Implementing BI and data sharing across Greater Manchester Health and Social Care Partnership

'It's a story of a story of collaboration and support rather than one of diktat' says head of BI Graham Beales

The Greater Manchester Health and Social Care Partnership (GMHSCP) was the first formally devolved healthcare service in the UK. Since 2016 it has been in charge of its own health and social care services and spending plans, the idea being to better integrate the medical and social care services provided to 2.8 million people by the NHS, ten local authorities, charities and other providers.

From an information perspective, doctors, social workers, commissioning officers, emergency services and the third sector all need to access to a trusted source of the truth, presented in a way that fits their requirements.

Graham Beales is head of business intelligence at GMHSCP, and it's his job to ensure that the information flows where it's needed. This is less of a technology integration - although that's certainly part of it - and more of a people integration, persuading individuals in the multiple departments and agencies to think of themselves as one team striving towards a common goal, he explained.

A story of collaboration

GMHSCP has invested in dedicated staff and also a Microsoft SQL-based data warehouse, but considering the scale of the Partnership, the budget is relatively small. That said, it's a major step up from the "one person and a spreadsheet" setup that existed previously, when annual Excel report distributed by email were the main way that informed about goals and performance were shared.

But while the intention is to get everyone on the same page by enabling much more frequent reporting, it has never been to get everyone using the same BI system. That would be impractical given the mix of systems already in use in hospitals, surgeries and offices across the Partnership, and it would almost certainly be seen as high-handed and unwelcome.

"This is a story of collaboration and support rather than one of diktat - saying ‘you must take this journey'. It's been one that people have come on of their own will," Beales explained.

"The vision is to have a single repository, a single web address for everybody to go to in order to access the information. If they want to maintain their local infrastructure as well as using this then that's their decision. It does not stop people accessing Tableau reports that we produce."

A single view

The BI programme, which kicked off in 2017, is a long-term venture that should eventually enable detailed querying of operational data across the Practice, much of which is currently still siloed, said Beales. Combined with open public datasets such as demographic and crime figures, this will help GMHSCP gain "far greater insight in terms of the influencing factors towards the development of long-term conditions around the interplay between people and services and the impact of social situation on their utilisation of health services."

That's the future. For now, though, the focus is on three main areas.

Already in place across 11 sites is a live A&E dashboard that puts the numbers of patients and waiting times at administrators' fingertips, allowing them to coordinate efforts when acute sites come under pressure. "it's really aiding collaboration across the system through the transparency that it brings," Beales said. Coverage by the system will be expanded.

The team has also pulled together data from various sources to provide a single view of young people's mental health activity and referral across Greater Manchester.

"We are now able to understand the waiting times in each locality the volumes of people waiting, the pinch points," Beales explained.

"It allows us to support localities quicker when problems are arising. The commissioners, the providers and ourselves have all got the same view of the world, so that's enabling us to identify problems quicker, such as if waiting times are growing."

Then there's adult social care in Greater Manchester. There was already a reporting system in place for quarterly benchmarking on metrics such as referral times and hospital utilisation. Beales' team initially worked to pull this into Tableau, which is when the need to be more ambitious became apparent.

"It got to the point when we realised it's useful, but it's not really making a difference - what we've really done is replace an Excel spreadsheet with a Tableau report. So we embarked on the journey of trying to get a personal level dataset, information at an individual level," he explained.

Following consultations, data sharing arrangements were drawn up with ten boroughs, data was stratified into broad categories to avoid reidentification, and the team is now on the cusp of completing a unified information sharing tool which should enable a much better understanding of the services across the region.

"We're close to releasing a series of reports in Tableau around metrics that people haven't even looked into in their own localities before, let alone consistently coded across all ten local authorities," he said.

Challenges and choices

Of course, integrating data across NHS organisations, councils and social services was never going to be easy. A positive start has been made, but there remain plenty of challenges. First, there are gaps in the data, particularly concerning general practice and social care; in addition, third-party providers like charities tend to keep their data private. Meanwhile, the public datasets that are available are often in the non-flat formats, spread over various locations, or stored four-folders deep, and there are all sorts of issues with standardisation. And that's before you get to the regulations.

Currently, most of the data covered by the BI system is not personally identifiable (PII) and so is outside the scope of GDPR and other data protection rules, but as the system expands the question of how to handle personal data will inevitably arise.

"We are edging ever closer to the idea," Beales said. "Greater Manchester is well on its way to building the architecture for a single patient record, and that opens up a whole world of possibility in terms of analytics. If we want to understand what is going on at an acute site, [by looking at] patients and their medical history, we can understand a whole lot more about why people are turning up.

"But there are also new challenges in terms of GDPR and making sure we're responsible with the data."

Then there's cloud.

"We're in an age of technology where cloud has expedited a lot of the historical problems we've had in IT," said Beales. "We're not relying upon some vendor telling us what to do so we are in control as much as possible technology agnostic, so if we want to put it in AWS we can, or we can put in Azure."

When it comes to personal data there are strict rules for what can go in the cloud, however, but Beale said attitudes are changing. "Salford Royal [Hospital], one of our global digital exemplar sites, is working towards a cloud-based infrastructure for most of what they're doing," he mentioned.

Asked about the organisation's choice of Tableau for BI duties when the data warehouse is Microsoft, and many parts of the GMHSCP use Power BI, Beales repeated the point about vendor agnosticism and added that he had used Tableau in a past role. The vendor was chosen from a shortlist that included Qlik and IBM, the former being rejected on the grounds of cost. Tableau, purchased through the reseller InterWorks, ticked the interoperability box and was more flexible in terms of deployment, he said. "With Tableau you can literally buy a couple of licences and start developing"

Delta is a new market intelligence service from Computing to help CIOs and other IT decision makers make smarter purchasing decisions - decisions informed by the knowledge and experience of other CIOs and IT decision makers.

Delta is free from vendor sponsorship or influence of any kind, and is guided by a steering committee of well-known CIOs, such as Charles Ewen, Christina Scott, Steve Capper and Laura Meyer.

Ten crucial technology areas are already covered at launch, with more data appearing and more areas being covered every week. Sign-up here for your free trial of the Computing Delta website.