amount of work on safety and for some time now have supported the Safety Thermometer work at a national level. I lead on patient experience work, am a bit of an expert on mortality, have developed a wide range of analytical tools focussed on long term conditions and undertaken lots of work in the field of maternity. I spend a lot of my time out and about supporting front line clinical teams which is really satisfying as I get to see the impact that my work has on improved patient care.

Wow that’s busy! Do you have any spare time to enjoy?

Oh yes! I like spending my free time with my two young boys, and I also manage to fit in a fair amount of swimming and running. I also love music, it has to be said that I have quite a diverse taste from Metallica to Mozart’s Requiem.

Oh and I’m also a member of the Sherlock Holmes Society!

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

14

Analysis Ancient and Modern—John Tukey (1915-2000)

By Katherine Cheema, Specialist Information Analyst My first experience of John Tukey’s work was discovering that he coined the term ‘bit’ (a contraction of ‘binary digit’) whilst working with legendary computer science mind John von Neumann (who was instrumental in making Turing’s universal machine a reality, ushering in the modern computing age in the process, maybe he will grace the pages of KM in a future issue!), but his name is also associated with a slew of statistical tests that in my beer-hazed experience of undergraduate life I usually read as ‘Turkey’ tests. Not a promising start…

But in the world of practical application of statistical practices, Tukey is second to none in providing pointers to people who want to get the best out of their data. Principally, he articulated the important distinction between exploratory and confirmatory data analysis. So rather than just using statistical techniques to confirm a hypothesis, exploratory data analysis is an approach to analysing data sets to summarise their main characteristics in easy-to-understand form, often with visual graphs, without using a statistical model or having formulated a hypothesis. Tukey encouraged statisticians to visually examine their datasets, to formulate hypotheses that could be tested on new datasets. Here at Quality Observatory towers, this approach gives us much more to work with than the former.

Tukey himself summarised the approach as: It is an attitude AND A flexibility AND Some graph paper (let’s say Excel instead!)

“No catalogue of techniques can convey a willingness to look for what can be seen, whether or not anticipated.

Yet this is at the heart of exploratory data analysis. The graph paper are there, not as a technique, but rather as recognition that the picture-examining eye is the best finder we have of the wholly unanticipated.”

Tukey had a lot to say about the usefulness of visual representation of data and was also the developer of the box plot (see below). And as if he needed anything more to recommend him to readers of Knowledge Matters, one of his finest pieces of wisdom was: “There is no data that can be displayed in a pie chart, that cannot be displayed BETTER in some other type of chart”.

So hopefully you are in agreement with me that John Tukey was a truly great statistician!

Sam’s crazy long distance walks Earlier this year Samantha signed up for two long distance walks in support of Help for Heroes. The first of these took place on Sunday 12th August with a 20 mile walk along Hadrian’s wall. There were a fair number of ‘undulations’ as they were described! Sam took 7 hours 29 minutes to complete the walk and is now in training for her next walk on 16th September. This walk is 26 miles from Winchester to Salisbury.

To date Sam has raised £788 and aims to raise £1,000. There is still time to donate to this valuable cause. Here’s the link if you would like to make a donation: http://www.justgiving.com/Samantha-Riley

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

15

Commissioning Outcomes Framework developments

By Samantha Riley, Director of Information for Service Improvement From April 2013, the Commissioning Outcomes Framework (COF) will be used to hold Clinical Commissioning Groups to account for improvement in quality of healthcare and patient outcomes through better commissioning. On 1st August (following public consultation which closed in February 2012) NICE published the first menu of 44 new proposed indicators recommended by the Commissioning Outcomes Framework Advisory Committee. This menu of indicators will now be considered by the NHS Commissioning Board for potential inclusion in the 2013/14 COF. COF indicators are either derived directly from the NHS Outcomes Framework; based on NICE Quality Standards; or from other sources to support the NHS Outcomes Framework. As NICE publishes more quality standards, the range of clinical topics in the COF will develop.

The categories for the COF indicators are; Cardiovascular, Gastrointestinal, Respiratory, Mental Health, Endocrine, nutritional and metabolic, Maternity and reproductive, Cancer and tumours and Other/cross cutting.

Where possible, direct measurement of health outcomes by indicators has been explored.

However, as Knowledge Matters readers will know, measuring health outcomes can be a tricky business due to the availability of electronic data to support measurement. Therefore, where necessary (and just as the Quality Observatory would do), proxies for outcomes have been used that measure health care processes that are linked to health outcomes and that can be substantially influenced by clinical commissioning groups as part of their commissioning activities.

