Crossing borders

Arden & Greater East Midlands CSU was the first to provide the DSCRO service outside of it geographical footprint

In July 2015, NHS Arden & Greater East Midlands Commissioning Support Unit (NHS Arden & GEM CSU) was successfully awarded the tender to provide data management, and Data Services for Commissioners Regional Offices (DSCRO) services to clinical commissioning groups (CCGs) across the north west. As a result, we were the first CSU to provide a DSCRO service outside of our geographical footprint, as well as being the first to directly support an integrated health and social care partnership board as a result of the devolution agreement for Greater Manchester.
DSCRO provides the secure infrastructure and analytical expertise required for healthcare data processing and data management, including handling patient confidential data. In the north west, DSCRO had traditionally been provided in close collaboration with the data management service that uses pseudonymised data to assess trends, understand care pathways and support service redesign work.
With the Greater Manchester agreement devolving powers and budgets to a regional integrated health and social care partnership board, the ability to underpin decision-making with robust evidence is increasingly important. In taking on this contract, our challenge has not only been to effectively manage a key service at a distance, but also to ensure that the data we handle is processed correctly with a focus on quality assurance and data integrity. Our longer term ambition, however, is to demonstrate that service delivery need not be constrained by geographical boundaries and there are real advantages to be had by sharing best practice across a wider footprint.

Bespoke procurement
Having been unable to secure a position on the Lead Provider Framework, it became clear that North West CSU would no longer be viable and the process of reallocating services began. NHS England worked closely with North West CCGs and other customers of the data management services and DSCRO to understand how the services were being used and how best to proceed.
Feedback from clients demonstrated a strong desire to keep DSCRO and data management together – it was a service that was working well and highly valued. Decoupling data management from DSCRO was felt to be unhelpful and potentially disruptive. As a result, NHS England proceeded with a separate procurement on behalf of the CCGs, which was open to all CSUs.
As one of the leading providers of data management services elsewhere in the UK, our team was keen to look at how we could deliver this service. Given the size of our footprint, we were already accustomed to working at scale, servicing multiple clients, but we would need a different approach given the distance involved. Across our core region, we operate a ‘hub and spoke’ model. Our centrally located data management and DSCRO team manages the data, supported by information specialists in local offices. In the North West, however, the analytical function is spread across CCGs and the CSU while still being supported from the centralised DSCRO and data management team.
The service was well regarded by clients and was self-sustaining financially. We therefore looked at a model that would enable us to keep what was already working well intact, while bringing greater efficiencies and shared learning through close collaboration with our teams in Leicestershire and Warwickshire. We wanted to give commissioners total confidence in the ongoing reliability of the service, while delivering added value.

Bridging the distance
We have successfully developed a solution that has enabled us to retain the two local offices in Salford and Chester – which now run as satellite Arden & GEM CSU offices – supporting 24 CCGs and other health and social care clients across the North West. We were keen to retain the skilled and experienced team that had been providing a good service in difficult circumstances given the previous uncertainty over the future of the service. We transferred 24 staff from North West CSU to Arden & GEM that completed on 1 September 2015. From day one, we embarked on a concerted internal communications campaign, including face to face staff meetings led by managing director, John Parkes, to welcome the new team and ensure they felt fully engaged as members of the organisation as a whole. We have already seen a significant improvement in morale, with staff feeling more assured about the future of the service. This is vital in retaining the excellent staff and their established skill sets, which in turn ensures the continuity of service for our clients.
Overall responsibility for the service rests with our data and systems team based in Leicester, while the day-to-day management of the service is led by David O’Callaghan, who is based in our Chester office. David’s role is not simply to run an independent service in a different location, but to work with colleagues across the wider Arden & GEM CSU team, enabling us to maximise opportunities to improve service and provide a consistent standard to data management and DSCRO across all locations.

Scale and value
Data management services and DSCRO have a vital role to play in supporting CCGs as they develop creative ideas to ensure the NHS is fit for purpose long term. This is where operating at scale is particularly useful. Whether responding to ad hoc requests or delivering the core day job, there is much to be gained by sharing knowledge across teams. While priorities and demographics may differ, there is a significant amount of crossover in what CCGs, providers and local authorities are tackling. Drawing on data to assess issues, understand behaviours, develop and test solutions is critical.
Providing these services across a number of regions has the potential to significantly enhance what we can all achieve.
Naturally, as elsewhere in the NHS, there is a constant focus on finding savings through more efficient ways of working. But there is even more to be gained through the sharing of best practice. With breadth of experience comes a deeper understanding of what’s possible, and a more efficient way to get from A to B without reinventing the wheel each time. That’s one of the reasons behind our approach to managing the north west contract. Simply running an independent service – albeit with different ownership – would be to miss an opportunity. By fully integrating staff and developing a management structure that ensures a close working relationship, we have already been able to respond to client requests more efficiently, maximising the experience that resides within the team.
This is particularly important in the Greater Manchester region, with Devo Manc leading the way in terms of integrated, devolved health care commissioning. We are already working closely with the CCGs, trusts, local authorities and other organisations, which are the pioneers of this new approach. As the new Greater Manchester Authority develops, we will look to work in partnership to provide the data that will be needed to support the implementation of the organisation’s health and social care priorities. The learning gained through this work will have implications for other areas, not only those working as devolved authorities but wherever partnership working and joint commissioning takes place.
It is very likely that we will see further changes to the geography of where services are managed and delivered. For those involved, the Lead Provider Framework is opening up opportunities for both CSUs and private providers – the challenge for us all is in demonstrating when and why we are the right provider, and whether we are locally-based or not.

Dr Simon Freeman, chief operating officer from Arden & GEM CSU.