knowledge matters volume 2 issue 6

I N S I D E T H I S I S S U E

2 Data Quality

3 Patient Experience Tool

4 Making Links – NHS Institute

5 Unify 2 Developments

6 Professionalising Health Informatics Portal

7 Specialist Commissioning Library

8 Skills Builder – Designing a Dashboard

10 HCAI Dashboard

11 A3 : Ask an Analyst

12 Who’s who in the Quality Observatory

14 News and updates

16 Institute Tools and Christmas Quiz results

February 2009 Volume 2 Issue 6

Knowledge Management Team, South East Coast Strategic Health Author ity [email protected] nww.sec.nhs.uk/knowledge

Fascinating Fact Between April andDecember 2008 in SouthEast Coast acute Trusts: One man was treated for "Third degree perineallaceration during delivery"and another was treated for "Other specified pregnancy-related conditions"!

Welcome to Knowledge Matters By Samantha Riley

Hello and Happy New Year! It has been a really exciting start to the New Year for me.... I am writing to you for the first time as the Head of the Quality Observatory for NHS South East Coast. ‘What does that mean?’, you may be asking.

“High Quality Care for All” outlined the expectation of the Department of Healththat each SHA would establish a Quality Observatory which built on existinganalytical arrangements, to enable local benchmarking, the development of metricsand identification of opportunities to help frontline staff innovate and improve theservices they offer. There has been no nationally prescribed model for a QualityObservatory; instead the Department of Health has described the functions thatthey expect the Observatory to provide. As a consequence the models which areemerging across the country are quite varied.

Here at South East Coast, we have for some time had the Knowledge Managementteam. You will (I hope) be aware that we have developed a wide range ofbenchmarking tools and dashboards (nearly 40 in fact) which we have provided tolocal organisations to enable them to understand how they are performing overtime against a wide range of indicators. We have also worked with local cliniciansand managers to undertake more exploratory work in the field of clinical metrics –examples of this include the stroke and dementia metrics and Safer, SmarterNursing Metrics.

So, in many ways we already have a Quality Observatory established (so in someway minimal change for us). The context in which we are working has, however,changed and the formal establishment of a Quality Observatory provides us with afantastic opportunity to re-focus our priorities to ensure that the information thatwe are providing to local organisations really drives improvement in the quality ofcare that patients receive. We will continue to provide support to the local NHS inthe form of the provision of benchmarking information and measurement advice. Inaddition, we aim to work with local organisations to increase the ability ofclinicians and managers in the area of measurement and interpretation of data.Strong links already exist with the Public Health Observatory and GovernmentOffice of the South East – these links will be formalised and additional links made toother regional bodies and teams to ensure that maximum synergy between relatedfunctions is realised. The work programme of the Quality Observatory will beoverseen by the regional Quality Board (chaired by Candy Morris).

I would be really pleased to present to any local groups that would be interested tolearn more about the Quality Observatory and what we can provide.

This will enable me to gain a better understanding of how we can helpall of you to improve the quality of care that patients receivethroughout Kent, Surrey and Sussex.

I look forward to hearing from you!

Samantha Riley

Do you have something you would like to contribute to Knowledge Matters? Please contact us!

Knowledge Matters

Data Quality Dashboards & KPIs Lorraine Gray, Programme Manager, SUS/HES Data Quality

The Data Quality Dashboards are published as national resource to support the improvement and completeness ofCommissioning Dataset (CDS) data flows to SUS in accordance with published data standards. The dashboards also assistorganisations in preparation for PbR and 18 week monitoring through SUS, with regular reports on the quality of dataitems used in the PbR and 18 Week algorithms that enable the allocation of a national tariff or link records into Referralto Treatment pathways.

The promotion of data quality is a core work stream of the NHS Information Centre for Health andSocial Care (IC). In order to support the quality of Commissioning Data Sets for providers andcommissioners of NHS patient care, the IC has developed and continues to develop tools to reportprogress and status of data quality and completeness.

The monthly SUS CDS submission Key Performance Indicator(KPI) report reports on Commissioning Data Set (CDS)submissions to the Secondary Uses Service (SUS) in light of thefuture direction outlined in the 2008/09 NHS OperatingFramework (see left) "From April 2008, we expect providers to deliver initiallycoded datasets weekly to support achievement of the 18-weektarget, and comprehensively coded datasets monthly. Theseare expected to be through the Secondary Uses Service (SUS),as soon as each provider can make the necessary technicalchanges. This is in preparation for April 2009, when the NHSshould use SUS as the standard repository for activity forperformance monitoring, reconciliation and payments." [NHSOperating Framework 2008/09 - section 3.35]

Two versions of the Dashboard are available – one that allows theuser to drill down to Provider level data and one to Commissionerlevel data. The dashboards use CDS data submitted by providers ofNHS funded care for:

- Admitted Patient Care (APC) - Outpatient (OP) - Accident and Emergency (A&E)

The current dashboards are based on data submitted to SUS for2008/09 by the Month 8 PbR inclusion date (19/12/2008). Recentupdates include the addition of new data items 'Site of Treatment'and 'Neonatal Level of Care'. For specific validation rules applied tothese items, please use the 'more info for data item' button withinthe Dashboard. 'Neonatal Level of Care' has been included in order toassist organisations in preparation for the use of HRG4 in 2009/10, asrecords where this is null are considered invalid for grouping. " More information on the Data Quality Dashboards is available at http://nww.connectingforhealth.nhs.uk/reporting-services/data-quality

• KPIs 1.1-1.3 looks at the percentage of providers showing evidence of weekly CDS submission for APC, OP and AEdatasets.

• KPI 2 looks at the percentage of providers showing evidence of comprehensively coded monthly APC CDSsubmission.

• KPI 3 looks at the percentage of providers with 100% of APC CDSs sent using net protocol. • KPI 4 looks at the percentage of providers using version 6 APC CDS with key 18 week wait fields populated.

The KPI report can be downloaded monthly from the SUS What's New websitehttp://www.connectingforhealth.nhs.uk/systemsandservices/sus/whatsnew Interpretation notes are included on the "Notes" worksheet within the report.