Where NICE COF indicators have been produced using existing quality standards, the process uses rigorous methods to ensure the development of valid and clearly worded COF indicators. In order to develop COF indicators from the existing quality standard statements and measures, further development and testing work with the Health and Social Care Information Centre has been undertaken to produce the indicators and accompanying technical specifications.

Where indicators are derived directly from the NHS Outcomes Framework or other sources, they will be assessed and tested for appropriateness to the COF through processes including the Health and Social Care Information Centre.

Details of the indicators are available on the NICE websiteâ&#x20AC;&#x201D;http://www.nice.org.uk/aboutnice/cof/cof.jsp

Quality Observatory COPD Dashboards featured in HSJ The Quality Observatory were very pleased to be featured in the Health Service Journal Long Term Conditions supplement published on 28th June. The article talks about how the COPD dashboards, developed by Nikki Tizzard at the Observatory, have been fundamental to making improvements in the care of COPD patients. The supplement can be accessed from the following link http://www.hsj.co.uk/Journals/2012/07/09/m/h/z/Long-Term-Conditions-supplement2012.pdf See page 10 of Knowledge Matters February 2011 to see a description of the COPD dashboards http://www.issuu.com/secqo/docs/knowledge_matters_volume_4_issue_6 And see the next edition of Knowledge Matters to learn about recent additions to the Quality Observatoryâ&#x20AC;&#x2122;s suite of respiratory dashboards.

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

16 Enhancing Quality & Recovery (EQ&R) Programme: Winner in Cardiac Care HSJ Nursing times Care Integration Awards

By Paul Carter , EQ Communications and Engagement Manager EQ&R is breaking new ground in the introduction of quality improvement metrics for full pathways for Heart Failure. Early indications suggest that improvements are being made in Heart Failure with reduced variation across the region and improved patient care and patient outcomes.

The quality of care of 4,880 hospital heart failure patients and 1,087 community patients has been measured across Kent, Surrey and Sussex: Quality has improved 54.29% (Composite Quality Score – CQS) to 76.01% across 10 Acute Trusts. Full care bundle delivery improved from 13.58% of patients in July 2010 to 51.11% in Oct 2011.

Patients receiving clear information about their condition and ongoing care are key to continuity of care, patient understanding and involvement. While not universally delivered across the region the numbers receiving this information has increased from a low 10.5% in July 2010 to 51.74% of patients discharged in October 2011.

In community personalised care planning improved over 5 months from 60.85% CQS to 80.4%; Optimum management, from 66.76% to 81.4%. The average proportion of the maximum licensed beta blocker dose has increased from 32.92% to 38.95% with ACE / ARB remaining static.

Improvement examples:



Development of dedicated heart failure ward



Creation of hospital heart failure register to rapidly identified patients wherever they are in the hospital and increased early involvement of community services.



Creation of new integrated specialist heart failure nurses, spanning both hospital and community.



Enhanced natriuretic peptide usage both for diagnosis in hospital and for risk stratification at the time of discharge.



Enhanced access to echocardiography.



Reduced admissions and delivery of savings. ‘How our BNP services saved £270,000 in a year’ Pulse.

EQ brings together Heart Failure specialist teams from Acute and Community settings for collaborative learning. Integrating care across delivery settings is essential to improving patient outcomes Using NICE Quality Standards and detailed underpinning metrics to measure delivery, EQ produces clinical information, on every patient every time (regardless of where they are admitted) it improves service delivery across whole pathways, spreads innovation and best practice rapidly and reduces variation in practice.

Quality.Observatory@southeastcoast.nhs.uk

www.QualityObservatory.nhs.uk

17 Accurate measurement of the care delivered was necessary to identify strengths and weaknesses and to quantify the impact of the implementation of changes.

The objectives:  to ensure every heart failure patient in hospital has appropriate diagnosis, management and appropriate information provided to them about their condition prior to discharge.  to ensure every patient has a continuing plan.  to optimise the ‘transfer of care’ between sectors  to ensure personalised care plans and patient held records meet ‘best practice’ standards and are completed with the patient within 2 weeks of discharge  to ensure drug management is optimised in the community  to ensure that end of life care is planned  to reduce variations in clinical practice and outcomes  to improve the patient experience Regional Clinical Leadership and expertise has been crucial, with Clinical Leads in each hospital and community setting forming the core leadership team supported by their respective organisational Programme Leads, who together created the appropriate local delivery team. The size and content of these teams was decided at local level, although sharing of practice at regional collaborative learning events allowed comparisons to be made.

