Apparently this statement of purpose is to take the form of a ‘common purpose framework’ and is scheduled to be published in May this year.

HSJ further reports that the Care Quality Commission, Monitor, the Local Government Association and the National Trust Development Authority are also lining up to add their signatures to said framework.

No mention of Clinical Commissioning Groups; which is interesting because I was rather of a view that it was CCGs who would bear the responsibility of making integrated care a reality. I thought that this was what commissioning and service transformation was all about? Indeed it is my understanding that there is a statutory duty on CCGs to consider the integration of health related services.

Driving to work this morning I was listening to ‘Start the Week’ on Radio 4. One of the learned guests recounted the following story about the sculptor Jacob Epstein. When asked how he made his bust of Ernest Bevin¹ look so much like the former Foreign Secretary, the sculptor said… “that it was simple. I took a big block of stone and chipped away all the bits that didn’t look like Bevin.”

So I decided to pen my own ‘common purpose framework’ for integrated care. It goes something like this…

When re-designing services around integrated care; jettison all the bits that don’t look like integrated care.

It’s a start … and it’s still only January.

¹ Secretary of State for Foreign Affairs 27th July 1945 – 9th March 1951

What has struck me, however, is the amount of consensus that is seemingly building on the subject of Integrated Care.

Sure there are shades of grey – probably more than fifty – but on the central premise of ‘is it a good thing?’ there would appear to be general agreement.

Whisper it, but I have even seen it written that “Integrated care is now a recognized paradigm for health care reforms around the globe.” ^[1]

The health commentariat also appear to agree that to do integrated care properly you need the data. Importantly this data needs to be joined up. Commissioning intelligence should be based on connected data and such data should be at the heart of the integration of health and social care.

Two recent articles in the Health Service Journal (HSJ) are worthy of mention. In ‘Lessons from Boston on Integrated Care’ (published 9^th January), Pam Garside talks about the “relentless use of data” by those involved in integrated care in Boston. She also talks about “the burgeoning opportunity to absorb data from multiple sources to the benefit of individuals and populations.”

In ‘The building blocks for integrated care’ (also published in HSJ on January 9^th), Rob Beardall writes about the importance of data being integrated across organisational boundaries. He states, “This shared data – effectively an electronic patient record – must be based on a single repository that allows complex decision logic to look across boundaries and identify gaps in care.”

In an NHS Confederation/RCGP report published before Christmas last year, titled ‘Making integrated out-of-hospital care a reality’ ^[2], I was particularly encouraged to see Johns Hopkins Adjusted Clinical Groups® (ACGs®) getting name checked. ACGs are specifically referenced as how organisations can use risk profiling systems to help identify those who should gain the most from an integrated care system. ACGs provide insight when run against joined up data.

So that’s good then …

Joined up data.

We are all agreed …

Joined up thinking.

So if this is the case; why, then, has all this proved so difficult to achieve?

It is tempting to look to the past and embark on a forensic analysis of the reasons for failure – NPfIT anyone? The result: naval gazing, hair shirts and more time lost.

Rather than agonise over past failings and opportunities missed, better surely to look to the future and design integrated solutions that address the problems of the ‘here and now’.

In terms of the data integration piece, there is no shortage of willing players. The NHS Information Centre (NHS IC) wants to do it. Newly created Data Management Integration Centres (DMICs) want to do it. Commissioning Support Units (CSUs) want to do it. Some Clinical Commissioning Groups (CCGs) may want to do it. The Private Sector certainly wants to do it and have I mentioned educated bees yet?

Importantly, if the patient is truly to be at the heart of the new commissioning paradigm, then the data needs to be joined up at a patient level.

It’s not as if we need a whole new tranche of NHS data sets to provide the insights required. We just need to make the existing ones work for us.

Furthermore when designing solutions we need to be cognisant of the new agenda for CCGs, which is concerned with localism. The clinicians who are going to make this happen operate at a local level, serving citizens and patients who live locally. The new system creates an environment where clinical leaders operate under assumed liberty.

Please, spare us from further dictacts from ‘mission control’.

Liberate (verb) 1. To give liberty to; make free

And yet, whilst everyone seems to argue that data is on the whole a good thing and intelligence is a pre–requisite to insight and better decision making, the reality on the ground is that battles still rage around data sharing agreements and information governance (IG).

A lot of talking, far less walking.

I understand the issues around patient confidentiality and IG. Honestly I do. But it occurs to me that the time has come for a mature debate around risks and rewards.

Of course the release of personal details into the public domain can damage lives and should never be tolerated. There are, however, also huge risks to entire populations of not linking the data at a patient level and not making it available to healthcare professionals who can make things better.

