Final Report > Chapter 6: Quality, Standards and Information > Information

Information

Systems for collecting information concerning clinical performance

21 The systems for collecting data in the hospital sector were numerous and fragmented throughout the period 1984 to 1995. Although there may have been rare exceptions, in most hospitals there was not one but many systems, operating in parallel. On the one hand, there was one type of system, the hospital-wide administrative system which collected data to facilitate dealing with patients as they passed through the hospital (including, for example, information on a patient's appointments, length of stay, date of discharge), and to keep track of waiting times. On the other hand, in any given hospital there was another type of system, the clinical systems which involved a plethora of free-standing clinical systems, often the preserve of an individual consultant or small groups of consultants with a shared specialty, which held data about treatments and outcomes.

22 The various clinical systems, many of them paper based, differed from one another and had no relationship with the administrative hospital-wide systems. The funding made available in the late 1980s and early 1990s for medical and later clinical audit helped to reinforce this separation by making available to groups of clinicians money for small local computer systems. The lack of any connection between these different systems, one administrative, the others clinical, for collecting data cannot be explained solely on the basis of some technical or technological reason. It was just as strongly a reflection of a mindset that clinical matters were the sole domain of clinicians and non-clinical matters, to do with the management of resources and with the movement of patients into and through the hospital, were the preserve of managers and administrators.

23 As it happens, cardiac surgery was somewhat exceptional in terms of there being information about clinical performance. There was a voluntary system for recording data which was, established in 1977: the United Kingdom Cardiac Surgical Register. The Society of Cardiothoracic Surgeons collected and distributed in aggregated form data about mortality rates in cardiac surgery, including in paediatric cardiac surgery. Anonymised data were collected from cardiac centres on the centres' activity and rates of mortality. The data were categorised by reference to diagnosis rather than the operation or procedure carried out. The data were made available to cardiac surgeon. The surgeons in turn could decide whether and how to distribute the data more widely. The data were not easy to interpret and were regarded by surgeons as a useful guide at best, rather than as reliable and authoritative.

24 Administrative systems were valuable in providing information relating to the management of hospitals. The DoH had always gathered data from the regions about financial performance and the extent and amount of care delivered. In the early 1990s, the collection and presentation of this information were substantially improved, providing Ministers and the regions with quarterly reports on performance in relation to key targets concerned with activity and finance.

25 Information about waiting times figured prominently in these quarterly reports. An important source of this information were the Patient Administration Systems (PAS) which, by the mid-to-late 1980s, had been established in most acute-care hospitals. These, in turn, contributed to a national database which produced information about the scale of activity in a hospital, the Hospital Episode Statistics (HES) database.

26 This information included, for example, the number of patients who came into and left the system, and the specialty in which they were treated. This national database, managed by the DoH, was intended and used for planning purposes. It was not designed as a system to monitor clinical performance, because the Department at the time, as we have seen, did not see its role as to be involved in matters of clinical performance. (As we shall see in Section Two, the database has belatedly been recognised as a valuable source of information on clinical performance.) Although views were changing over the period of our Terms of Reference, there was no question of the DoH itself interrogating its database with enquiries about clinical performance. Quite simply, it did not consider that such questions were for it to ask. Moreover, the mood of the times was such that, had the Department thought to use the database in such a way, it would have been seen as provocative by healthcare professionals.

27 Information on mortality in hospitals, which is one indicator of the quality of a service provided by a hospital, was contained in the HES database. But the quality of the data was relatively poor until after 1991. Miss Catherine Hawkins, Regional General Manager, South West Regional Health Authority (SWRHA), told the Inquiry that, in the late 1980s, there was no reliable information on how a hospital was performing in terms of the outcomes for patients. She described the situation to us graphically: `... at that time, you did not know when people left hospital whether they were dead or alive.' [11]

28 We have set out briefly the approach to quality which prevailed during the period of our Terms of Reference and the limited systems which existed to capture information. We now move to a description of the respective roles of the DoH, the regional health authorities (RHAs) and the DHAs in seeking to secure and improve good quality healthcare.

Footnotes

[11] T56 p.54-5 Miss Hawkins