Data Quality; Data Standards Information Context Nick Armitage, NHS Information Centre

2. Introduction: Data Quality Background ESR and Data Quality Data Quality and iView Data Standards The National Workforce Dataset (NWD) version 2.3 The NHS Occupation Code Manual version 9 The Healthcare Scientists Workforce Information Pilot

4. Data Quality Overview Background - What is Data Quality? - How to Measure Data Quality - How to Improve Data Quality ESR and Data Quality - Using ESR Data and DQ Consequences Data Quality and iView - Highlighting DQ Issues - Benchmarking Conclusion

5. Or what is quality dataOr what is quality data

10. Data Quality in ESR � Important Messages: Ensure Occupation Code is correct Correctly identify Locum Doctors Equality monitoring and other details Area of Work and Job Role? If you host staff, ensure you record them correctly within ESR Position Workplace Org Assignment Hosted Use the data quality tools in ESR � NHS IC �WOVEN� (Workforce Verification Engine)

11. ESR Data Quality/Validation 3 levels Operational ESR Trust driven � to take responsibility for their own data quality Run at trust discretion ESR Data Warehouse Dashboard reports (not validation) Covering key areas For interest at Trust level and DW users Run at trust or DW User discretion IC To feed official publications and management information Demonstrate increased confidence in ESR data Provide evidence of increasing quality over time Run monthly DQ reports for each Trust All 3 developed in partnership (ESR, IC, NHS) Aims, objectives, guidance Guidance is that Trusts should action local quality reports IC process Can be ignored if this is done Aim: kill off census Rules Worked with the service (volunteers) for a year Published Challengeable Governance (MR SIG) (approved Nov 2008) Ranking based on relative priority of fields Aims, objectives, guidance Guidance is that Trusts should action local quality reports IC process Can be ignored if this is done Aim: kill off census Rules Worked with the service (volunteers) for a year Published Challengeable Governance (MR SIG) (approved Nov 2008) Ranking based on relative priority of fields

12. ESR data � the IC data quality cycle Outline of the situation in England � parallels in Wales? A summary and detailed monthly report for each Trust Provide a useful assessment of data quality for key annual NHS Workforce Census fields Identify good performers � reduce their burden to complete the annual census return Identify poor performers � target help Identify systemic issues that may be addressed by changes in ESR iView � additional DQ measure (numbers versus quality) Objective measure of when official statistics can be published direct from ESR Effective communication � frontline NHS staff need to be aware data is available and the importance of data quality How directly do front line NHS staff need to use the data for improvements in it�s quality to be of benefit to them? Difficult to actually measure or quantify this effect - so many factors are at play that it is almost(?) impossible to put a quantifiable value on the impact of these improvements. However; patient care and safety depend upon good quality data poor quality data can damage the reputations of organisations and individuals poor quality data can lead to flawed clinical, administrative and planning decisions Effective communication � frontline NHS staff need to be aware data is available and the importance of data quality How directly do front line NHS staff need to use the data for improvements in it�s quality to be of benefit to them? Difficult to actually measure or quantify this effect - so many factors are at play that it is almost(?) impossible to put a quantifiable value on the impact of these improvements. However; patient care and safety depend upon good quality data poor quality data can damage the reputations of organisations and individuals poor quality data can lead to flawed clinical, administrative and planning decisions

13. ESR data and PQs/AMQs Parliamentary or Assembly Questions can highlight the �margin of error� between ESR data and local knowledge NHS Workforce Census bulletin caveat �The HCHS non-medical workforce census is a large statistical exercise collecting over one million records from over 400 organisations. It is not, and is not intended to be, carried out to exact accounting standards.� Example: PQ asked for number of school nurses in a PCT. 2008 Census return stated 1, the PCT said 20. PCT indicated to DH it had made some coding errors and wanted to correct its Census figures. IC policy is that unless the impact is significant at national level figures are not changed, post publication. Poor quality data can damage the reputations of organisations and individuals