Is there something that you wish you knew more about? To suggest future topics for knowledge matters contact the team

Knowledge Matters

Patient Experience First Steps Diagnostic Tool Jeremy Burrows, Assistant Statistician, Department of Health When we go into hospital, or visit our GP, it is a pretty stressful time and of course our number one priority is to havegood treatment and to get well. However, people also want to be treated with dignity and respect, to be listened toand to have a say in their care and treatment, and how local services can be shaped to meet their needs. TheDepartment of Health is committed to achieving sustained improvements in patient experiences as measured byindependently validated surveys. This is set out in the Department of Health’s PSA target 19.1 ‘The self reportedexperience of patients/users’. The Healthcare Commission is responsible for managing the national patient survey programme. The surveys areconducted among a sample of recent service users, and are completely standardised – all Trusts/PCTs use the samequestionnaire, select patients in the same way, conduct the survey at the same time, and analyse results in the sameway. This means that the experience of patients using services provided by different trusts/PCTs can be compared. So, how can a toolkit help? Analysts and policy leads in this area believe that organisations can make big improvementsin patient experience by focussing on a relatively small number of key areas. The sheer volume of data can make itextremely difficult to identify where those key areas are. With this in mind, the Department of Health has developed a‘Patient Experience First Steps Diagnostic Tool,’ to aid understanding of the available data sets. The tool concentrates on data from surveys across five healthcare settings and uses the latest available data : - Adultinpatients 2007/08; community mental health services 2007/08; primary care services 2007/08; outpatients 2004/05;A&E 2004/05.

The ‘Possible quick wins’ page automatically displaysthree questions for which the selected Trust performspoorly in relation to other Trusts. It also shows fourquestions where scores are low across most Trusts.Users are able to select up to six other Trusts forcomparison of scores. The ‘Comparison across the SHA’ page enables Truststo compare their scores, for all questions that make upthe domain and overall PSA scores, with other Trustswithin their SHA or elsewhere. Along with the selectedTrust’s score, the England average and SHA averagescores are given for comparison.

If you would like to download the tool, please go to the following link. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091660 The tool will be updated as and when new survey data is available (new data for the A&E 2008 and Adult Inpatients2008 surveys will be available soon). Keep an eye on Knowledge Matters for further news. I hope that you find the tool of use - comments or suggestions for improvement are most welcome as we really do wantthis to be a useful resource for the NHS. Here is my e-mail address [email protected]

The tool is really easy to use. From the ‘Start Here’page users can select their organisation type, theirspecific organisation and the survey of interest. Thepage then displays all the questions used to calculatethe domain and overall PSA scores. Users can 'drilldown' to the individual questions for each domain tosee how the scores are built up and can easily seewhich questions they need to improve upon toincrease their score. The two most recent years ofdata available are shown where possible. Charts showthe selected Trusts score against the 80th percentilescore.

Select your organisation type:

Choose your organisation:

Then choose a survey:

Overall scores - click on a 'domain' to see how the score is built up:

OVERALL DOMAIN SCORES 80th percentile

Trust Score

2006/07 Data

Access and waiting 87 82 85aw

Safe, high quality, coordinated care 68 67 66shqcc

Better information, more choice 69 67 64bimc

Building relationships 85 83 85br

Clean, comfortable, friendly place to be 80 80 81ccfp

Overall 78 76 76Overall

DATA MINING On this sheet you can drill down from the national patient experience scores. For example, you can look at the headline scores included in plans for Vital Signs and drill down to see which survey questions feed in to those scores. Use this sheet to find out which survey questions feed in to the national scores and to identify the question areas where you might focus attention to improve the overall score.

2007/08 Data

Domain scores against 80th percentile

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80th percentile Trust Score

Inpatient 2007/08

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Aintree Hospitals NHS Trust

Acute trust

The ‘Chart data’ page allows users to select individual questions to be charted from their chosen survey. A bar chartdisplays data from the survey and, where possible, the previous year’s survey for trusts selected from the ‘Possiblequick wins’ page. Lines indicating the England average and the 80th percentile scores are also shown.

Select the question you would like to chart from the Inpatient 2007/08 survey

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Q9: How do you feel about the length of time you were on the waiting list before your admission to hospital?

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Inpatient 2007/08 survey Inpatient 2006/07 survey80th percentile (07/08) England average (07/08)

Q9: How do you feel about the length of time you were on the waiting list before your admission to hospital?


Knowledge Matters

Making Links – NHS Institute Martin Samuels, Head of Commissioning for Health Improvement

‘All too often healthcare managers and leaders see data as the beginning and ending of the journey. They live and die by numbers. The data allow us to set our improvement journey, not define an end to the journey.’ Dr Robert Lloyd, Executive Director of Performance Improvement for the US-based Institute for Healthcare Improvement

Measurement for improvement

The latest Operating Framework describes measure for improvement as ‘an important priority for all NHS organisationsand staff in 2009/10’ (p 25) and here at the NHS Institute we offer a programme built around improving technicalcapability in this area.

It is one part of a broader commissioning work programme that is currently being negotiated with the ten Strategic HealthAuthorities for the 09/10 financial year. In addition to improving technical capability in a range of areas, we can alsooffer support in the areas of enabling change and working with partners. We also signpost to other support and guidanceavailable to commissioners, see www.institute.nhs.uk/pctportal

Improving technical capability in measurement for improvement

The NHS Institute currently offers a powerful combination of data tools and a development programme – Turning data intoinformation for improvement.

We provide a wide range of data tools – please have a look at the back page of the newsletter for a summary of what iscurrently available.

In September of last year, we launched Turning Data into Information for Improvement, a six-month development forStrategic Health Authorities, Primary Care Trusts and their partners. We are privileged to be working with Dr RobertLloyd, Executive Director of Performance Improvement for the US-based Institute for Healthcare Improvement, who leadseach of the three workshops. Bob is the only person that I know that can make statistical process control exciting; he isan excellent communicator and a great teacher.

Over the last five months we have been joined by over 600 individuals who have engaged in thought provokingconversations about aim statements, driver diagrams and variation. They have also provided our logistics team with afair number of challenges! Not only are we taking our participants on a learning journey, but after each session inLondon we travel en masse to Manchester to get ready to meet our colleagues from the north of the country. We spendthe journey reviewing the feedback forms to identify any improvements that we can make to day two – that’s assumingwe all manage to get on the same train! Colleagues from NHS South East Coast are playing an active part in applying the principles at a local level and we aregrateful for their contribution to the development of support material. We are currently exploring the potential to workmore intensively with selected PCTs across the country to learn how best to embed the science of improvement incommissioning organisations. I’m really excited about where we have got to and look forward to working with you all more closely as we turn datainto information for improvement For more information about the NHS Institute’s work in commissioning go to www.institute.nhs.uk/commissioning oremail me [email protected] - I am happy to put you in touch with a member of my team to discuss anyaspect of our work in more detail.

