Knowledge Matters Volume 11 Issue 3

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Volume 11 Issue 3 April 2018

Welcome to Knowledge Matters During the Middle Ages, St George was regarded as one of the 'Fourteen Holy Helpers' - a group of saints people turned to for assistance during times of need, and this Knowledge Matters is all about help and assistance. Samantha previews the Making Data Count guide, which will be a real boon to understanding data, not just for us analysts but getting to the clinical heart of the NHS. Our team have also been turning to others for assistance over the past few months. Sophie and Trishna talk about gaining insights, and Nikki, Dani and Becki talk about a number of conferences and events that they have been to that have greatly helped expand their knowledge. We also provide assistance too! Dani’s article on plotting a dynamic indicator line on Excel charts answers a problem that I have had many times before. Hope you enjoy this St George’s Day edition of Knowledge Matters, and as ever if you have any ideas for articles or want to make a contribution then please let us know.

Inside This Issue : Long Term Conditions Summit 2018

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Applied Analytics

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Ask an Analyst

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Making Data Count – a new interactive guide

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Dicing with Demand and Capacity Modelling

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Christmas Crossword - The Answers!

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Valuing Insight

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NHS Benchmarking Network Conferences

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News

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Long Term Conditions Summit 2018 By Dani Collier, Specialist Information Analyst On Thursday 25th January 2018 I was invited to attend the Long Term Conditions (LTC) event at the Queen Elizabeth II Centre in Westminster (Twitter feed #ltc2018). The morning started with speakers from different organisations and included a patient participation panel. Later we were able to attend seminars for a variety of LTCs. There are over 26 million people in the UK (source NHS England) that live with at least one long term condition. With this in mind, the question is how do we start well, live well, age well and die well? The theme throughout the day was to engage patients to take more responsibility for their own health, including making changes now before health problems set in. As James Sanderson (Director of Personalised Care, NHS England) said “We need to stop having to pull people out of the river - we need to stop them falling in in the first place. And the only way this can be done is through person-centred healthcare.” Jacquie White (Deputy Director - LTCs, Older People & EoLC, NHS England) stated “‘We need to stop making assumptions about people, and support them better to selfmanage”. Clinicians should listen to patients about their own health and take the patient more seriously as they often understand themselves and their conditions better than the doctor that will see them for a (http://www.countyhealthrankings.org/explore-health-rankings/what-and-why-we-rank) very short time.

There are currently just fewer than 23,000 personal health budgets (PHB) in place, which exceeds NHS England’s target of 20,000 by March 2018. A PHB is not new money, this is a new person-centred approach to spending health funding on NHS funded services to support the health and wellbeing needs of the individual. These can be used in conjunction with personal budgets for care and support from social care services. It was noted many times how frustrating it can be for everyone that many new studies, information and technology can take time to become embedded in the NHS. Unfortunately there does not seem to be any quick fix to this, but