14. ESR data, impact on Finance/Planning Examples from England � the same or similar in Wales? NHS Litigation Authority premiums 2007 Census fed the 09/10 premium 2008 Census has fed the 10/11 premiums which DoF received in January to sign off Poor data quality of doctors now has a financial cost attached to individual trusts Planning/Targets Commitment to increase the number of Health Visitors Reduction in management costs NHS Pharmacy Education and Development Committee � survey of staff numbers and vacancies in departments Commissioning Frameworks for Clinical areas � e.g. Diabetes � creation of Minimum Data Set using ESR as a potential feed Improving the quality of data improves financial flows � NHS Litigation Authority Time savings for front line staff, having a reliable central source of data they do not need to collect similar data themselves or further self validate data provided to them to ensure it is fit for purpose Secondary use of data � taken from live administrative / clinical systems used in studies of outcomes from different care pathways / best practice etc. Epidemiological studies - poor data quality could result in false positives / negatives and therefore improving data quality helps to ensure against the wrong clinical decisions being taken development of several clinical secondary uses datasets.� For each there is an information requirement to identify the types of staff undertaking activity such as appointments or responsible for certain aspects of the patients care.� In many cases this has resulted in the development of multiple lists of roles that are relevant to each domain.� � We are keen standardise these lists wherever possible and are keen to investigate whether it would be feasible adopting the JOB ROLE (FOR A POSITION) values used in ESR for this purpose within clinical datasets. Improving the quality of data improves financial flows � NHS Litigation Authority Time savings for front line staff, having a reliable central source of data they do not need to collect similar data themselves or further self validate data provided to them to ensure it is fit for purpose Secondary use of data � taken from live administrative / clinical systems used in studies of outcomes from different care pathways / best practice etc. Epidemiological studies - poor data quality could result in false positives / negatives and therefore improving data quality helps to ensure against the wrong clinical decisions being taken development of several clinical secondary uses datasets.� For each there is an information requirement to identify the types of staff undertaking activity such as appointments or responsible for certain aspects of the patients care.� In many cases this has resulted in the development of multiple lists of roles that are relevant to each domain.� � We are keen standardise these lists wherever possible and are keen to investigate whether it would be feasible adopting the JOB ROLE (FOR A POSITION) values used in ESR for this purpose within clinical datasets.

15. ESR data - iView Content Annual Census � greater granularity Monthly � Staff in post, Earnings, Sickness Absence, Turnover Benefits More immediate than the Census More accessible More flexible More fields More potential Benchmarking between similar organisations Highlights DQ issues for further investigation

16. Data Quality and iView Benchmarking is only as good as the data that is input at source key improving data quality of non-core payment data ESR data linked with iView can help to highlight data quality issues that have not previously been investigated Example of miscoding of Managers and Senior managers distorting figures Provided area of focus for data quality messages Lead to improvements in the guidance provided in the NHS Occupation Code Manual that are to be applied in other areas Manager / Senior Manager coding now more reliable

17. DQ Example � Managers and Senior managers by Agenda for Change Band (Sept 2008) Incorrectly coded line managers as managers and senior managers using occupation codes (and others � included PAs to Director level staff as senior managers?), not followed the guidance correctlyIncorrectly coded line managers as managers and senior managers using occupation codes (and others � included PAs to Director level staff as senior managers?), not followed the guidance correctly

18. Next Steps 1 � for the IC

20. Data Standards

22. NWD Overview The National Workforce Dataset (NWD) is a reference dataset comprising standardised definitions to facilitate the capture of nationally consistent information relating to the NHS workforce.�� NWD data items and definitions under pin the ESR and support a variety of workforce based collections including the annual NHS Workforce Census. The NWD is primarily used in NHS organisations, mainly within HR and Workforce Planning functions to support planning and delivery for: Services: the services required to meet the patients' needs and how they are planned to change Workforce inputs: the workforce inputs required to deliver specific services Requirements: How workforce inputs map onto skills, roles and numbers Options: Options for changing the workforce demand through new service models or ways of working The NWD is reviewed on a continuous basis to ensure that it remains fit for purpose and is updated to reflect any changes to workforce policies and practices. NHS Occupation Codes are not part of the NWD but are referenced in the NWD and are updated and approved as part of the same process for consistency

23. NWD Version 2.3 - Updates Version 2.3 approved by ISB on 24th November ISN to follow and update to details on the NHS IC website Area of Work updates 2 minor to correct the names of medical specialties New Sickness Absence Reasons Implementation of more detailed list based on the Institute of Occupational Medicine Sickness Absence Recording Tool (SART) values Additional Reasons for leaving 3 new reasons for leaving to cover Mutually Agreed Resignation Schemes (MARS) To be implemented in ESR by 01/04/2011? Updates to Ethnic Categories in version 2.4? Awaiting confirmation on optional detailed codes

27. Healthcare Scientists Workforce Information Pilot Why do we need the Pilot? Occupation codes are approaching 20 years old, trying to do two jobs, limited granularity especially for non-clinical roles Workforce data standards are out of line with general data model Difficult to relate workforce to activity and outcomes Big issues including productivity, patient safety etc. Also added pressures of significant changes to the structure of the NHS including movement out of the core NHS � and away from ESR? Revalidation � will go wider than GPs / Medics � how will the data support this?