Dr Robert Lloyd

When we set out on this journey early last year, we knew that world class commissioningwas placing greater emphasis on a sound evidence base and that a greater level ofsophistication was required in the use to which data was put. The NHS typically uses dataas a tool for performance management, rather than as a tool for service improvement.We wanted to create a movement that challenged that. But we didn’t want to provideonly a lesson in theory; we wanted to deliver a practical programme that enabled realprogress to be made on local challenges.


Knowledge Matters

Hello and Happy New Year! In this issue I am aim to provide you with an overview of forthcoming developments to improve Unify and make your lives easier! Plus update you on progress made over the last 2 months.

Unify 2 Developments …….

Dianne Tew, Department of Health

PEXIS (Patient Experience) The Patient & Public Empowerment teamare keen to store Pexis data within Unify2.This will enable patient experience data tobe compared and combined with other datacollected by Unify2. Central Contracts Management Unit(CCMU) The CCMU collects data from IndependentSector Healthcare providers. In the future,we hope that this data will also becollected by Unify2.

UNIFY2 Enhancements I am pleased to report that the Information Systems Programme Board (ISPB) board met at the end of January andapproved Phase 1 of the proposed enhancement project. Improvements in the following areas are included in thisphase of the project – we believe that these improvements will make a significant difference to all of you who use Unifyon a regular basis :

• Improvements to the status reporting of data entered into Unify2; • Performance tuning and improved functionality in the View/Manage module; • Greater control over when the NHS can upload data into the system; • Efficiencies in the management of user accounts to reduce errors and improve security; • More flexibility in the administration of user forums; • Automation of the “un-collect” process that allows collections to be rolled back to Provider level, allowing re-

submissions; • Access enabled for a wider NHS audience; • Improvements to the processes for data revision and the migration of data into the system; • A comprehensive and definitive set of testing scripts for the system, together with training and guidance

material We are proposing a second phase of the enhancement project which will incorporate more strategic changes to Unify2that will improve the performance and scalability of the system to cater for the current and future growth in demand. Iwill tell you more about this in a future issue.

Report library problems A number of problems raised in respect of the report library have nowbeen addressed. Seven of the 10 previous period’s logs have beencompleted and are now live. The final two library logs are planned tobe part of the March release. The January release contained fixes foranother two logs relating to the report library. As a result of thiswork, feedback from users suggests that the report library hasbecome more stable and easier to use. If you are still experiencing problems, please do contact the Unify 2 Inbox : [email protected] Quick place Quick place is a collaborative working tool which we think could bereally helpful to Unify users as it can store a range of documentsrelating to the day to day management of Unify2 and other usefulinformation in one place. We have begun to populate the Unify2Quickplace with Unify2 News and other supporting documents. Wewill be testing this out with selected users and then hope to provideaccess to all Unify 2 users later in the spring.

Again, can I please take this opportunity to remind you all to please continue to log your queries with the Unify 2 [email protected] If you have forgotten your password or need a Unify 2 account created, you can contact RebeccaOwen or one of her team (contact details appear on page 13).

Coming soon to Unify 2 …..

The number of outstanding logs are at thelowest level since Unify2 was launched inMay 2007. There are currently 59 logs onthe Unify2 Logs database. Progress is now being made in reducing theoverall number of logs.

Good news


Knowledge Matters

Professionalising Health Informatics Portal By Jackie Smith, Health Informatics Development Manager

Background As the development of Health Informatics has progressed and development opportunities and materials have multipliedgrowing need was identified for an online ‘one-stop shop’ facility containing information and links to all Health Informaprofessional, personal, educational, training, leadership and managerial development opportunities.

Further development The content of PHI will continue to be regularly reviewed and increased, withadditional pages being added over time. The Learning Web has also been designedto enable further sections to be added. Find out more The best way for users to familiarise themselves with PHI is to explore the resource,as there are likely to be topics of interest to all. These include subjects likementoring, networking, leadership, career pathways and the development ofessential IT skills. To find out more visit PHI by following this link:http://www.connectingforhealth.nhs.uk/phi.

Introduction The aim of the Professionalising Health Informatics (PHI) portal is to provide anonline facility, a 'one-stop shop', containing information and links to HealthInformatics professional and personal educational, leadership and managerialdevelopment opportunities. It has been developed in response to an identifiedneed for the availability of a single URL for individuals and organisations, providingaccess to information on personal and professional development activity in HealthInformatics.

In order to ensure the success of PHI and deliver a consistent and quality assured onlineresource, we need the support of everyone working in health informatics to help identifyrelevant, up to date content. The interests of the PHI audience are key to determiningits content which is why you are encouraged to use the feedback facility to forwardsuggested changes and additions. If you would like to bring a subject to our attentionplease send details using the feedback form under the Contact Us section:http://www.connectingforhealth.nhs.uk/phi/about/contact-us

PHI is hosted on the NHS CFH website and the project team has worked closely with the NHS Connecting for Health teamplan and develop this online facility, which was launched on Friday, 9 May 2008.

• A comprehensive single point of access, an online ‘one-stop shop’ for all HI-related development opportunities; • Primarily an information filter, rather than duplicate information available elsewhere, PHI signposts users to

original sources ensuring latest versions of resources and information remain with and are owned by theoriginator;

• Main sections: About Us, Personal Progression, Hot Topics and Useful Links; • Key Resource – the Learning Web.

