Faced with the recession, demographic changes and rising expectations, the NHS is under increasing pressure to do more with less.
Rising to that challenge is likely to require health service managers to make greater use of business intelligence: information providing historical, current and predictive views about how their organisations operate.
"This sort of information helps people understand where there are opportunities for improvement," says Brian Derry, director of information services at the NHS Information Centre. "And in this particular environment, evidence-based change is imperative."
Primary care trust NHS Manchester uses business intelligence for two main reasons, says its associate director of information management and intelligence Mike Jones.
"One is to help us plan our healthcare, by looking at what has gone before, use of hospitals services, GP services and to tell us how people are using those services and where we can make changes to improve the care," he explains.
"The other is at an operational level, to look at how we are getting the most in terms of staff and that the quality of care we provide is the best it can be."
The trust uses a combination of in-house business intelligence applications, some of which are based on Access, and standard applications, particularly a Microsoft SQL platform and data mining software.
"Effectively that allows us to measure performance and then drill down into that measurement and look in more detail to perhaps understand where issues may lie," Jones says.
The trust is planning to use enterprise wide agreements between Connecting for Health (CfH) and Microsoft for the latest versions of SharePoint, which contain business intelligence tools to enable information to be presented in, Jones says " a more meaningful way".
Elements of the NHS National Programme for IT are helping business intelligence, says Jones, citing examples of the clinical dashboards initiative, to provide frontline clinicians and managers with high level information on the quality of those services. Meanwhile the Secondary Uses Service supports the collection of data about different NHS activities for commissioning PCTs, so that those data sets can be analysed locally.
Usually the NHS uses the same business intelligence software as the commercial sector – provided by SAS, Business Objects, Cognos and Oracle – according to Derry. He believes that implementation of major new software is unlikely: "The big players are already in place and they are continuing to develop their systems and tend not to launch brand new ones."
So where is the push for business intelligence coming from? "I don't think it's a push, it's a pull from frontline services," Derry responds. "People are constantly trying to improve their services, and yes money is part of it, but it is not the only thing."
Observing improvements
Lord Darzi's 2008 report High Quality Care for All has been a significant driver. It recommended that each strategic health authority should set up a "quality observatory" to develop existing analysis tools and enable local benchmarking and the identification of opportunities to help frontline staff innovate and improve the services.
Some SHAs have yet to launch observatories, but one of the first, the South East Coast Quality Observatory covering Kent, Surrey and Sussex, opened in April.
One of its first tasks was to find evidence about the impact of a specialist team in reducing MRSA infection rates. "So successful were the interventions the trust put in place, as evidenced by the analysis, that they were presented at an international conference," says Katherine Cheema, specialist information analyst at the observatory.
Cheema also says that an online peer review tool, to allow staff to assess how patients are treated with privacy and dignity in acute trusts, has help to raise awareness of possible problems and improve patient experience. "The tool allowed members of staff to assess standards in their own organisations, compare them with peer reviews and link them to action plans," she says. "The online delivery of the tool made it easier to access and meant that reviewers weren't reliant on email or paper based mechanisms."
In Brian Derry's experience the NHS is getting better at using business intelligence, partly because of technological advances. "If you went back five years even, the IT made this stuff very expensive and quite difficult to do, and that is no longer true," he says. "It is easier to implement, more cost effective and people have got more enthusiastic about an information based model of management.
"With all of that, and the present economic situation, I would expect demand for this to rise."
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