Annex A > Chapter 7 - Supra Regional Services > Monitoring of quality > The information collected by and available to the SRSAG
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The information collected by and available to the SRSAG
255 When Sir Michael Carlisle became Chairman of the SRSAG, in April 1989, he perceived a need to improve the system of assessing bids for supra regional funds. The minutes for the SRSAG meeting of 28 September 1989 stated that:
`The Chairman noted that the White Paper reforms raised large issues for the supra regional services. He felt that the current method of assessing bids for additional funding left a good deal to be desired; the broad brush approach would need to give way to a system of contracts. The Group needed to know much more about the costs of providing supra regional services ...'
`When the principles were resolved, there would be a need for reliable accounting data as well as information on outcomes of treatment.' [277]
256 Sir Michael emphasised that his desire to see a system of collection of information about the quality of SRS was not part of the de-designation debate, but was something he saw as an important management tool:
`Q. So the position is, is it, that in 1992 the units in the various different services were not giving very detailed information about outcomes to the Group?
`A. I, of course, did not see much evidence of that. It may be that Dr Halliday and others - not others, Dr Halliday in particular - who had strong liaison with units, may have seen more information than I did, but I do not think it is wrong to say there was more emphasis on the volumetric than the qualitative data ...
`You can see from the 1989 paper that I was very keen that some outcome information should be brought forward to complete the total picture, so that our judgement as a group in the corporate sense could be better informed. So we have an interest in it. What we did not have was the information ...
`This was nothing to do with designation or de-designation; it is about running good services. I should like to have seen, this was the very first step, the annual report and the annual report of the units, leading up to a situation where I hoped that there would be periodic performance reviews of the units and services within the Supra Regional Services Advisory Group. We could not do every service and every unit every year, but we could start to commence that process ... I was hoping through reports and performance reviews to establish some process whereby the total picture of what is going on could be more evident, not just for management purposes but also so we could advise the Secretary of State that continued investment in these services was appropriate or not.' [278]
257 Sir Michael explained that the SRSAG lacked what he called `hard management information'. He said that, despite this, `I think we got a reasonable feel for most things except outcome'. [279]
258 Dr Halliday said that the SRSAG received anonymised data from the SCS each year and this allowed the SRSAG `to identify the trends in terms of mortality in all the units, but we could not identify the units'. [280] However, Dr Halliday did not know how the SCS collected its data, nor the form in which it was made available by it to cardiac units across the country. [281] He described the Society as `very secretive' and referred to `difficulties' which the SRSAG had `in getting any progress from the Society'. [282]
259 Dr Halliday said that it was only when contracting began, in 1991, that the SRSAG `insisted' [283] that the returns to the UKCSR were included in the monitoring returns sent annually by units to the SRSAG.
260 Sir Terence took the view that `it would have been perfectly proper to have analysed quality of output in terms of mortality, and de-designate it if necessary.' [284] Having said that, he recognised that nothing other than crude measures of mortality were available:
`I think that the output of crude mortality is there as a sort of warning, if you like, that if it raises an issue, that then you need to go in and do a much more detailed and difficult analysis.' [285]
261 Dr Halliday explained that if the SRSAG had information about an apparently under-performing unit, it would produce a paper and recommend to the Chairman of the SRSAG that the President of the appropriate Royal College set up a working group to review the situation. [286]
`Q. Suppose the Working Group reports and says, "Well, it is not doing very well; on the other hand, it is not doing desperately badly". What would the likely outcome be? Would the service likely remain designated, or not?'
`A ... I think people would sweat over midnight oil about what we should do, but the difficulty would be, if that is the professional advice that it should continue, how do you stop it?
`Q. It all comes down to - this started the question I was asking you - it depends on the professional input you get in the Supra Regional Services Advisory Group from the Royal Colleges?
`A. I do not know who is better to judge the practice of medicine than the doctors ...' [287]
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Footnotes
[277] DOH 0002 0214; minutes of meeting, September 1989
[278] T15 p.11-14 Sir Michael Carlisle
[279] T15 p.16 Sir Michael Carlisle
[283] Sir Michael Carlisle's word - T15 p.15
[284] T18 p.109 Sir Terence English