Hot Topics Content 'of the moment' is available through this section of PHI. References will change to reflect key topics at the time, or new development opportunities in Health Informatics

The content of PHI will continue to be regularlyreviewed and increased, with additional pages beingadded over time. The Learning Web has also beendesigned to enable further sections to be added.

eSpace is a community basedtool dedicated to improvinghealthcare by encouragingmembers to share theirexperiences of technologyenabled change. Communities are groups ofpeople with a common interest,including R&D, technologies andmany more. You can join acommunity by clicking on theCommunity Insights tab - justclick on a community link torequest access. There are loads of links to news and events that can affect all Health Informatics professionals; registration is free. Check it out at: http://www.espace.connectingforhealth.nhs.uk/

On-line communities…


Knowledge Matters

National Library for Health - Specialist Commissioning Library Trudy Turner, Library and Knowledge Services Manage, Kent and Medway NHS & Social Care Partnership Trust & Eastern & Coastal Kent PCT I would like to tell you about a unique on-line information service which will help PCTs commission effectively. Commissioning health services is an increasingly important and complex task. Commissioning teams have responsibilitiesranging from assessing population needs and prioritising health outcomes, to procuring products and services, andmanaging service providers. The Commissioning Specialist Library (CSL) is a new, online information service delivering 24/7desktop access to timely and high quality information and knowledge resources for anyone with an interest in, orresponsibility for, commissioning for health and wellbeing. The CSL, managed by The King’s Fund, offers guides on the various types of commissioning and brings together resourceson commissioning processes and competencies such as collaborative working or engaging the public, as well as advice ondeveloping knowledge and skills.

cations as well as a useful little set of legal references. There are signposts to comparative, demographic, episode, financial and performance statistical resources and, if you click over into commissioning competencies, supporting materials for everything from financial investment to stimulating the market. New additions to the site are highlighted, but if you aren’t going to have time to visit too often, why not sign up for an RSS feed to alert you of the very latest resources available? To be an excellent commissioning organisation, you have to be a learning organisation, right? Have a look at the CSL’s handy list of professional journals accessible via your desktop. Titles include Development and Learning in Organizations, Leadership and Organization Development Journal and Public Management Review. Electronic journals can be tricky to access, and for many you will need an NHS Athens account. Ask your local health librarian to demystify electronic journals for your commissioning team to promote active learning and engagement with the evidence base in its broadest sense. Find your local health library service at the following link http://www.library.nhs.uk/mylibrary/default.aspx As a frequent user of many web based knowledge resources, I sometimes longed for more ‘overview’ information for each subsection of the site – instead of being launched straight into the resource collection for each site area. Some people, especially busy commissioning teams, may not agree and may argue that the 3 clicks rule (If users can't find what they're looking for within three clicks, they're likely to get frustrated and leave the site) matters more. Also, in places, the content of this site seems to work against the rigid specialist library website structure, with case studies crow-barred into the guidance and pathways tab for example. The patient information tab often feels underused and therefore slightly pointless. However, the site is a wonderful collection of genuinely mission critical information resources. I would urge you to visit and browse the full content. Then, set up your RSS feed to receive regular updates from this valuable new resource. For help and support in making the best of the CSL, and converting the many useful online information resources into a usable business asset for your commissioning team, contact your local NHS Library Service!

The CSL offers Key Topics - brief summaries and links to useful sources of information on some tricky subject areas, including demand management and transformational change. It also provides a stash of Toolkits to help with many commissioning challenges. The anticipating future needs toolkit, for example, provides a proven, consistent methodology for consultation on the future care needs of older people in the local community. Dig deep, and there are some great nuggets on this site. Some time-saving model job descriptions and person specifi-


Knowledge Matters

Skills Builder – Designing a Dashboard Charlene Atcherley-Steers and Nia Naibheman Performance Analysts, South East Coast SHA

I am sure you have all been wondering how we create such beautiful dashboards. Believe it or not, it is muchsimpler than you think. Especially if you follow our step by step instructions. If you are unsure of what a dashboard is here is a simple definition: “A visualisation tool that provides graphicaldepictions of current key performance indicators in order to enable faster response to changes in areas” In just three articles we will cover an in-depth guide on how to make your own dashboard. In this first part, we willdiscuss the design of your dashboard including graph types, colours and the types of questions that a dashboard canhelp you answer. The second part (in April) will cover the data sheet behind your dashboard and the final part (inJune) will bring it all together. Before you can start to create your dashboard you need to be clear about its purpose. Are you trying to compareperformance across a range of organisations? Or actual performance over time against a plan or target? Or, are youtrying to gain an understanding of how a range of indicators might be inter-related? This really is the mostimportant part of your dashboard design. If you don’t know what you are trying to answer, a lot of time willpotentially be wasted on the development of a dashboard which doesn’t tell you what you want to know. For thoseof you who are not analysts, we would recommend that you sit down with your local analyst at the very start andhave a discussion about what you are thinking of – by doing this you should end up with a better product. Let’s have a look at a few examples….. For a simple question such as ‘What percentage of GP’sare offering extended surgery hours’ we use a simpledashboard (right) which the target percentage (in blue)and the actual percentages reported each month. AtSHA level, we are interested in all PCTs (we have 8) sowe have a graph for each of these. A PCT may beinterested in how other local PCTs are performing, butwould also want to have a look at individual practiceperformance. Some of you may simply view this data in a table orspreadsheet. One of the problems with this is that it

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BRIGHTON & HOVE EAST SUSSEX DOWNS & WEALD EASTERN & COASTAL KENT HASTINGS & ROTHER

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MEDWAY WEST SUSSEXWEST KENTSURREY

PERCENTAGE OF PRACTICES OFFERING EXTENDED OPENING 0809 Vital Signs Target

Actual Monthly Figures

Some areas are more complex and therefore require amore sophisticated dashboard. A good example of thisis 18 weeks. Here’s our weekly PTL commissionerbased dashboard (left). We are using a broad range ofindicators – all of which directly impact on achievementof 18 weeks. By viewing the indicators together, wegain a richer picture of how an organisation isperforming in this area. Here we are using a range ofdrop down boxes which enable the user to select theview that they are interested in – e.g. admitted or non-admitted patients, different providers. Again, we cansee actual performance over time against the target.Colour is used to differentiate between time bands onthe bottom right hand graph.

can be difficult to identify trends. The benefit of a data table is that it provides you with the exact values which maybe difficult to identify on a graph. If precise data values are important to you, we would recommend using a datatable in addition to a graph showing progress over time.

Have a look at the dashboards section of our website (nww.sec.nhs.uk/knowledge) for more examples of dashboardsthat we have created.


