Meaningful data for UK and international patients

 

The PHIN has recently published clinical outcomes data for around 1,000 consultants working in private practice in the UK. Approximately 25% of private hospital and consultant income in London is generated from international patients, and this data should help inform medical tourists in the future.

With the increasing move to providing value- rather than volume-based healthcare, countries across the world are facing a substantial task in putting reliable and accurate information about private healthcare outcomes into the public domain.
In the UK, the PHIN will eventually publish performance data for around 14,000 consultants treating patients privately.   The end result should see it become the UK’s first fully comprehensive online search engine for UK and international patients to look up clinical outcomes data by provider.

A total of 11 performance indicators, specified by the UKs Competition and Markets Authority (CMA), will be published at both hospital and consultant level. The measures include average lengths of stay per procedure; infection rates; mortality rates; readmission rates and adverse event rates.

Matt James, PHIN chief executive, expects that it will take another two to three years before all the data can be submitted ‘robustly’ and ‘fairly’ to the CMA, which mandated PHIN to collect data on private healthcare services after its investigation in 2014 found there was a lack of transparency for consumers.

Baby steps in the UK

PHIN says it has been cautious in setting deadlines for publishing its latest clinical indicators – the number of procedures undertaken by a consultant and length of patient stay – describing its progress since it was established in 2012, as a process of both ‘professionalisation’ and ‘maturing’ its capabilities. It admits it still has a lot of work to do regarding data quality and completeness, despite shifting more towards data insight. James says the sector initially did the bare minimum that was required, meaning PHIN has moved more slowly than the CMA would have liked.

The PHIN believes however that by developing a good relationship with hospital providers, insurers and public bodies, it has facilitated an effective process for liaising with consultants to quality check the data.  To be taken seriously, it also has to report this data to the same standards as the NHS and in NHS language.

A single reporting system for the UK

So, why has the private sector lagged behind the NHS in data reporting? According to James, some information systems designed to collect the data have never made it mandatory for independent hospitals to report in to, while others – such as the National Reporting and Learning System – have prohibited the participation of private hospitals altogether. He says, ‘There has been 70 years of the NHS doing one thing, and independent hospitals not being a system but being 200 different organisations doing their own things separately.’

Another reason why the private healthcare sector has had less of a reporting culture on clinical outcomes, said James, is that it has always revolved around payment processes with information systems that reside with the private medical insurers.

In 10 years’, time, James hopes there will be a single system for the collection of data for all regulated care services in England – and the UK – that is the same regardless of who is paying for it and who owns the hospital in which the care is provided.  This one system should ideally sit within the public infrastructure, such as NHS Digital.

Attitudes are changing

Recent pressures and scrutiny on the sector have contributed to a mood change among providers, in the form of a greater acceptance of the benefits of data transparency.  New CEO’s in the big healthcare provider groups have also brought with them a new culture of wanting to be seen to be doing the right thing and using data to evidence quality and support strategic intent.

This coincided with increased public scrutiny, influenced by the Care Quality Commission’s report on independent acute hospitals in April; and some high-profile safety failures in the sector. ‘Various public sector bodies are now saying that there is a public interest in seeing properly produced data about private healthcare that affects UK citizens,’ James says.

Quality assurance is a thorny issue

So far, PHIN said around 4,000 consultants, representing 40% of private admissions in the UK, have begun reviewing their private practice data through PHIN’s online portal. For the first time, said James, senior clinicians are participating in a ‘data cleansing’ procedure, and paying attention to the quality of information being recorded.

There is a two-fold process that PHIN has to be mindful of when quality assuring the data it receives: how good is the data coming in and how good is the data going out? PHIN recognises that bringing about meaningful information for patients and healthcare consumers is difficult. One reported complication of surgery, for example, does not necessarily constitute a bad surgeon or a bad hospital.

Hospitals are legally required to submit the data and to a reasonable quality and even if the quality of their data is good, we put it into our own system and then go back to them and ask them to review it before publication,’ James explained. ‘Everything we do we run past academics, stakeholders, specialists, consultants and say, ‘what would you make of this?’ It takes about 50 people to work on a project like this but we’ve got 23 so we’ve run pretty tight all the way through and we will expand our team to be at the right size at the right point.’

In February, PHIN published information on which providers were making the most progress in the collection and publication of health outcomes data, with Spire Healthcare at the time reportedly ahead of the pack, followed by Circle Health and the New Victoria Hospital.

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