Local Intelligence Support Team
The integration of health and social care was seen by the Scottish government to require support to ensure that benefits of both national and local data and knowledge were able to be shared across two very different cultures and service providers to jointly develop more appropriate services for local populations.
LIST using their expertise in analytical work was seen as a way to develop a sound evidence base to allow decision makers to develop effective services.
The Local Intelligence Support Team (LIST) was established as an intermediary service to support the integration of health and care organisations into Health and Social Care Partnerships (HSCPs) across Scotland in 2015. These HSCPs were formed to provide more effective integrated services for their local populations. Prior to this health and social care organisations worked independently to provide services that were within their remit with no ability to influence the others decisions. LIST analytical staff were co-located in HSCPs to provide intelligence in a local context allowing local managers from health and social care to better understand their populations requirements and to co-design and deliver services to meet these needs.
LIST has been able to analyse and link, local and national data to provide a unique view of the local population providing intelligence which allows a holistic and more thorough understanding of the way users move into and across health and social care services, which was not available previously.
By working together with local partnerships, and by using innovative communications methods (VPNs, Qube and Skype) across the dispersed team. LIST has provided the opportunity for a change in culture, devolving decision making to local levels, whilst being able to access data and additional expertise held nationally in centralised locations.
To demonstrate this we have given some examples of work LIST analysts carried out in two HSCPs.
Delayed Discharge & Care Home Vacancy Dashboard
Analysts working locally with a HSCP recognised that census data on delayed discharges and care home vacancies was presented poorly and not well used by managers even though this partnership struggled with a number of challenges around delayed discharge. Analysts recognised that there was an opportunity to apply new analytical techniques and presentation methods to support the operational managers’ ability to interpret the data and monitor performance.
The innovative solution was to create an interactive dashboard tool which would provide the managers with the necessary data in a more visual way, statistical process control charts were used as a means of highlighting variation in the system. This gave the senior team, alongside service managers in both health and social care a better overview of the current situation of hospital delays and care home vacancies.
It is envisioned that the dashboard will be incorporated into the delayed discharges clinical system. This will provide even more real-time information and save on staff time spent cleansing and distributing the data. Ultimately the system could be adapted for other partnerships across the country.
Following on from this work a wider collaboration now undertaken with clinicians and academics has resulted in the development of a predictive tool for delayed discharges. This demonstrates innovative use of data to help health & social care professionals identify patients who are potential delayed discharges, and plan early intervention. This is currently being piloted with local health and social care partners and could become a feature in a future iteration of the dashboard.
Homeless Needs Assessment
Homeless people are a key vulnerable group who experience health inequalities with higher morbidity and mortality than the rest of the population.
LIST analysts have assisted one HSCP as part of their objective to reduce health inequalities by co-producing a health needs assessment for homeless people.
Linking client data from homelessness (HL1) applications with local and national health data allowed in depth service utilisation analysis of this cohort, compared to the wider partnership population to be performed.
The intelligence from this analysis was used to inform and develop a multi-agency health and homelessness plan, which aims to improve outcomes for this vulnerable population.
What Makes Your Project Innovative?
The use of new visualisation tools (dashboards) with statistical process controls, allows users with limited statistical knowledge and/or limited subject knowledge to understand the data in a more meaningful way. Dashboards bring together data and eliminate the use of data tables, providing data visually including trends for multiple years’ worth of data.
Using national health datasets and approved Information Governance protocols, local housing and homeless data was then linked to various national health data sets using a unique patient identifier. A comparator group was identified and treated similarly. The intelligence gained was used to inform and develop a multi-agency health and homelessness plan, which aims to improve outcomes for this vulnerable population.
These examples show how linking LIST analysts working with local and national data can provide a much greater level of understanding and knowledge to local managers which can improve their decision making.
What is the current status of your innovation?
Both examples are at the stage of implementation. The dashboard is currently sent out weekly to aid operational working in reducing delayed discharges. Training sessions were held with service managers to provide them with the correct skills to operate and interpret the dashboard as part of a pilot group. Discussions are taking place to recreate a similar dashboard for other operational areas, in particular Care at Home.
With regard to the homeless work, a multi-agency health and homeless plan has been created and some of the actions from this are currently being worked on locally to increase knowledge with work analysis underway to look at the health needs of children who experience homelessness.