How many citizens and patients currently carrying long term conditions are receiving sub-optimal care as a result of the absence of connected NHS data sets and an integrated health and social care record?

As I say, the arguments will continue well into 2013 and beyond.

But at least we all agree that integrated care is a good thing and that integrated data and the relentless application of that data to secure better understanding and better healthcare outcomes is actually unarguable …

… don’t we?

[1] International Journal of Integrated Care – Nick Goodwin & Lourdes Ferrer (December 2012)

[2] Making integrated out–of–hospital care a reality / Royal College of General Practitioners and NHS Confederation (December 2012)

http://www.nhsconfed.org/Publications/reports/Pages/Integrated–out–of–hospital–care–reality.aspx

I have also been reflecting on an excellent article by Daloni Carlisle, Small is beautiful.

It is always a delight to be the recipient of a great and overpowering love; but I do question the unrequited nature of such emotions in reality.

And reality is the key here. Judge the policy makers by their deeds, not their words. A finely constructed sentence, delivered eloquently from a lectern needs to find substance on the ground.

Nonetheless I’m an optimist at heart and therefore I will feel the love. But if the NHS and SMEs are going to get this done, then we haven’t much time.  “Lovers ever run before the clock” [1]

We need leadership at the Centre; true visionaries who speak and act with authenticity and who are not afraid to fail.

Be assured such vision and leadership will be matched from within the SME community itself.

But if we SMEs are to be truly part of a brave new world then sitting back on the side-lines shouting “we told you so” is not enough. We must raise our game also. Indeed we have a duty to do so, because it may just be that our time has truly come.

Never before has NHS IT required the entrepreneurial spirit and creativity that is part of our DNA.

So to the policy makers and to our prospective customers I say, “Build it, and we will come.”

Then again, we never ever really went away.

[1]The Merchant of Venice – Act 2, Scene 6

To this end I have just finished reading a book called ‘Will It Make The Boat Go Faster?’ (Olympic Winning Strategies for Everyday Success)[1]. The principal author is Ben Hunt- Davis. Ben was part of the Olympic Gold medal winning rowing eight at the Sydney Olympics in 2000. It charts the team’s journey from ‘failure’ in Atlanta 1996 (8^th) to Gold in 2000. It is a riveting read on many different levels, but for me the most striking message is captured in the books title.

http://www.hunt-davis.co.uk/will-it-make-the-boat-go-faster/

The team set themselves a ‘simple’ goal: an Olympic Gold medal in 2000. To achieve this goal the team and the support crew designed strategies and agreed a set of behaviours that would help them win the prize. In doing so – and for every day of their journey – they asked themselves one simple question: “Will It Make the Boat Go Faster?” This question was to guide all their actions and behaviours over the four year period.  If the answer to the question was yes, they did it. If the answer was no, they didn’t.  When you think about it, it is a beautifully simple construct.

The other central message of the journey was attention to detail. Every activity and behaviour was analysed forensically. No stone was left unturned. Importantly, strategy and behaviours were governed and guided by the available data.

The result: Gold medal glory; world class achievement.

Soon after finishing the book I happened across an article in Computer weekly titled ’How Data Analytics Swept Team GB Sailors To Gold’.

The article describes how the British sailing team – Skandia Team GBR – used business analytics software to help them sweep up five medals at the London 2012 Olympics. It talks of how the team used data analytics to measure factors affecting the team’s performance. Over a four year period data was gathered and information garnered not only about the teams own performance, but also those of its competitors. The resulting intelligence enabled the team and support crews to draw up a profile of the team’s strengths and weaknesses. Every piece of available data from boat class to weather conditions to race officials was broken down with the aim of giving the sailors a critical edge.

Out of the water and on to terra firma, we have the story of British Cycling. Thanks to Dave Brailsford – Performance Director, British Cycling – we are now familiar with the concept of the quest for ‘marginal gain’. The principle of marginal gain comes from the idea that if you broke down everything you could think of that goes into riding a bike, and then improved it by 1%, you will get a significant increase when you put them all together.

And you just know that when Dave and the team weren’t ‘obsessing’ about the teams bed linen and hand washing habits, then they were pouring over the data and crunching the numbers in a bid to eke out every last piece of intelligence that might ‘make the bike go faster’. Their success has been underpinned by analytics and an obsession with the data. For Brailsford and the team there is a laser focus on the numbers to inform decision making.

The result: multiple gold medal successes on the track at successive Olympics – Beijing and London – plus Olympic Time Trial Gold at London. There is also the little matter of a Tour de France victory.