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3 technology and innovative ways of working can help. More joined up working between health care, social care and voluntary sector organisations can only be a good thing. A great bit of advice was “Don’t wait for perfection, test the product” - it is only whilst using new technology we can feedback on what is working and what is not, in order to improve. Even though it does sometimes appear we are behind in terms of technology, there is still much going on around the country. We heard from Surrey and Borders Partnership NHS Foundation Trust about their major new NHS study, called TIHM (Technology Integrated Health Management) for dementia. The study aims to improve the lives of people living with dementia and their carers using different technologies and machine learning. This can help inform clinicians on a patient’s health and wellbeing, providing insights to help identify issues before they escalate, in turn helping reduce hospital and care home admissions. You can read more here http://www.sabp.nhs.uk/tihm NHS Choices have created a useful guide to a few smart phone and tablet apps that are being used by patients within the NHS https://apps.beta.nhs.uk/ It’s not just the public that need to embrace technology. We all need to help create a workforce that is confident with the technology to really understand the data. Technology should be used to help make our lives and day job easier. Although with this said, we should be careful to use targets skilfully; sometimes the data will disagree with ground knowledge. It is also known that pressure to meet targets can influence data collected. How can we draw the correct conclusions if we are reading the wrong information? With so much to do and so many people to see, it can often be difficult to learn new skills, or even just keep up to date with an ever changing society. Yeovil District Hospital Foundation Trust delivered a presentation on how virtual clinics and remote monitoring are helping create predictive services for LTC management. With the help of technology and shared access to the local intranet, primary and secondary healthcare can work closer together and keep learning fresh. A day out training is not always possible (and not always needed) so 15 minute videos created by subject matter experts can help greatly. Also something as simple as an advice and guidance line (called ‘Consultant Urgent Connect’) between Consultants and GPs can give people confidence in helping their patient. It’s not just technology that is being promoted to help keep us well. The Complementary and Natural Healthcare Council (CNHC) has been set up by the government to provide the UK with a voluntary register of health practitioners. CNHC currently register the following professions: Alexander Technique teaching; Aromatherapy; Bowen Therapy; Craniosacral Therapy; Healing; Hypnotherapy; Massage Therapy; Microsystems Acupuncture; Naturopathy; Nutritional Therapy; Reflexology; Reiki; Shiatsu; Sports Therapy; Yoga Therapy. The register has been approved as an Accredited Register by the Professional Standards Authority for Health and Social Care, which is a body accountable to Parliament. You can find out more here - https://www.cnhc.org.uk/ The gap between mental health and physical health appears to be closing too. As set out in ‘Implementing the Five Year Forward View for Mental Health’ people with LTCs and/or medically unexplained symptoms will have a new psychological therapy provision which will see physical and mental health care provision co-located, with therapies integrated into existing medical pathways. https://www.england.nhs.uk/mental-health/adults/iapt/mus/ I definitely learned a lot at the Long Term Conditions 2018 event and I have a clearer picture on how our healthcare is changing. I feel more confident to signpost friends, family and colleagues to places that can help them become more proactive in taking care of themselves, as well as see what I can do myself to live healthier for longer.

www.QualityObservatory.nhs.uk

qoteam.scwcsu@nhs.net


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Making Data Count – a new interactive guide coming soon By Samantha Riley Do two point data comparisons frustrate you? Do RAG charts make your heart sink? Do you think that your organisation could make more informed decisions if it made better use of data? If so, I have exciting news for you! A new guide on how to make better use of data is currently being finalised and will be available next month.

Making data count is designed to support people working in the NHS make the best use of their data to inform judgements and decisions for action.

This is an interactive guide for analysts, managers and clinicians. It describes the case for change, explains the importance of SPC, describes how to create and interpret Statistical Process Control (SPC) charts and contains practical scenarios and exercises to strengthen collaborative working between analysts and decision makers.

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Throughout the guide, handy icons make it easy to identify resources that will be useful:

Readers are encouraged to join the growing community striving to make the best use of data #plotthedots AND pledge action to make data count.

Keep an eye on the NHS Improvement website https://improvement.nhs.uk/ and Twitter to be one of the first to use this exciting resource.

www.QualityObservatory.nhs.uk

qoteam.scwcsu@nhs.net


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Valuing Insight By Trishna Julha and Sophie Purcell What does it mean to be insightful and aspirational? Three of the QO Support Team decided to find out what our organisation’s values mean to them by registering on the Gaining Insight course. This programme has a strategic aim of increasing self-awareness, enhancing personal skills and increasing confidence to influence for improvement. Its aim is to support and develop staff who are currently working within bands 2-5 and involves attendance at four separate sessions spread over several months. The Modules are: Module 1: Emotional Intelligence, Learning Styles, Team Roles (Personal Fit), Culture & Values (Yours And How They Fit), Motivation Module 2: Effective Communication/Ethics, Coaching Conversations, Assertiveness, Influencing Module 3: Personal Planning And Organisational Skills, Problem Solving, Resilience, Wellbeing And Stress Module 4: Reflective Practice, Next Steps For Development And Action Planning

So far the Support Team have completed three sessions over in Eastleigh; Emotional Intelligence, Effective Communication, and Personal Planning and Organisational skills. With the aim of self-improvement and greater understanding of team work, do the team think the sessions are worthwhile? Here are just a few comments: “The sessions are great! The course leader is knowledgeable, engaging, and really knows how to interact with the group. I’ve realised some big things about the way I like to work and how I interact with people. They seem really obvious now, but they’re things I’d never taken the time to think about. It’s really helped me to feel more fulfilled about my work, and to work more collaboratively in my team. The course has allowed me to get to know some of my colleagues in similar roles over in Eastleigh.” “I’ve completed three out of four sessions of the Gaining Insight course and I am thoroughly enjoying this journey. As the name suggests, I have gained insight and reflected on myself, leadership styles, emotional intelligence, communication skills, resilience and so much more. The course comprises use of a variety of tests, tools and group exercises.” “We’ve had great discussions about the ‘mask’ when we enter the workplace and the perception of how we manage our emotions. In emotional intelligence we examined how we view the emotions of those we interact with and our own triggers; helping in conflict resolution, being respectful and gaining respect, and influence, amongst others.” “Learning about leadership styles has helped me as a manager. I have built more confidence and am better prepared to adapt to situations through insightful, collaborative and inspiring leadership. We also learnt about assertiveness and resilience.”