LIST is also sharing these examples across the team so that these ways of working can be utilised in other areas of Scotland and for other topics. This ensures that the next iteration will develop further analysis and understanding more effectively by sharing what has already been done.
Collaborations & Partnerships
LIST collaborates with staff from different areas of HSCPs.
These are strategic decision makers, operational and data managers and specialists.
They provide guidance on what the project should achieve and how products are used. Other staff share their expert knowledge of the topic area and local population, giving LIST the necessary information they need to analyse and design outputs or tools.
LIST works closely with national teams who assist with the process of linking local & national data.
Users, Stakeholders & Beneficiaries
Dashboards allow data to be presented in a more informative and engaging manner, to a larger audience.
Staff can view current performance of delayed discharges, and identify trends much more easily. This allows them to query or provide evidence-based feedback about the service.
With a much clearer knowledge of the local homeless population’s needs services can be designed that will ultimately improve the lives of homeless individuals, particularly their health needs.
Results, Outcomes & Impacts
LIST has been able to influence local decision making across a range of services by providing a much better evidence base for staff to understand local needs and how services can be designed to meet these. LIST has not just provided evidence but has facilitated joint working across health and social care which has benefitted both staff and local populations.
The success of the dashboard allows feedback to staff and can help develop services to improve outcomes for local users. Staff are better equipped to understand trends that are highlighted automatically providing near ‘live’ figures on delays and care home vacancies in a clear visual format that is easy for busy managers to interpret and to take action as required.
Similarly the information supplied on the homeless population has encouraged joint work across areas to provide services which will improve outcomes for this vulnerable population and reduce local health inequalities.
Challenges and Failures
Due to the number of different organisations LIST works with and the nature of the data that is handled there have been significant issues in getting Information Governance processes agreed in a timely manner which can impact on progress.
Software and network limitations in a partnership can often cause a variety of problems which mean that bespoke solutions have to be designed by LIST staff. One example was that the delayed discharge system operated on a separate health service network and an immediate solution to allow automatic data linkage was not possible. This meant analysts had to create the best possible interactive dashboard and manually transfer data on a weekly basis.
Financial constraints in service areas means that although issues can be identified not all actions can be implemented as soon as required. Instead work is started on the actions that require little or no financial input but can be of value.
Conditions for Success
Analytical expertise identified new ways of working with data guiding managers to improved use of data and better ways of delivering services. LIST has been instrumental in assisting a shift in behaviours across partnerships. By providing clear evidence and intelligence it supports the development of new services to meet service users’ needs and discourages doing things the way they have always been done. Service providers need to be prepared to be flexible and to use an evidence based approach to designing new services.
Personal values and motivation have played a big role in this innovation, analysts saw that data was not being used as well as it could be and identified that better presentation of data has the potential to help managers understand systems better, and therefore benefit the users involve. Their commitment to providing intelligence to improve decision making and ultimately services is motivated by their knowledge and desire to improve services for the local population.
LIST has facilitated the sharing of templates for different work across other partnership areas. The team has already developed a subsequent dashboard to check the progress of General Practitioners prescribing a certain type of antibiotics to patients. This tool is being used across other partnerships, in one area to display patient flow through hospital services.
The methodologies of the statistical process control charts used within the dashboard are being used across sectors for various types of projects. In particular, the statistical process control charts are useful in determining if a process is stable across a time period or if an implementation of a new product or idea has resulted in a favourable or unfavourable outcome.
The housing and homeless data led to the development of a needs assessment process and this was extended in the area to look at children’s specific needs. This work is currently informing development of other needs assessment work.
LIST has tried to build a solid base of work that demonstrates the power of good intelligence based on using local and national data and linkage where this builds knowledge.
LIST will try to involve everyone and every service that is involved in the work from the start as each service brings their own expert knowledge which is beneficial to the end goals of the work.
Gaining support from the senior team can help build momentum for a project, so early engagement is essential.
Sometimes it is difficult to provide an optimal solution but a good alternative which is quick to create with limited expense and resource can provide enough information about the potential value to persuade local staff to support further development It allows basic ideas to be realised and put into action in situations where software or networks do not allow for more advanced solutions.
Group learning sessions in the early stages provided staff with the necessary knowledge to understand the methodology of the dashboard when it was rolled out.