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10 July 2008. Our use of secondary data. Martin Gibson, Performance Specialist Wales Audit Office. An Overview. Role and function of the Auditor General for Wales and the Wales Audit Office Focus on health sector An example of data use within a national report How we develop our work
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10 July 2008 Our use of secondary data Martin Gibson, Performance Specialist Wales Audit Office
An Overview • Role and function of the Auditor General for Walesand the Wales Audit Office • Focus on health sector • An example of data use withina national report • How we develop our work • The data we use • The local and national productswe produce • Opportunity for questions
Role and function • Our mission is to ensure public money is wisely spent across all public services in Wales, being is responsible for auditing some £19billion of public expenditure • The Wales Audit Office remit also includes the specific obligation to promote improvement. • Working in every Unitary Authority, NHS organisation, Police Service, Fire & Rescue Services, National Parks, Higher and Further Education Establishments, Community Councils and the Welsh Assembly Government and its Agencies.
Health sector • AGW’s role in relation to health sector: • audits the accounts prepared by LHBs and NHS trusts. • a programme of local and national value for money studies • reports laid before the Assembly and may be taken in evidence by the Assembly’s Audit Committee • Work in collaboration ie Concordat • Types of health studies: • National (large often multi-organisations) • Local (smaller, often single client)
Health sector (2) • New powers for data matching • Serious Crime Act – fraud detection through computerised audit analysis tools (CAATs) • The data we use • Existing sources (examples given later) • Fill the gaps with bespoke data collection (surveys, focus groups)
NHS Trust staff input patient details into WAG db DToC patients in Welsh NHS Trusts Annual DToC burden on NHS Trusts Analysis by the47 SITREP codes Monthly DToC snapshot census Monthly DToC analysis by 6 DToC groupings Fig 1. illustrates data by: Any 1 of 22 LHB areas Between any 2 months (03/06 – 02/07) Fig 2. Health Community Monthly trend data for respective LHBs Fig 3. Any LHB of 22 Any SITREP code placed in Welsh context 2 years of DToC patient data (c.9000 recs) • Data analysis by: • Trust • Hospital site ward type • Referrals to Social Services • 4 SITREP code categories • Delayed days (05-06, 06-07, variance) • “Map” of social Services referrals • Automated graphs of the above Positives: • Regular periodic measure • Source data aggregated into 6 groupings Negatives: • Timing issues with data input • Complication with “local agreements” • Only static analyses provided by WAG National study example: Delayed Transfer of Care
How we develop our work?IssuesAnalysis and DrawingConclusions • Assembling the issues • Overall question that project will address • Supported by logical structure of sub-questions • What we need to answer the questions (data availability and gaps) • Most effective way(s) of conducting the work • Implement fieldwork design with resource planning and continual evaluation of progress • Examine the outcomes of the fieldwork • Answer the questions (with reasons and evidence) • Determine key messages • Outline structure of product (written report, presentation, workshops, web site) Scoping Issues Analysis Design fieldwork Conduct Fieldwork Drawing Conclusions Consult with stakeholders
Examples of other data sources • PEDW • Prescribing Audit Reports • GP registered populations/QOF achievement • Trust/LHB IT systems • Fraud data sources • Welsh Health Survey • Personal Social Service Stats • Workforce census – GMS, NHS trusts • ONS – mid year estimates • Vacancy surveys • PIs to look at performance when deciding on local audit priorities • SaFF target monitoring • Prescribing audits reports
National studies 2009 – future work programme • Dentistry • Voluntary Sector • Unscheduled Care 2008 – to be published • Chronic Disease Management • Chronic Heart Disease 2007 • Healthcare Associated Infections • Tackling Delayed Transfers of Care • Review of GMS Contract • Increasing Physical Activity 2006 • Ambulance Services in Wales • Making Better Use of NHS Day Surgery • NHS Waiting Times Follow Up 2005 • Baseline Review of Adult Mental Health Services • Protecting NHS Trust Staff from Violence & Aggression
Local reviews • Acute Hospital Portfoilio • Review of Maternity Services • A&E departments • Ward Staffing • Pathology Services • Medicines Management in hospital • Demand Management reviews Prescribing Audits • Items, costs, therapeutic groups