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Applied Analytics By Sophie Purcell, Programme Support Assistant At the Quality Observatory, we are dedicated to the continued improvement of our team and in our network. Two of our team had a great opportunity to do just that as they travelled up to High Wycombe to attend the first Applied Analytics meet. The point of these course sessions is really to build a community rather than training skills – although with the complimentary membership to Future Learn and AphA for every participant, improving your skill base is by no means discouraged! Over the course of a year, there are four face to face meetings, and several WebEx meets. There is also a year-long project where groups are challenged to provide a ‘fix’ for an issue within the NHS, making sure to use the wide range of data skills we have. It also gives attendees a chance to develop a project collaboratively and share skills.

“It’s a great chance to meet others in similar roles and network. Our project involves a team made up of two QO team members and three brilliant colleagues from the Bristol team. We plan to build a simple ‘How To’ website, based around MSK injuries. This will be a simple pathway finder for the injured, supported by the statistics regarding this particular type of injury and treatment.”

The main purpose of these sessions is to build connections and an analytics network – and not to forget that, as a professional group, we are able to achieve a lot of excellent work which is worth sharing and shouting about. These meetings offer a chance to see excellent practice across the patch. As this will be running for the next year (with hopefully more STPs getting involved) watch this space for more updates.

www.QualityObservatory.nhs.uk

qoteam.scwcsu@nhs.net


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Dicing with Demand and Capacity Modelling By Becki Ehren, Information Analyst In December Nikki, Dani and I took a trip to London to participate in ‘An Introduction to Demand and Capacity Modelling’ training, which was a joint programme between NHS England and NHS Improvement. The idea of the training was to promote a systematic approach for both providers and commissioners, in order to make sure that patients do not wait unnecessarily for treatment. The NHS Constitution states “you have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible”. This covers waiting times standards for cancer, referral to treatment and urgent care to name a few. Not only is it a right for patients to access services within a reasonable amount of time, but delaying diagnostics and treatment can be very costly for the NHS, which puts all services under even more pressure than they already are, showing that demand and capacity training is more important now than ever. The training covered how it is important to get to know the people that are involved before you start trying to plan or implement changes, because for any process or scheme to be successful it requires full commitment and effort from everyone. We were encouraged to think of how we would do Demand and Capacity modelling, why, where and when. A lot of the answers are quite straightforward – you would do it in the service provider environment in partnership with the commissioners, and as far in advance as possible (and ongoing after that) to help support better decision making. We were reminded that, as it will take longer for patients to be seen if the waiting list size is too big and the capacity cannot meet the demand, it is important to include projections based on past events and lessons learned. As nobody can ever fully predict what is going to happen with people’s healthcare, it is imperative to include recurrent concerns. For example, in winter more people suffer from flu, so setting up a flu jab initiative will help to minimise the amount of patients that suffer and may require further medical assistance; which will help reduce demand.

To help us understand demand and capacity modelling, we were shown a practical example through a dice game! We were split into groups of 6 to simulate a simple clinical pathway. The first person represents the demand source (GP) and the last is the discharge ward. Each person in between represents a different work station which was split into ‘patients waiting’ and ‘patients treated’. To start the game we each had 4 toy soldiers - to represent patients - in the patients waiting box (although the GP had 60!), and rolled the dice to determine how many to move over to the treated box. If the number on the dice was higher than the amount of soldiers that we had, then we had to move them all over to the treated box. For example, if we had 4 soldiers and the dice said 6, we would move all 4. Once you were able to move any soldiers out of your treated box, you would then put them in the patients waiting box of the person next to you, and continue to do this process until the end of the round.