28. Where are we now? Dated coding/classification schemes Inconsistencies in recording Guidance not always robust Aimed at national collections, not mgt. information Non-clinical roles not well represented Poor levels of granularity Specialist surveys used to fill gaps Public health Informatics Inability to link with activity/outcomes/finance Occupation codes trying to do two things, and not (historically) doing either of them fully. Ties what staff do with where they do it. Codes devised to answer the demands of politicians and policy � not the needs of the NHS Granularity variable (e.g. estates breakdown abysmal) As a result, people do their own thing And we cannot answer the current questions on productivity, efficiency, safety Plus we have no ability to provide professional staff with information to support their re-validationOccupation codes trying to do two things, and not (historically) doing either of them fully. Ties what staff do with where they do it. Codes devised to answer the demands of politicians and policy � not the needs of the NHS Granularity variable (e.g. estates breakdown abysmal) As a result, people do their own thing And we cannot answer the current questions on productivity, efficiency, safety Plus we have no ability to provide professional staff with information to support their re-validation

29. Where would we like to be? Separation of Role/profession/function, from Patient-client group/specialty/work area, from Setting/site/context Better coverage of non-clinical roles Links to activity and outcomes (i.e. tied into national data model) Robust guidance for HR depts. Clear/unambiguous validation rules Role: Nurse, phlebotomist, accountant, plumber Work area: Orthopaedics, elderly care, women and children�s services Setting: Community, primary care, acute Role: Nurse, phlebotomist, accountant, plumber Work area: Orthopaedics, elderly care, women and children�s services Setting: Community, primary care, acute

30. What do we want to know about the NHS Workforce? Aspirational list: Registration / Profession Qualified (yes/no or level?) Clinical (yes/no) Staff grouping / Occupation Area of Work Provider / Commissioner Job Role (level?) Care Group Subjective code (and dependant codes?) What can realistically be achieved / expected to be accurately captured? Overarching need to tie in with Activity / Outcomes measures?

31. How do we get there? Pilots develop (where possible) Occupation Codes Areas of Work Job Roles Guidance (linking above items) Validation rules (including algorithms) Links to activity/outcomes Settings Test classifications/guidance in the field Test generic application (i.e. to other staff groups) Follow ISB/ISN process Plan for first output in first quarter of 2011 � more fundamental changes will take longer Set up ongoing maintenance arrangements

32. N.B. Not only ESR: two non-ESR sites have to upgrade their own systems as well Need policy push (ideally well in advance) to encourage trusts to accept they should update ESR for their employeesN.B. Not only ESR: two non-ESR sites have to upgrade their own systems as well Need policy push (ideally well in advance) to encourage trusts to accept they should update ESR for their employees

33. Healthcare Science: Current Situation & Developments Over 51 different HCS professions Confusing for those coding Not all roles are regulated Codes don�t match current roles in the service New roles and new ways of working Modernising Scientific Careers Simplifying access to the professions Simplifying career progression through the professional levels Increasing workforce flexibility Identifying 6 broad job levels across all professions Terminology not well understood � so for example there are too many staff coded as clinical scientists. Brief overview of the current situation, lots of professions, not straightforward, difficult for HR teams who are undertaking coding to identify where HCS should be, regulation isn�t as clear as other professions in that some professions are (Biomedical Scientists, Clinical Scientists), others aren�t Terminology not well understood � so for example there are too many staff coded as clinical scientists. Brief overview of the current situation, lots of professions, not straightforward, difficult for HR teams who are undertaking coding to identify where HCS should be, regulation isn�t as clear as other professions in that some professions are (Biomedical Scientists, Clinical Scientists), others aren�t

35. Healthcare Science: Difficulties Inconsistent approach to coding HCS � biggest problem Unable to obtain accurate picture of whole HCS workforce at local or national level via data warehouse � the census thought to under count by about 20,000 in England (coded elsewhere) Difficult to workforce plan without accurate data Difficult to identify the contribution made to the service by HCS Need to link coding to new MSC developments Mapping existing workforce to new career framework � example of an early win Persuading employers to recode � scope for mass update in ESR following consultation with employers? Identifying regulated professionals Summary of the problems faced now with regard to the existing coding system and the proposed changes Summary of the problems faced now with regard to the existing coding system and the proposed changes