Bringing this closer to home I was much taken by a Briefing Paper from The Nuffield Trust that I came across in 2011. The paper ‘GP commissioning: insights from medical groups in the United States’[2] looked at the experiences of doctors’ groups in the US who for many years now have held the equivalent of commissioning budgets.

One of the key messages of the paper was the importance placed on data and the intelligence and insights generated by that data. When drawing lessons to be learnt, the authors are at pains to emphasise the substantial investments made in data collection, IT systems and analysts. One Medical Group Chief Executive Officer is quoted as saying: “Information is key. You have to have the data. You have to be able to analyse the data. You will not be successful in this venture without understanding the data.”

For those of us who have been working in healthcare business intelligence for the past twenty years, all these stories resonate and yet from where I sit there is clearly much more work to be done.

Of course it is not the I.T. itself that will make the boat go faster. However, the intelligence driven from the data surely must provide insights that can help healthcare commissioners achieve their goals.

Back in July this year, the BBC website ran a piece on Dave Brailsford and British Cycling. The title of the article was ‘Team Sky think of everything. You name it, they’re already doing it.’[3]

Wonderful to think that sometime soon – with intelligence to the fore – we might make the same claim for Team Commissioning.

For me the show was of particular significance as it fused two great passions in my life; sport and the NHS. I was particularly delighted that the good people at Great Ormond Street Hospital (GOSH) took centre stage as it was only a few months ago that my six year old daughter was under their care. And what care it was; pretty much faultless in every regard.

GOSH is a timely reminder of what world class healthcare looks and feels like and the Olympics instructs us in what it takes to deliver world class performance. World class performance is delivered by people not structures. World class performance is certainly not delivered by people whose mind-sets are narrow, insular and introspective. Success is attained through communal endeavour and driven by a unified vision that is forged through the interconnectivity of expert practitioners. Team GB is so called for good reason. In short if we believe in a better healthcare service for the future, we had all better work together to realise the vision.

If clinical commissioning is to play a part in that better future, then commissioning support needs to be truly that; supportive. The best commissioning support solutions will be driven by a coalition of the talents and we should embrace the notion that such alliances may be forged from the best that the public, private, third sector and academia has to offer.

No man is an island and one of the most telling images of the Olympics for me was when Bradley Wiggins – ‘fresh’ from gold medal glory in the Time Trial –  tore himself away from that garish throne in Hampton Court to seek out the friends and family who had helped put him there.

I talk a lot about the NHS family. The NHS has more friends than enemies and it will take the best, the boldest and the bravest – working together towards a common cause – to deliver gold medal performance. ‘Team Commissioning’ if you like.

We owe it to our children.

http://www.hopestreetcentre.com/

The conference in question was a ‘Platform’ event focused on the topic of “How to create commissioning systems that create good outcomes for homeless people”. Chaired by Professor David Colin-Thomé and hosted by Alison Holbourn, Chief Executive Hope Street Centre, I had been invited to present a vision for how actionable data could be turned into commissioning intelligence to support better health outcomes.

During the morning an array of speakers principally, though not exclusively, representing social enterprises in Liverpool and Leicester, presented on how they were making life better for the homeless communities they served.

Two of these speakers were Kevin and Tom. Kevin and Tom were once homeless. Both are ex addicts and both had transformed their lives with the help and support of a number of support organisations working with the homeless in Liverpool.

Kevin and Tom are now employed by the very organisations that had given them a lifeline, and they are actively involved in helping make life better for some of the people with whom they had once shared a street, a needle and a bottle.

At the end of Kevin and Tom’s ‘presentations’ (without the aid of PowerPoint I might add) I witnessed delegates in tears. I am not ashamed to admit that I was amongst their number.

This was truly transformational stuff, real life examples of better healthcare outcomes. Success stories that we should all celebrate.

Moreover it demonstrated just what can be achieved when organisations, and more importantly the people in them, join up and work together towards delivery of a shared vision and cause.

This was compassionate commissioning at its very finest.

This was integrated care writ large.

This was people recognising that whilst some of the answers lay within themselves, some of those answers were also to be found elsewhere. This was joined up people, demonstrating joined up thinking and taking joined up action. This was the power of partnership.

Lessons here methinks for everyone out there currently seeking to play a role in delivering commissioning support.

Nigel Slone
05:07:2012

So some months ago when I was first preparing this blog – and with a nod to James Carville – I had developed a nice line of reasoning, I thought, which spoke loudly about “It’s the patients stupid”.