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The next round involved extra resources where one person was allowed to take out some of the soldiers and move them around to others’ boxes to help out the areas that were struggling. This was an important part of the game as it highlighted that no matter where you add additional resources to one part of a struggling system, you can risk passing the struggle on to another department. In the real world, managers rarely have a helicopter view of the whole situation either, so it is difficult to allocate resources where appropriate and in a fast enough time to make a difference.

From all of this, the main points we learnt to consider are:

- Have realistic and aligned activity plans (both commissioners and providers) - Work transparently - Communicate with everyone involved so people are prepared, or at least know what to expect - Learn from past experiences – what went well and what did not work so well - Ensure you calculate your waiting list size correctly – this is very important!

We were also provided with some interesting links which you may find useful! *Use breach analysis to identify the most common causes of RTT pathway failure https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/Reviewing-pathways-over-18-weeks-January -2012-Final.pdf * Online demand and capacity programme training (this takes around 90 minutes to complete) https://www.e-lfh.org.uk/programmes/demand-and-capacity/

*Improving patient flow http://www.steyn.org.uk/

*Additional resources and information https://www.england.nhs.uk/ourwork/demand-and-capacity/ https://www.england.nhs.uk/ourwork/demand-and-capacity/models/

www.QualityObservatory.nhs.uk

qoteam.scwcsu@nhs.net


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NHS Benchmarking Network Conferences By Nikki Lawford, Specialist Information Manager For those of you who haven’t yet come across it, the NHS Benchmarking Network is a professional membership organisation for publicly-funded health and social care services. They provide a number of benefits to commissioners and providers, including a range of benchmarking projects focussed on various topics of interest. They recently put on a series of conferences to deliver the results and findings from some of these projects and invited speakers along to talk about some of the challenges and achievements in those areas. The QO went along to find out moreR.

Dani and I attended the first one about Delayed Transfers of Care (DToC), an area which neither of us had much prior knowledge of. We were excited to see that Dwayne Johnson was giving the first presentation however, somewhat disappointingly, this turned out not to be ‘The Rock’ but the Director of Social Care and Health at Sefton Council. His presentation about the challenges that local government and social care face when it comes to DToCs was really interesting however. Throughout the day we heard about some new ways of dealing with delayed transfers that are being trialled, for example processing a patient’s formal discharge after they have physically left the hospital. The final presentation of the day came from James Lowell, Director of Clinical Operations at Medway NHS FT. As a trust, they have had their fair share of struggles over the years so it was fantastic to hear about the innovative ways of working that have been introduced recently to turn things around. He told us how they have adopted the Brighton and Hove system initiative to better manage their DToCs, which involves a daily teleconference for exec directors of all relevant organisations including the acute trust, CCGs, community providers, local authority, social care, CHC teams and others. On these daily calls, delayed discharges are discussed at an individual patient level until each situation can be resolved. This multiagency approach of collectively challenging each other and owning the issues, combined with a special focus on acute care discharges on a Monday morning, has not only dramatically reduced their DToCs but also had a positive effect throughout the patient pathway. It was genuinely exciting to hear about these initiatives and how well Medway are doing these days.

A couple of weeks later we headed back for the next event, which this time centred around Outpatients and Planned Care. Again we received lots of information from the NHS Benchmarking Network team about their findings from the Outpatients project. There was a lot of talk about the need to reduce DNAs (where the patient does not attend a planned outpatient appointment) and we heard several examples of how this is being tackled across the country. Manchester University NHS FT told us how the great patient feedback they have received about their Nuclear Medicine outpatient procedure has resulted in it being embedded in the trust and is helping to reduce DNAs. Others talked about how a rethink of the referrals procedure has greatly reduced DNAs, such as using e-referrals or abandoning the traditional

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practice of posting an appointment letter to a patient without any prior attempt to find a date and time convenient to the patient. The presentation from Cambridge University Hospitals was about how they have moved from an ‘inadequate’ CQC rating in 2015 to an overall ‘good’ rating in 2017, largely by better use of daily and monthly reporting tools. There was a really interesting presentation from Tim Briggs, National Director of Clinical Quality and Efficiency, about the National GIRFT Programme (Getting It Right First Time) and how some of the outpatients-related issues are being tackled. This included problems with data and coding and the effects that can have on accurate reporting, which in turn can hinder attempts to improve outpatients processes.