Knowledge Matters

Another example of a more complex dashboard is the provider based stroke metrics dashboard which Simon hasrecently completed. Drop down boxes enable different types of patients to be included/excluded in each graph. Additional information is provided on the

top left hand corner of the graph – here wecan see what types of stroke unit areavailable at each hospital site and also howeach organisation performed on thesentinel audit. The large graph is an SPCchart – this shows the length of stay forindividual patients, colour coding adds anadditional dimension by indicating whethera patient were discharged alive or died. Some colours have preconceived meanings,for example using Red, Amber and Greenare commonly used to indicate bad, ok andgood respectively. So if you are showingsomething good try not to use red!Consistency is imperative, keep the colourscheme the same if possible on each chart,

selection. Placing the drop down box above a chart should tell them that it changes only that chart. It is alsoimportant that you size the boxes appropriately so that the whole line of a selection can be seen. These features provide a good foundation for a dashboard. But as we explained at the start, one of the mostimportant steps in dashboard design is being clear about it’s purpose – please please do take time to think thisthrough and plan your dashboard design with your local analysts In the next edition we will be explaining how to create the data sheet that drives your dashboard. In the meantime,if you have any questions on dashboard design (or can’t wait until April for the next instalment), please do get intouch with one of the team – we would be more than happy to help and advise you. Finally, we do have a large number of dashboards already created – log on to the website (remember that you needto be registered as a user) and have a look – you may get some good ideas about the type of dashboard design whichwill best support your needs. See you in April!

aA bB CC DD eE fF gG

hH iI jJ kK lL mM nN

Admissions

0

20

40

60

80

100

120

140

04/0

5 Q

104

/05

Q2

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5 Q

304

/05

Q4

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6 Q

105

/06

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305

/06

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06/0

7 Q

106

/07

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306

/07

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8 Q

107

/08

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8 Q

307

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Mortality

0%

5%

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5 Q

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7 Day 30 Day

Nat 06/07 7 D Nat 06/07 30 D

% Patients With CT Scan / MRI Scan

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10%

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30%

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100%

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/06

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6 Q

305

/06

Q4

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7 Q

106

/07

Q2

06/0

7 Q

306

/07

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07/0

8 Q

107

/08

Q2

07/0

8 Q

307

/08

Q4

CT Scan

CT Scan 01

Target

% Discharge Destination

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10%

20%

30%

40%

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/05

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6 Q

105

/06

Q2

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6 Q

305

/06

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06/0

7 Q

106

/07

Q2

06/0

7 Q

306

/07

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07/0

8 Q

107

/08

Q2

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8 Q

307

/08

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UPR CH / NH

Other Hosp DiedOther

Length of Stay (Days)

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/06

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305

/06

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/07

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7 Q

306

/07

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07/0

8 Q

107

/08

Q2

07/0

8 Q

307

/08

Q4

All LoS

UPR LoS

Nat All LoS

Nat All LoS UPR

Total Value of Activity 000's

£0

£100

£200

£300

£400

£500

£600

04/0

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104

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04/0

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304

/05

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6 Q

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/06

Q2

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6 Q

305

/06

Q4

06/0

7 Q

106

/07

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306

/07

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8 Q

107

/08

Q2

07/0

8 Q

307

/08

Q4

Average Value per Spell

£3,800

£4,000

£4,200

£4,400

£4,600

£4,800

£5,000

04/0

5 Q

104

/05

Q2

04/0

5 Q

304

/05

Q4

05/0

6 Q

105

/06

Q2

05/0

6 Q

305

/06

Q4

06/0

7 Q

106

/07

Q2

06/0

7 Q

306

/07

Q4

07/0

8 Q

107

/08

Q2

07/0

8 Q

307

/08

Q4

Ashford & St Peters Hospital Trust Stroke Dashboard - All Patients - ICD10 I61-I64

% Stroke Patients Admitted from UPR & Discharged to UPR

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04/0

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6 Q

105

/06

Q2

05/0

6 Q

305

/06

Q4

06/0

7 Q

106

/07

Q2

06/0

7 Q

306

/07

Q4

07/0

8 Q

107

/08

Q2

07/0

8 Q

307

/08

Q4

Site

National

Most Recent 100 Patients Run Chart

0

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17/1

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24/1

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28/1

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31/1

2/07

06/0

1/08

11/0

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17/0

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27/0

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Day

s

Alive Died Unknown Mean 10.7 UCL 46.5

ASURSUCSU Sentinel Overall 08 vs 06

T M B

Exclude I60 - Subarachnoid Haemorrhage

further more make sure that the background colour scheme doesn’t drown out the foreground. Some national benchmarks are provided on the stroke dashboard. We’d recommend that you include nationalcomparators where at all possible. The national average can be useful, but indicating performance within differentquartiles adds even more value. It isn’t possible to obtain national comparators for every single indicator and youmay have difficulty in tracking national comparators down. This is an area that we can potentially help you with –please make contact with one of the team who will help you out. If you have labels on your chart make sure they are readable, although itis easy to get carried away with fancy fonts it may not always be easy toread and defeats the purpose. A good rule to keep in mind is that anyinformation on a dashboard should be adding value and providing the userwith additional, relevant information – meaningless distractions are nothelpful and should be avoided at all costs. If you need to show a key on your chart then the positioning is alsoimportant, again try to keep it consistent across all charts so the user cansee easily which chart it relates to. The aim of the dashboard is to make iteasy for the user to ‘read’ and navigate. Positioning of the drop down boxes is essential in giving a guide to the useron how they work. Placing the drop down boxes at the top will lead theuser to believe that the whole dashboard will be affected by their


Knowledge Matters

• Only MSRA bacteraemia (blood stream infections) are monitored

• Antibiotic resistance makes it difficult to treat

• Killed by alcohol hand gel

• Over 85% cases occur in the

65+ age range • Produces spores that can

stay dormant on surfaces until ingested

• Only effective hand washing will get rid of it!

HCAI Information Katherine Cheema, Specialist Information Analyst

These are ambitious and high profile targets relating to animprovement programme that benefits from analyst input,enabling effective surveillance and ultimately governance. Arecent HPA/DH publication has recommended that trustsimplement antimicrobial management teams, stating clearly thatan analyst be part of that team to effectively monitor andfeedback on antimicrobial prescribing. The code of practice forthe prevention and control of HCAI (part of the Health and Socialcare Act, 2008) also specifies the requirement for analyticalcapacity in Infection Control Teams. There is an SHA wide HCAI dashboard containing data on ratesand cases, and a forecasting module. This is updated monthlyand is available on the KM website under the banner of clinical information and patient safety. I’m the HCAI information lead and I’m keen to develop a network of analysts who areinterested in this area so please get in touch if you think you might fit the bill! E-mail me at [email protected]