Then John Appleby – Chief Economist, Health Policy at the Kings Fund – beat me to it when back in February of this year – in the Health Service Journal (23.02.2012) – he wrote a piece called “It’s the money stupid”.

As with much output from the Kings Fund, it is an excellent article and I would commend it to anyone with an interest in the current NHS reforms. And it got me thinking. What really lies behind these reforms? Is it about the patients (stupid) or is it really about the money?

My original intention was to focus on the importance of the patient as part of the reform agenda. It had occurred to me that the patient was getting rather lost in the continuing debate around ‘transition’, ‘assurance’ (process) and ‘organisation’. In my heart I think I still believe this and I hope to return to this theme in a later blog.

However last week I was reminded of the John Appleby article, and my thoughts came back to the question of money. Last week was a busy news week (Leveson, Murdoch, Hunt etc…), however the headline news was unquestionably the fact that the UK economy has fallen back into recession.

Even before that deeply worrying announcement, the new Chief Secretary to the Treasury – Danny Alexander – was announcing the need for Government departments to find a further £16bn savings. This represents a further 5% reduction in government departmental spending and I have seen no communications yet that suggest the NHS is immune from this further austerity measure.

By the middle of the week Professor Malcolm Grant – Chair of the NHS Commissioning Board – was briefing the Health Service Journal that, “There is going to be nothing by way of relief from austerity in the NHS for years to come, so we have to find new ways of doing things.”

Last month Anita Charlesworth – Chief Economist at the Nuffield Trust – was blogging on ‘What the budget means for the NHS?’ It is required reading. She makes it quite clear that the contents of the budget report have profound implications for NHS funding….”things look very tough, probably tougher than the current £20 billion efficiency target” she states. She concludes…”whatever happens, the NHS needs to plan for two more years of belt tightening and it needs to be prepared for them to be tougher than they are now”.

On a related theme, the Financial Times – also in March – was reporting that the £20bn ‘Nicholson Challenge’ could be looking more like £50bn challenge.

Which takes me back even further. To May 2010 in fact and the note left to his successor – David Laws – by the then Chief Secretary to the Treasury – Liam Byrne – which is said to have read… “Dear Chief Secretary, I’m afraid to tell you there’s no money left.”

So where is this all leading?

Well in simple terms these are the waters that the new clinical commissioners are navigating. In pure financial terms the waters are dark and choppy in both equal measures.

Of course for the Government, clinical commissioning is seen as the essential driver for delivering the efficiency savings demanded of the NHS. The vision is that they will do this by capping demand through service re-design. For my part, the elephant in the room here is de-commissioning.

But no sane government is simply going to put £65bn into the hands of a group of clinicians and simply let them get on with it.

The NHS Commissioning Board and its outposts will ensure that performance management and financial accountability is writ large across the system.

So what does this mean for emerging Clinical Commissioning Groups (CCGs) and Commissioning Support Services? (CSS) Well it means that these organisations had better get a grip on the money.

Which means of course that they need robust and reliable sources of data about the quantity, quality and cost of their activities. Furthermore the CEOs, COOs and FDs of these commissioning organisations need a precise understanding of financial risk.

Put simply information is key. You have to have the data and you need to analyse and understand that data. The era of Big Data is surely upon us.

So whilst we never forget that at the end of every piece of data there is a person, we also understand that at that same time there is inevitably a pound sign.

Maybe it is all about the money stupid?

Nigel Slone
30:04:2012

I did so because I think that at some point in any company’s evolution there comes a time when it is necesary to ‘step back’ and ask the question “What is our fundamental purpose? What are we in business for”?

I like to think there was a certain logic to the timing of the question. The current NHS reform agenda has of course created huge uncertainty,and this uncertainty touches all engaged with this iconic public service. In this regard the most important community of course is patients and carers, however suppliers and their customers are not immune from the ‘slings and arrows’ of what at times can feel like ‘outrageous fortune’.

The point of the question was to get everyone here at Sollis focused on what I believe we are really in business for and that is “to make a difference”. To make a difference for our customers and in the end analysis to make a difference for patients. In this sense we are very definitely not in the technology business. We are in the people business.

Now that is an easy statement to make, and it could be argued – with some justification - that any company in any realm of business could make the same claim.

But for Sollis it is particularly true. It is true because the NHS is the absolute focus of our operations. It is true because the products and services we supply to the NHS have to ‘add value’. In simple terms they must contribute to making life better. Better for our customers and ultimately better for the populations they serve. Better for patients.

Everyone here at Sollis understands that we deliver healthcare intelligence. But importantly, all of our people understand that at the end of every piece of data we present there is a person.