The final conference in the series was all about Learning Disabilities, and there was really good news from the team about the project and how length of stay for nearly all bed types in this area has reduced over the last year. This is testament to some great initiatives going on across the country to help people with LDs live independently and happily at home, and again we were able to hear about several of those throughout the day. This was another area where we had much to learn, in particular about some of the less obvious challenges that people face and how culture change and variation are such a focus. It’s also an area that can be difficult to measure and we heard about how important it is to combine locally-derived knowledge and metrics with the more traditional analytical methods. Work is still going on to make sure we get this right.

These events have been really informative and overall we’ve found being involved with the NHS Benchmarking Network to be of real value. As mentioned at the start, they are a network of public organisations so it’s worth getting in touch to see if yours is already a member. If so, you could attend future conferences like these for free and also benefit from all kinds of good stuff, such as the opportunity to ask the rest of the network about good practice and receive regular updates and case studies. If you’re interested, they can be contacted at: https://www.nhsbenchmarking.nhs.uk/

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Dynamic Date Indicators Microsoft Excel My dashboard includes a vertical line on each of the trend charts which indicates the date when a new procedure was introduced, in order to highlight any changes since then. Each month I update it with the latest data which means the line needs to be manually moved along to the correct date each time. Is there a way to keep the line at the correct date automatically whenever new data is added to the chart?

Solution: Complexity 2/5 — This is actually quite simple to do... Let’s say we are monitoring the number of A&E attendances, and in January 2017 a campaign began advising people where to go based on a self-assessment of their illness. 1) Select your data range and create a line chart (fig.1) 2) Next, add in the start date (Jan-17) in two blank cells (I’ve used D1 and D2). Next to the first one (E1) enter ‘0’ and next to the second instance of ‘Jan-17’ (E2) enter the Max value of your dataset

(fig.2)

3) Right click the chart and select ‘Select data’ > ‘Add’ > enter the series name (e.g. ‘Campaign began’) and select cells $E$1:$E$2. Your chart will then look a little odd (fig.3). Don’t panic! 4) Click on the (red) line you have just inserted, right click and select ‘Change Series Chart Type’ and select X Y (Scatter) – ‘Scatter with Straight Lines’

Right click the chart and then ‘Select Data’. Now edit your new data series and in the ‘Series X values’ which will be the campaign start dates in cells D1:D2 click ‘OK’ and ‘OK’ again.

You should now have a vertical line (fig.4) which will update whenever you add to the data range!

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Christmas Crossword - The Answers! Well done to all those who had a go at the crossword in our Christmas edition! Here are the answers for you....

And hats off to those of you who managed to solve the mystery winter quote: “ADVICE IS LIKE SNOW - THE SOFTER IT FALLS THE LONGER IT DWELLS UPON, AND THE DEEPER IT SINKS INTO MIND”

SPC: more than just a tech thing We recently came across an interesting blog from Kurtosis about statistical process control (SPC). It’s a thought-provoking piece about how this important approach to measurement needs to become more mainstream and, in order for this to happen, we information folk need to do more than just master the technical side of producing an SPC chart. When it comes to SPC, the story is no good without the data but also, you guessed it, the data is no good without the story. It’s vital that us analysts have a thorough understanding of the actual process we’re trying to illustrate through our SPC charts. In other words, a general change in behaviour may be needed, as the ‘soft’ side of analysis can often be something we try and leave to others if we can! Anyway, take a look and let us know what you think at qoteam.scwcsu@nhs.net Here’s the link: http://www.kurtosis.co.uk/musings/spc_behaviour.html

www.QualityObservatory.nhs.uk

qoteam.scwcsu@nhs.net


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NEWS GDPR Everyone should be aware that the European Regulations on the GDPR come into full force on the 25th May. This has huge implications for everyone working with data. There is an in depth guide to GDPR from the Information Commissioners office - it’s well worth a look if you are interested. https://ico.org.uk/for-organisations/guide-to-thegeneral-data-protection-regulation-gdpr/

Statistics on Obesity, Physical Activity and Diet NHS Digital has released a report on Obesity, Physical Activity and Diet in England. It has found that there were 617,000 admissions in 2016/17 where obesity was a factor (primary or secondary diagnosis of obesity). This is up 18% from 2015/16. It also found that 26% of adults are classed as obese. While this is an increase of 15% from 1993, it is similar to the levels of 2010. You can find the full report on the NHS Digital website at the link below: https://digital.nhs.uk/catalogue/PUB30258

