Comunicación serie PC-PIC con visualización a través de display LCD

Systems capabilities differed slightly between CCGs in terms of the IT systems used to gather information, but all had access to similar data sets, guided by the same centrally determined governance structures:

We have our own information . . . what patients have gone to hospital, what’s happened to them. Also we have a lot of information for secondary care. We can look at trends, emergency admission trends, elective admission trends. For long-wait domains we actually have an absolutely granular understanding of waiting lists to make sure we’re going to hit key targets.

CCG B, interview 1

The thorough nature of secondary care data sets was frequently acknowledged as enabling them to be particularly strong sources from which to acquire information. However, the ease with which CCGs could assimilate and transform these data into commissioning decisions was not as clear. Many respondents voiced concerns about their ability to use the information to fully guide their decision-making:

There’s an awful lot of data out there, but it never really comes back as intelligence and I see quite a lot of leaps of faith in terms of data to conclusions.

CCG C, interview 4

This problem was also articulated by a manager from another CCG, who noted‘we are awash with data, but probably not awash with information’(CCG B, interview 2). One reason for this barrier to assimilating the data was related to the centrally predetermined nature of the information, which was not always meaningful in terms of its representation of the CCGs’local population needs:

It’s not geared up around us as a CCG. It’s not really meaningful for us in terms of making decisions. CCG C, interview 3

This was further illuminated by respondents who acknowledged the benefits of using local information to commission in response to patient needs, but also reported barriers to doing so. For example, one GP commissioner was clear on the need for CCGs to commission according to local need:

You can’t use national statistics to drive what we’re doing locally because our patients have different needs and we need to build data up from the ground asking‘Well, what do we need for our patients? How should that look? How will it serve them best from a clinical perspective?’.

However, that same GP commissioner subsequently described the problems in accessing that information:

So one of the barriers we’ve met right now is we’re trying to get the data for local patients and it seems to be a nightmare trying to get the data. All sorts of people hold this data and say‘Oh well, for governance issues you can’t have this and you can have this. You can have the regional data, but not the local data’.

CCG A, interview 8

In addition to the concerns about the local responsiveness of data, there was a sense of distinct lack of information from community or tertiary services. This was a particular problem for commissioners attempting to reduce potentially avoidable elderly care admissions into hospital by ensuring comprehensive community care. Although secondary care providers could generate information about admissions, interventions and discharges, community services could only provide vague metrics that were not always seen as helpful for the commissioning process:

But for us as commissioners even if we have the data, we need to know is that a good thing or a bad thing? Well I’ve no idea. It doesn’t mean anything. We have information about different services provided . . . but the information is fundamentally a garbage metric whichever way you look at it.

CCG B, interview 1

Subsequently, the systems capabilities of CCGs were undermined by their reliance on data sets that did not provide comprehensive information about their service provision. This was also compounded by continuing central control, which could undermine the ability to commission according to local needs, as CCGs also needed to conform to centrally set priorities:

The National Commissioning Board have started saying‘These are your targets. You’ve got to do this. This is how you will do it’, and they’re starting to be very prescriptive.

CCG C, interview 7

However, despite the problems undermining the systems capabilities of CCGs, it was evident that there were also mechanisms in place to mediate these problems and enhance their capabilities. Most notable was the integration of clinical knowledge, through GP involvement, into the system:

They’re watching us really closely, but it does also still feel like we are in control . . . we listen to them, of course we do . . . but we’ve still got to use our patient data and everything that we know about them to drive intervention.

CCG A, interview 5

This was also acknowledged by a member of the management structure, who reported that the gaps in information with regard to service provision were less important when commissioning decisions were guided by the tacit knowledge of clinicians. This increased their systems capabilities and, subsequently. their commissioning capacity:

If I’m being honest, there’s probably some retro fitting of that information to the things that the GPs want to do. So kind of regardless of all of that analysis, from the experience of the GPs in their consulting room the key issue is with the elderly and we need to be more integrated.

CCG C, interview 1

Therefore, the involvement of clinicians within the data acquisition process could mediate the problems encountered as a result of their limited systems capabilities. However, unleashing the potential of that information also relied on CCG socialisation capabilities.

CONSTRAINTS OF SYSTEMS AND SOCIALISATION CAPABILITIES

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