Designing appropriate metrics using the evidence, gaining a clinical consensus and then having providers of the different parts of the pathway come together to review their respective performance against the metrics and how they can work together better in the interests of the patient. For example, a standard has been agreed across 17 providers for the ‘transfer of care’ between the acute hospital and community services, the clinical information that community nurses need to continue the care appropriately and how this communication can take place each and every time.

Collaborative learning provides the opportunity for HF clinical teams to share and discuss results with their peer group, to set objectives for their team in a “neutral” environment; to learn from others what works, what doesn’t and why and to have open discussions about improvement methods and innovative ideas.

The ability to benchmark results at individual clinician, ward or team level assists with peer review, the improvement cycle and identifying beacons of excellence or areas of concern. A clear data dictionary ensuring comparability and transparency of the data is key.

Patient experience measurement commences in May 2012 focusing at service interfaces and the patient’s perception of their information, their understanding and involvement.

For more information on the Enhancing Quality Programme, please visit http://www.enhancingqualitycollaborative.nhs.uk or contact paul.carter4@nhs.net. For more information about the Care Integration Awards, please visit http://www.careintegrationawards.com/424865

www.QualityObservatory.nhs.uk

Quality.Observatory@southeastcoast.nhs.uk

18

NEWS NICE Pathways - get involved

Quality Standards Advisory Commitee

NICE Pathways online tool provides quick and easy access, topic by topic, to the range of guidance provided by NICE and is intended to help you make decisions in your work. The NICE User Research team would like to give people the opportunity to review and test NICE Pathways and provide feedback. This will ensure NICE Pathways is developed in accordance with your needs.

Recruitment has now begun for a number of additional members to join the Quality Standards Advisory Committee.

Volunteers will be asked to take part in one-to-one sessions with a researcher. The session will take place at a time and place convenient to you. You can also opt to take part in the session online and by telephone.

If you would be prepared to take part, please contact: user.research@nice.org.uk.

Further details will be sent after contacting NICE.

They are looking to appoint several standing members including social care professionals, public health professionals and experts in measurement.

Information on the posts, including how to apply, is available on the NICE website. http://www.nice.org.uk/getinvolved/joinnwc/ join_a_nice_committee_or_working_group.jsp.

The deadline for applications to these posts is 25 September (5pm).

New Sexual Health Balanced Scorecard

Local Alcohol Profiles for England 2012.

The North West Public Health Observatory is pleased to announce publication of the Local Alcohol Profiles for England 2012 (LAPE), produced by them on behalf of the Public Health Observatories in England.

The profiles contain 25 alcohol-related indicators for every local authority (LA) and 22 for every primary care trust (PCT) in England. These indicators measure the impact of alcohol on local communities including local area data on alcohol-related hospital admissions and alcohol-related crime. The updated LAPE website also includes a new Atlas function that enables the user to view i n t er ac t i v e maps an d trend data.

A new Local Authority (LA) tool on the Sexual Health Balanced Scorecard has been launched. The online toolbrings together 20 sexual health related indicators for each LA in England.

The Primary Care Trust (PCT) indicators on the Scorecard have also been updated, as have related resources and links.

The tools have been developed by the South West Public Health Observatory on behalf of the Public Health Observatories in England. You can find them here: www.sexualhealthscorecard.org.uk

The profiles can be accessed online at www.lape.org.uk.

DH Informatics Publication The Department of Health (DH) has published an organisational summary that describes the role and functions of key organisations in relation to informatics in the future. ‘Informatics: the future’ incorporates the agreement for the establishment of a new Health and Social Care Information Centre to collect, analyse and present data and to deliver key national systems and services.

Child’s Play?

The London Health Observatory’s (LHO) latest publication of Child’s Play? can be downloaded from: http://www.lho.org.uk/Pages/viewResource.aspx? id=17927 The report marks the beginning of the Olympic health legacy and the commitments to reduce the gap in health and development between the children of the Olympic boroughs and London.

It can be found here: https://www.wp.dh.gov.uk/publications/files/2012/07/ Informatics-the-future_final.pdf

Quality.Observatory@southeastcoast.nhs.uk

The LHO would welcome comments on the new report via their enquiry desk: lho.enquiries@lho.nhs.uk.

www.QualityObservatory.nhs.uk

19

NEWS Cancer Outcomes and Services Dataset (COSD)

Information – to share or not to share?