Integrated Care Settings Set to Use the Electronic Prescription Service

Data Off-Shoring Approved NHS Digital have agreed that individual care providers can use public cloud services to store patient data if they so wish. The plan has been developed in partnership with the DH, NHS England and NHS Improvement and it is believed this would mean reduced costs and flexible data sharing. Details have been included within NHS Digital’s latest published guidance along with a guide to migrating cloud services, which covers risk assessments and choosing data hosting locations. You can read more here: https://digital.nhs.uk/article/8497/NHS-Digitalpublishes-guidance-on-data-off-shoring-and-cloudcomputing-for-health-and-social-care

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Following a successful pilot in London and the East Midlands, use of the Electronic Prescription Service is going to be rolled out nationally. The use of the service should free up time for healthcare professionals meaning they have more time for patient care. More information is available at the following link: https://digital.nhs.uk/article/9444/Patients-in-urgentcare-settings-to-benefit-from-electronic-prescriptions

Surge in Online GP services Latest figures show an increase of 42% in patients who have signed up for online GP services, including booking appointments and ordering repeat prescriptions. This increase in online activity is helping to ease the pressure on GPs and their staff as well as save patients time. More information is available at: https://www.england.nhs.uk/2018/03/dramatic-annualsurge-in-online-gp-services-as-patients-sign-up-forconvenience/

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NEWS Say hi to QO newbie, Darren PeallI.

Birthdays

Before joining the NHS I worked across many different areas. From school I joined the British Army as a Royal Engineer where I still continue as a reserve, serving as an explosive ordinance disposal (EOD) searcher. Following my discharge from the regular army I spent a short time working for local government in Essex and then Major League Soccer in the United States. On my return I worked in the leisure industry managing health clubs.

The first few months of the year are always the busiest for birthdays within the team. Since the last edition Joe, Liam, Kate, David, Adam, Charlene, Aleks and Stephen have all celebrated theirs! Here they are showing off the goodies received from their pals in the QO.

In 2013 I started my NHS journey working for First Community Health & Care as a data analyst and IMT technical officer, before moving to SCWCSU working on specialised commissioning, and have spent just under 3 years at East Surrey CCG as PMO & Commissioning Business Intelligence Manager. I now arrive back at SCWCSU as Customer Delivery Manager for the Quality Observatory. Away from work, I try and keep active; walking the dog, going to the gym, many, many holidays, I continue work in the armed forces and I’m currently studying for my commercial pilot’s licence, so between exams I may just fly off to Europe for the weekends!

.... and goodbye to Annette Sadly Annette’s contract with us came to an end in January and it was time to say goodbye. She felt bad about leaving us just for a little while - but then felt much better when she headed home to Australia for a month!

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SCW celebrates NHS70 The NHS is turning 70 on the 5th of July, so along with the South, Central and West CSU we are using this as an opportunity to celebrate the fantastic work of the NHS and to reflect on what an amazing institution it really is. The NHS has transformed how the nation sees health and wellbeing and has proudly become one of the most respected and impressive healthcare systems in the world. Whilst the NHS is facing one of the toughest times yet with an increasing and ageing population, we feel that it is important for as many of us as possible to shout about how proud we are to be working with all NHS staff, and to continue to celebrate the hard work and dedication shown on a daily basis. Watch this space to see what we have been up to in the next edition of Knowledge Matters! #NHS70

A Poem About GDPR The GDPR is very confusing

Fascinating Facts You are actually taller in the morning...

if personal data is what you are using. Data agreements must be sorted If you want the data to be imported. The data owner runs the show

Throughout the day, the cartilage between your bones is compressed, making you about 1cm shorter by the end of the day!

They'll let you know when it's good to go. The data controller knows the score, if you want to know what the data is for. The data processor churns it through, and makes it right for you to view. Data protection must be given its due, or one day we'll all find out about you!!!

Sophie’s Joke of the Day! A SQL Query walks into a bar. In one corner of the bar are two tables. The Query walks up to the tables and asks:“Mind if I join you?”

Knowledge matters is the newsletter of NHS Quality Observatory. To discuss any items raised in this publication, for further information or to be added to our distribution list, please contact us. Hosted by: South, Central & West Commissioning Support Unit

E-mail: qoteam.scwcsu@nhs.net Twitter: @SCWCSU_QO Facebook: facebook.com/quality.observatory


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