The main data source for HCAI is the HPA Surveillance database (also referred to as MESS,which stands for MRSA Enhanced Surveillance System) which is updated by acute Trusts.And here is where things get tricky……not all incidences of HCAIs (in this case defined asMRSA and C.Difficile) are acquired in a hospital but it is almost always a hospital basedlab that carries out tests and report cases. So, how do we decide what has been acquiredinside hospitals (trust acquired) or outside hospitals (community acquired)? Well, the definitions have been fought out by the microbiology people; there are twodifferent definitions for MRSA and C.Difficile: For MRSA if a person has tested positive for a bacteraemia (blood stream infection)less than 48 hours after they have been admitted then the case is consideredcommunity acquired

The issue of healthcare associated infections (HCAI) is a big priority for the NHS and there are pledges in place from theDepartment of Health, the SHA and HM Government to decrease incidence in a big way. As it is not currently possible tomonitor all infections, the focus has been on two: MRSA and Clostridium Difficile, both very nasty little bugs (see theboxes!). As with all targets in the NHS there is an expectation that Trusts, PCTs and SHAs monitor progress against agreedtrajectories very carefully and provide assurance to all that issues are being dealt with.

In both cases, the HPA considers cases where patients have not been admitted to theacute Trust (e.g. are diagnosed in A&E or a PCT run hospital) as community acquiredUNLESS (yes, unless) they had been admitted in the previous 28 days (in which case itcan still be acquired in the acute hospital). In reality, it is difficult to measure time elapsed based on hours and the calculation isactually based on calendar days; this can cause some confusion when reviewing casesso it is important to be aware of the distinction. There are no fewer than three different trajectories for these organisms: an SHA‘ambition’ trajectory for MRSA, seeking to reduce hospital acquired MRSA to zero by2010/11; a national C.Difficile trajectory, looking to reduce the national incidence ofthe disease by 30% by 2010/11; and finally an SHA ‘ambition’ trajectory, hoping tobring SEC wide incidence of C.Difficile to less than 2,000 cases by 2010/11.

1

Monthly Summary of Healthcare Associated Infections - South East Coast SHA

Number of MRSA Bacteraemia

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35

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8

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Jan-

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Feb-

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Mar

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Monthly Actual Local Limit National Limit

Data Source: HCAI Data capture system - Health Protection Agency (last downloaded 14th January 2009)

Number of C-Diff cases (aged over 2 and attributable to the Trust)

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250

300

Apr

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May

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Jun-

08

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8

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Dec

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Jan-

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Feb-

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Mar

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Monthly Actual National Limit (Vital Signs)

Local Stretch Limit Previous year actual

Notes:Rate of MRSA bacteraemia reported per 10,000 admission - Based on HES 06/07 admissions

Rate of C. Diff cases (aged 2+) reported per 1,000 admissions - Denominator calculated using 06/07 HES data. For each episode within a Trust where the patients age at the start of the episode was 2 or more years ,and was classifed as an elective or emergency ordinary admission (this excludes daycases, but does include patients intended to be daycases but that stayed overnight, and patients intended to stay over night but discharged on the day of admission).

YTD, National limit 228, local limit 181, actual 188. The National cumulative rate of 5.19/10,000 ordinary admissions.

MRSA Performance:

C.Diff Performance:

Actions:

Commentary:

Local Stretch Limit for CDI currently under negotiation

YTD, National limit 1475, local limit 1664, actual 994. The National cumulative rate of 2.96/1,000 ordinary admissions. Total C.diff for SEC in December is 157.

PCTs and Trusts continue to report root cause analysis (RCA) information to the SHA, enabling continued local analysis of pre and post 48 hrs cases. Findngs will be shared with PCTs and Trusts. Collaborative working between Trusts, PCTs, community and pri

Estimated rate of MRSA bacteraemia reported per 10,000 admissions

0

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8

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Mar

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Monthly Rate (actual) Monthly Rate (limit)

Monthly SEC Rate (actual)

Estimated rate of C-Diff cases (aged over 2) reported per 1,000 ordinary admissions (attributable to Trust)

0

1

2

3

4

5

6

Apr

-08

May

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Jun-

08

Jul-0

8

Aug-

08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Monthly Rate (actual) National Rate (limit)

Local Stretch Rate (limit) Monthly SEC Rate (actual)

NB: national limits have been updated to reflect provisionally revised trajectories. Stretch limits remain at pre-refresh levels. Please interpret with caution!

For C.Difficile, if a person has tested positive less than 72 hours after they have been admitted then the case isconsidered community acquired.


Knowledge Matters

If you have a question for the team please e-mail: [email protected]

A3: ASK AN ANALYST –

Q – Do you know which function to use in Disco to convert a text format to number? The default for ‘overriden std grade hours’ is in Text for some reason and I need to do a condition that says ‘contract hours is less than override std grade hours’ but it won't let me as the override hours is a text format. The function you are looking for is the TO_NUMBER function The Syntax is broken down as follows: TO_NUMBER(char[, fmt[, nlsparams]]) Char would be the text string to convert. fmt is the format Mask and you can use any of the Following in combination to create a format mask : 9 999 0 0999 9990 . 999.99 , 9,999 $ $999 B B9.99 C C999 D 9D99

EEEE 9.99EEEE FM FM90.9 G 9G999 L L999 MI 999MI PR 999PR RN rn RN rn S S999 999S

TM TM U U999 V 99V99 X XXXX

Q – How can I add a vertical line to a chart? For example, on my 18 weeks charts I would like to add a line to mark18 weeks. Can this be done?

You can format this line if required by right clicking on it and selecting‘Format Error Bars’. You can also add a data label in the same way as anyother series on a chart. I have used this technique in the ‘Shape of RTT Pathways’ charts that Iupdate on a regular basis (see right). You can download this dashboard fromthe 18 weeks downloads section of the Knowledge Management website. I hope that this helps you out – if you have any problems please do get intouch with me directly.

You need to ensure that this figure is greater than the highest value of all the other series displayed in the chart – thebest way to do this is to use a MAX or a LARGE formula to pick out the highest value. You could just look through theother values on the chart and pick out the biggest one, but this gives a lot of opportunity for error and also won’t workif you have a chart with a drop-down menu, so chart data that changes according to what is selected. Depending onyour chart, you may want the line to be above all of the values – in this case you can just build an increase into yourformula. If your chart data was in columns C-P in rows 12 and 13 you could ensure the value for your vertical line was10% higher than any other value in the data by using the formula =(MAX(C12:P13))*1.1. This gives you the value for thevertical line which can then be added onto the chart as a new series. At the moment all you have is a dot in the right place on the chart – this now needs to be turned into a line. To do this,find the dot (you may need to hover over the chart to find where it is). Right click on this and ‘format data series’ thenclick on the Y error bars tab. You will need to select ‘minus’ for the display and the error amount should be equal tothe amount you worked out with your MAX formula. Under ‘Error amount’ select ‘Custom’ and in the negative box thecell reference needs to be the cell with your MAX formula. This will give you a line starting at a point 10% higher thanthe highest value on the chart dropping to the x-axis.

