Health Service Focus

Seeing the value in sharing data

Dr Mary-Ann Sherratt, a trustee of the College of Optometrists who has been heavily involved in a new report on how better collection and sharing of data can improve public eye health, speaks to NHE about the challenges and opportunities involved.

The Department of Health believes that information is core to good quality care – and this is a view shared across the health professions.

The College of Optometrists certainly agrees, and in its new report, ‘Better data, better care: Ophthalmic public health data report 2013’, it makes the case for better collection of data to help persuade commissioners about the value of services that optometrists can provide to improve public eye health.

An eye health indicator is now included in the Public Health Outcomes Framework for England, tracking the rates of three major causes of sight loss – glaucoma, age related macular degeneration (AMD) and diabetic retinopathy.

The indicator is based on the certifi cates of vision impairment (CVI) data, generally perceived as being a good quality dataset, albeit with some concerns. For example, there is anecdotal evidence that CVIs are “regularly not completed”, the report says.

It adds: “While the CVI data set is useful and important, there is clear scope to improve and strengthen it. It is important to ensure that CVI data are as rigorous, timely and universally applied, and thus as reliable as possible.”

Sharing data

Dr Mary-Ann Sherratt, a trustee of the College of Optometrists who has worked in eyecare across south Wales and south west England, and who also currently works at Bristol Eye Hospital, sat on the steering group that produced the ‘Better data’ report.

NHE asked her how optometrists measured up against different clinical specialisms when it comes to believing in good data, and she said: “I don’t suppose optometrists are different to any other clinicians in their attitudes to data. Optometrists have been recording this sort of data for years, collecting it up in paper form, but have never really reaped the benefits of having that data out there.

“The College itself is working with its members to help them understand the benefi ts of data collection, and the fact that the data may then be a help in terms of benchmarking and improving the quality of care, and also making their own lives easier. Good-quality information leads to good-quality eyecare.”

‘Confusing and disjointed’

But too often, that information isn’t of a good enough quality. That applies to the information given to patients too, since, as the report puts it: “There is evidence that patients find the eyecare system to be confusing and disjointed, and this can create barriers to their seeking appropriate care. Any steps that we can take to improve a patient’s continuity of care should therefore be seriously considered.”

Dr Sherratt expanded on this for us, saying: “Patients fi nd it quite tricky to know where to access the care that they need. People are pretty knowledgeable about where to access care to get glasses, but if you’ve got an eye problem, or a red eye, for example, do you go to A&E, your GP surgery, your optometrist? Without the intimate knowledge of the system that we as professionals have, it’s not always easy for people to know where to go. That’s why it can be confusing and disjointed at the front end.

“Then, as you go through the processes and you have someone tell you that you have a problem that needs some form of specialist care, you then probably need to go via a GP to a referral service to a specialist clinic.

“Perhaps those referrals could go straight through to a specialist clinic, without the need to go through the GP.

“There is some benefi t in having the input from the GP, but some patients can be referred direct to a specialist service.”

Referrals

Better management of referrals is a key demand of the ‘Better data’ report. Although the NHS Commissioning Board in England is preparing national specifications for electronic submissions for payments for NHS-funded eyecare – which the eyecare sector is cooperating with – there are no plans at the moment to do the same with electronic referrals.

“We would be quite keen for that to happen,” Dr Sherratt said. “[An effi cient electronic referral system] is not impossible, it’s not purely aspirational – it could happen, and it does happen in Scotland. Making it fit with practice management IT systems is perhaps a little bit of an issue.

“But, we reckon that if we could get agreement that it can happen, we could roll out a pilot within a year. It’s about getting the IT systems to talk to each other.”

The ‘Better data’ report calls the NHS’s reliance on paper-based systems within optometry “one of the most detrimental factors to ophthalmic public health data”.

It adds that since optometrists cannot access Choose & Book, those not on NHS secure email “are unable to email letters of referral, test results, or images of the eye to hospital eye departments or GP surgeries, to access a patient’s medical history, or to request payment for an NHS funded sight test”.

There is also the problem of non-standard referral forms. Dr Sherratt said: “We’ve been working for years with the Department of Health to try to agree a single referral form, but for various reasons we’ve not been able to agree a version. Perhaps with the NHS Commissioning Board, we may have another opportunity to get that agreement – a bit of change might be helpful in that regard.

“There are agreed referral forms in certain areas: NHS Sheffi eld has got one, for example. It does work, if you can agree it, but it’s dependent on the PCT / CCG.”

The right data

The report explains why the data gathered from forms fi lled in as part of the General Ophthalmic Services (GOS) contract has only “limited use” for public health.

This is primarily because they are ultimately to do with claims for fees, but also because they lack data on ethnicity, they lack the patient’s NHS number, and even where a patient is entitled to an NHS-funded sight test for multiple reasons (someone aged over 60 with diabetes, for example), only one reason is entered in the system. “This means that the data from NHS sight tests does not accurately capture why someone is receiving a free sight test,” the report says.

Its conclusion is clear. “Robust data will help ensure that eyecare is patient centred and meets the public’s need, is of good quality, and provides value for money.”

Recommendations from the report

Support the public health indicator on eye health

• Work to improve the quality of data obtained from the CVI process to ensure that the eye health indicator remains in the public health outcomes framework beyond 2016.

Improve IT systems and review the data collected

• Move to electronic systems for GOS payment claims.
• Include information about ethnicity on and record all data from GOS forms to better understand the eye health needs of the local population.
• Move to electronic systems to enable community optometrists to communicate with hospitals and GP surgeries and include back-up information with referrals.
• Encourage the completion of the Department of Health project to produce a standardised data set for referrals (GOS18).
• Design a system which will allow referrals from optometrists to be clinically audited.
• Work with the government to include the NHS number in a way that is feasible to operate in community practice.
• Reintroduce a system to provide a more accurate estimate of private sight tests.

Work with optometrists to highlight importance of data collection

• Help optometrists understand how the collection of full and accurate data will protect the future of the profession and raise its profi le with key decision makers, other health professions and the public.

Learning from Scotland?

Funding has previously been made available in Scotland to address many of the issues raised by the ‘Better data’ report, via the Eyecare Integration Steering Group.

Asked why Scotland was pulling ahead of England and Wales on this, Dr Sherratt said it was a combination of central leadership and engagement from within the specialty.

“Certainly, Scotland benefits from having a Government interested in providing a universal healthcare model. The working relationships between clinicians, civil servants and politicians in Scotland seem to work quite well. They are good at looking at the evidence, and re-designing things according to the evidence in front of them.

“My own personal opinion is that because Scotland is smaller, in terms of population size, than England, they can agree national contracts more easily. It’s about having the political will but also the clinicians’ engagement.”

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