COSD will become a full NHS Information standard across the NHS from January 2013. This has been led by NCIN in collaboration with the cancer registries, Cancer Networks and clinical experts.

Dame Fiona Caldicott is currently leading a review to ensure that there is the right balance in place between making patient information accessible to provide good, joined-up care and ensuring that it is secure. Further information about this can be found at:

The full NHS Information Standard for COSD will go live from January 2013. This will finally enable the collection and use of a standardised cancer dataset to support the challenge of improving patient outcomes, and providing cancer services which are amongst the best in the world.

http://caldicott2.dh.gov.uk/ .

Rebecca’s going on maternity leave

http://www.ncin.org.uk/collecting_and_using_data/ default.aspx

Rebecca Matthews, Performance and Planning Analyst, is going on maternity leave from 21st September. Most of her work will be covered by Charlene AtcherleySteers and Nazir Zarnosh, so please contact them if you need help with anything Rebecca usually deals with.

Good luck Rebecca!

Publications and Guidelines

Make a contribution to the newsletter

Several new publications and guidelines have been released recently. They include:

If you have an article you would like to submit or a topic you would like to write about, please get in contact with us: quality.obersvatory@southeastcoast.nhs.uk.

For more information see the COSD website:

Public Health England (PHE) establishment and transition process documents that include PHE structure factsheet and final geographies map sets. More information can be found here: http://healthandcare.dh.gov.uk/category/public-health

Olympic Watch Unfortunately the Quality Observatory had to support Team GB mostly from their sofas. However two lucky members got to go and see some of the action. Rebecca Matthews went to see weightlifting and Kiran Cheema went to watch fencing.

The ‘Care and Support White Paper’ was published on 11th July along with the ‘Draft Care and Support Bill’ and the ‘Progress report on social care funding reform’. More information can be found here: http://www.dh.gov.uk/health/2012/07/care-and-supportreforms/ The National Institute for Health Research’s (NIHR) School for Social Care Research has undertaken a largescale review of the evidence on support for people with complex needs. You can find out what the review found here: http://php.york.ac.uk/inst/spru/pubs/2225/

www.QualityObservatory.nhs.uk

Trolley Dolly Update….

Once again we have been making good use of the tea trolley. The goodies we have had since the last issue include; birthday cakes from Sam, apples, banana cake, healthy seed flapjacks, Brighton rock and lots of chocolates, including chocolate from Paris from Fats and a tin of Cadbury’s Heroes.

Quality.Observatory@southeastcoast.nhs.uk

Quality Observatory Birthdays Since the last edition we have celebrated two birthdays here at the Quality Observatory.

The first was Sam’s in July. To go with Sam’s new tea obsession the team bought her a selection of herbal teas and a giant mug! Sam treated the team to a nice chocolate cake.

The second was Naz’s in August. Naz received an iTunes voucher from the team and is still deciding what to buy with it!

Happy birthday guys!

Fascinating Facts

Olympic Poem

By Adam Cook, Olympic Torch Bearer 'Twas in the year of Twenty-Twelve that London held the games, A myriad of sportsmen both unknown and household names, From across the globe they came to the Olympics, the thirtieth so far, To test the human limits, and to try and raise the bar.

The General Medical Council granted temporary registration to nearly 900 doctors from around the world, for the treatment of athletes during London 2012.

France, Brazil and the US registered the most doctors (58, 50 and 46 respectively).

Swimming, jumping, throwing, running round the track, Rowing, sailing, lifting, riding on horseback,

Team GB have 18 doctors treating their 542 athletes.

Balls of different sizes were hit, and kicked and thrown, And a hundred different bicycles filled the velodrome.

The crowd they cheered loudly for whoever took the gold,

Simon says…….

And then cheered just as loud for last one thru' the post.

Records they were broken, and then broken once again, As new Olympic champions began their 4-year reign.

The athletes were indomitable, buoyed up by the crowd, Showing Best of British spirit, Team GB did us proud.

A spectacle unsurpassed, we may never see its like, Inspiring us to run or swim or get out on a bike.

Of all those different heroes bound for glory and for fame, The ones I like the best are the ones who carried the flame ;-)

You’ve probably seen while browsing on the internet HTTP status code “404 – Not Found” but did you know there was a humorous one on the official list of codes?

It’s “418 - I'm a teapot” and yes it has been seen on websites! http://en.wikipedia.org/wiki/ List_of_HTTP_status_codes

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