Firstly, in your chart data you need to add a new series with data at the point where you want your line to be. Forexample, if you had a chart with patients waiting in various time-bands and you wanted a line at 18 weeks, you wouldneed to have data in the 18 weeks column.


Knowledge Matters

Who’s who in the Quality Observatory Samantha Riley, Head of the Quality Observatory Hello. As head of the team, I’m responsible for ensuring that we consistently provide ourcustomers with high quality products that are delivered on time and which meet yourneeds. Over the coming months I am keen to meet as many current and potentialcustomers of the Quality Observatory to gain a better understanding of how we can helpyou make improvements to services. I have good links with a wide range of nationalbodies – if you have any unanswered data/information queries please do contact me andI’ll do my best to obtain an answer!

Simon Berry, Specialist Information Analyst My primary area of responsibility is around urgent care (A&E, Ambulance Trust) where Ihave developed a number of tools and dashboards. I also have responsibility around theacute sector and community services / PCT provider services. I have recently developed aprovider based stroke clinical metrics dashboard and will shortly be developing somethingsimilar for commissioners and the cardiac area. I am the main point of contact forobtaining HES data within the South East Coast patch.

Kate Cheema, Specialist Information Analyst My key lead areas are healthcare associated infections and world class commissioning,which also encompasses using information for improvement in commissioning and thedevelopment of information skills for commissioners. I’m currently looking at thedevelopment of clinical quality metrics in primary care and also analyse the PBC surveyand have been known to be involved with dentistry data too! I am also the lead analystfor patient experience data and have an interest in PbR and maternity, as well as thepractical application of statistics in quality improvement projects!

Adam Cook, Specialist Information Analyst Like Simon and Kate, my role focuses on developing and designing metrics, and tools toapply those metrics - very much with the quality agenda in mind. I’ve got the lead forMental Health Data (including dementia metrics), and am also leading on the NursingMetrics programme. I’ve added Data Quality to my portfolio and should be able to helpyou out with any queries related to SUS, HES or the data model and dictionary.

Peter Nyaga, Information Support Analyst Mostly I am involved in setting up various dashboards and tools as well as preparing theregular Board Information Pack. My other area of work involves managing as well asupdating the Knowledge Matters website. Having recently developed a risk managementtool for Foundation Trusts, I am now creating web-based finance and workforcedashboards as well as transforming our current dashboards to become web-based.

David Harries, Health Analyst I provide analysis to support work of the Public Health Directorate, particularlymonitoring progress against South East Coast Inequalities Strategy. Other areas I coverinclude all Public Health related Vital Signs, Stop Smoking Services, Sexual Health,Clinical Quality and Outcomes, SUIs and Patient Safety, Thrombolysis, Immunisation andanything else deemed public health. I will be officially joining the newly created SECQuality Observatory from the end of March. Other area of interest is in geographicalvisualisation (i.e. maps!)


Knowledge Matters

Who’s who in the Quality Observatory

Images from the 2008 Christmas Party…All are real…… no photo manipulation involved – honest! Festive Photos….

Kiran Cheema, Workforce Analyst I cover all areas relating to workforce information, including: monitoring through the ESRdata warehouse, WIMS and redundancy returns; supporting forecast modelling tools andtechniques for organisations in South East Coast; developing web based tools and collectionsystems for our products, and acting as a contact point of any ad-hoc queries andcoding/classification advice.

Rebecca Owen, Performance and Planning Analyst I cover all areas of performance and planning including Vital Signs, 18 Weeks andHealthcare Commission targets. I have also been involved with setting up a primary careprescribing dashboard and monitoring the GP extended hours and PCT procurement returns.I’m currently looking at setting up a new dashboard to monitor the new cancer targets and,along with the other performance analysts, can help with anything to do with Unify2.

Nia Naibheman, Performance Analyst Currently my main area of work is around 18 weeks. I am heavily involved in updating boththe weekly and monthly dashboards. I also update numerous other dashboards such as thePerformance dashboard for acute trusts and the PCT key performance indicator dashboard.If you need any help with Unify 2 please contact me - I can create accounts, reset your password and create Discoverer plus reports for you.

Charlene Atcherley-Steers, Performance Analyst Most of my time is currently taken up on a Data Warehouse project which will be used alongside our dashboards. I also report on the following Vital Signs VSA04 toVAS08, VSA11 toVSA14, VSB06 and VSB18. Other things I deal with are reporting timeliness and ad-hocqueries. I can also help with out with Unify 2 and resolve any problems you experience withour website.

Aleksandra Bujnicka, Workforce Support Analyst My main area of work is around workforce information. I am involved in updating theWorkforce Dashboard with the records retrieved from ESR Data Warehouse. Additionally, Ido some work around the CAST PLUS tool including customising and updating it, mostrecently specifically for the needs of the Midwifery Sector.

Nia Kiran Simon Rebecca Peter Adam Kate Charlene


Knowledge Matters

News

PROMS guidance published New guidance to support collection of patient reportedoutcome measures (PROMS) has recently been published bythe Department of Health. New guidance that will support the NHS to collect patientfeedback on the success of their operations was publishedtoday by the Department of Health. The new PROMsguidance sets out in detail:

• The procedures for which PROMs data should becollected

• Details of the national PROMs questionnaires • Roles and responsibilities of the different

organisations involved in the delivery of the PROMsprogramme

• A step-by-step guide to the administration ofPROMs questionnaires.

FREE HRG4/PbR Roadshows The PbR Assurance team of the Audit Commission will betaking part in the upcoming HRG4/PbR roadshows, alongside the Department of Health, the NHS Information Centreand NHS Connecting for Health. The introduction of HRG4in April will transform the way PbR is delivered by the NHS,and these events will give you the opportunity to hear keymessages on from all four organisations. The dates and venues are: Monday 9th March 2009 – St. James' Park, NewcastleWednesday 11th March 2009 – The Reebok Stadium, BoltonFriday 13th March 2009 – Villa Park, BirminghamTuesday 17th March 2009 – The Emirates Stadium, LondonWednesday 18th March 2009 – The Emirates Stadium,London Booking for these events is now open. See the InformationCentre’s website for details http://www.ic.nhs.uk/news-and-events/events/calendar/all-events National Institute for Mental Health OutcomesCompendium published The Department of Health has recently published anOutcomes Compendium for Mental Health. Thecompendium provides information on available outcomesmeasures tools for use in mental health services. Itprovides an evidence based evaluation of existing measureto support informed choice. It is designed to supportclinicians engaged in service delivery and developmentwho wish to gauge clinical effectiveness and recovery in abalanced, culturally appropriate and ethical manner.

New face for Health Informatics Careers …… NHS Careers have recently re-published their brochure for careers in health informatics in the NHS. The new face of NHS Informatics Careers is our very own Kate Cheema! The brochure provides useful information regarding the benefits of working for the NHS, describes the variety of roles within health informatics, provides an overview of the Career Framework and contains a number of real-life case studies (including Kate’s).

Brochures can be ordered from :-

NHS Careers PO Box 2311

Bristol BS2 2ZX

Tel: 0845 60 60 655

Alternatively, the brochure can be downloaded as a pdf from the NHS Careers website www.nhscareers.nhs.uk

New Maternity Data Quality Dashboard The Information Centre has recently added a maternitydashboard to their suite of data quality dashboards. Thisdashboard reports on the completeness and validity ofcodes used in key maternity fields, in each of thematernity related CDS types. Here’s the link to thedashboard http://nww.connectingforhealth.nhs.uk/reporting-services/data-quality/maternity.swf/ PbR National Benchmarker - Q2 data now available Q2 2008/09 data is now available in the PbR NationalBenchmarker. Further updates planned for the National Benchmarkerare: 27 Feb 2009 - additional functionality - including theoption to view all activity for a HRG or chapter within thedata explorer 1 May 2009 - Q3 data available 29 May 2009 - HRG4 benchmarking - all measures updatedfor new PbR rules and currency, plus the addition of newHRG4 specific indicators The PbR benchmarker can be accessed via the AuditCommission website http://www.audit-commission.gov.uk/

For more news items visit our website: -

nww.sec.nhs.uk/knowledge


Knowledge Matters

The online privacy and dignity tool has been up and running for about six months now and we thought that wewould give you an update on its progress! The tool was created to facilitate the collection of Peer to Peer assessment questionnaires developed from NHSinstitute collection template. Every NHS organisation within South East Coast has the ability to create self assessments, create and view peerreviews and to review reviews undertaken for them by others. To date 33 site assessments have been loaded on to the system by participating organisations. You can viewSummaries of the South East Coast Position by one of the 4 Principle areas or by individual question on the KMwebsite so log on and take a look!

Privacy and Dignity Peer Review Tool Update

Principle 1: The board of directors actively support patient’s privacy and dignity

Principle 3: Individual staff actions actively support privacy and dignity.

Principle 2: The physical environment actively supports patients privacy and dignity

Principle 4: Record keeping and management of patient information actively supports privacy and dignity

Sneak Peak

QOF Benchmarking Tool Announcing the development of an on-line QOFBenchmarking Tool. This tool is being designed to use the QOF datatables to provide benchmarking on QOF diseaseareas at Practice and PCT Level. To the Left is a Screen Shot of the Practicelevel Tool in its current form. The tool is being developed to allow the displayof indicators and ranking of recordedachievement against PCT/SHA/Country and ONScategories. For further information on this development orto get involved in the design of the tool pleasecontact us: [email protected]


Knowledge Matters

Knowledge matters is the newsletter of NHS South East Coast’s Knowledge Management Team, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact:

Knowledge Matters C/O Knowledge Management Team NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE

Phone: 01293 778899

E-mail: [email protected]

To contact a team member: [email protected]

173 people took part in the 2008 Christmas Quiz Congratulations to Jo Woolgar from West Sussex PCT who is the overall winner of the Quiz. Rosie Harding from Surrey PCT was this year’s runner up. The team have voted the winner of the tie-breaker question (which asked which your favourite bit of Knowledge Matters was ) as Del Herridge with: ‘I still have it to look forward to reading on Xmas Day :)’ Other’s that we liked include: -

‘The organisational coding questions of course – who would not love those’

‘Testing the knowledge that I thought I had but realise I

haven’t!’

‘….. discovering that Max Bygraves fans still exist!’ Many congratulations to all of you. Prizes will be winging their way to you!

Christmas Quiz results

www.institute.nhs.uk/wccdatapack complements the world class commissioning data pack issued by theDepartment of Health. It presents your data in a range of different formats, moving you from performancemanagement towards identification of improvement opportunities and service redesign.

www.institute.nhs.uk/opportunitylocator explores the potential for shifting services from an acute hospitalsetting into the community at PCT and PBC cluster level.

www.institute.nhs.uk/priorityselector facilitates objective scoring of proposals for service improvement, inorder to develop a portfolio of projects that combine impact with practicality (contact me for your organisation’spassword).

www.institute.nhs.uk/scenariogenerator is a software tool specifically designed to allow simulation of wholehealth and social care systems.

www.productivity.nhs.uk will take you to the Better Care, Better Value Indicators. The website is based around15 high level indicators that identify potential areas for improvement in efficiency.

www.library.nhs.uk/commissioning provides access to high quality information resources for all those involved incommissioning for health and wellbeing.

Data Tools available from the Institute

SELECT You.[UniqueID], Me.[UniqueID], You.[UniqueID]&" and "&Me.[UniqueID] AS Us FROM You LEFT JOIN Me ON You.[Date]=Me.[Date] GROUP BY You.[UniqueID], Me.[UniqueID], You.[UniqueID]&" and "&Me.[UniqueID] HAVING ((Me.[Date])=#1stDate#) AND (You.[End Date]) Between #Never# And #Forever#) AND (Me.[Heart])=(You.[Heart]) And Max(Me.[Soul])=Max(You.[Soul];

LOVE …… (in SQL!)

The providerbased strokedashboard is nowavailable to down-load from the KMwebsite. Seewhere to find it inour website newssection….

New!

knowledge matters volume 2 issue 6

Documents

quality observatory

data quality

quality ofcare

public health observatory

local nhs

nhs south east coast

local benchmarking

high quality care