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Volume 7 Issue 4 October 2013 Welcome to Knowledge Matters I’m glad I got this issue of Knowledge Matters as it means I have an excuse to theme this issue around the 50th anniversary of Doctor Who. I can trace my love (obsession?) with this fine television programme back to 1978 when I bought issue 3 of Doctor Who Weekly, I never suspected then how much it would inculcate my life. The NHS is in many ways just like Doctor Who. There’s a big change every few years, and people complain that they don’t think the new one will be as good, or it’s not as good as it was years ago, but actually things settle into place and we get used to the new regime, and whilst all the public fuss is going on, the NHS and The Doctor get on with fighting the ills of the human condition and of the universe respectively. We’ve undergone a major regeneration in the NHS recently, there was turmoil and upheaval, but things are now settling into place and we’ve become accustomed to new ways of working, and are doing our best to make sure everything works. We know that The Doctor in his current incarnation will be changing soon, and we can only hope that he settles in and is ready to take on any amount of evil that may come his way in the future. This issue of Knowledge Matters is bigger on the inside with all the usual features plus articles on the Virtual Ward project at Surrey Heath CCG, a couple of different pieces of work on asthma, the Health Informatics Diploma, and all the usual gubbins. That only leaves me to say: “One day, I shall come back. Yes, I shall come back. Until then, there must be no regrets, no tears, no anxieties. Just go forward in all your beliefs and prove to me that I am not mistaken in mine.”

Inside This Issue : Surrey Heath CCG— A Virtual A-Ward?


Better data, better decisions, better NHS


Analysis Ancient And Modern


Asthma UK—Compare Your Care


Friends And Family Test


Ask An Analyst


South of England Asthma Dashboard


Skills Builder—Mapping it




Developments in the world of NHS Insight`


Health Informatics Diploma



Surrey Heath CCG: A Virtual A-Ward? By Nikki Tizzard, QIPP Analyst Regular readers of Knowledge Matters may be aware that the Quality Observatory provide a dedicated analytical resource to Surrey Heath CCG, and a significant part of this has been to support their Virtual Ward project. The project commenced in August 2012 and has been achieving great results since then, so it came as no surprise to us when the Surrey Heath Virtual Ward team were shortlisted for a Nursing Times award, in the category ‘Nursing in the Community’. We thought we’d take a look at the project and how the QO have been able to support the team through comprehensive health intelligence. The Surrey Heath Virtual Ward is a collaboration between Surrey Heath CCG and Virgin Care. It is a multidisciplinary team working collaboratively in the community to provide proactive health care, education and support to targeted individuals with long-term conditions who are at high risk of admission to secondary care. There is no physical ward building but patients are identified for admission to the ‘ward’ using a risk stratification tool or by local knowledge.

The team is led from the front by community matrons working alongside GPs, as well as others such as specialist nurses, pharmacists, mental health practitioners, the falls team and voluntary sector organisations. They collaborate with a number of partner organisations such as the local acute hospital, ambulance service, social services and out of hours service. In short the aim is to provide patients with a ‘one stop shop’, utilising existing service provision to support seamless care delivery.

The Quality Observatory became involved with the project very early on and began by developing displayed

appropriate in







monitoring the impact on secondary care and other measures. We included all major longterm



also falls, for


individual practice in the CCG as well as a group summary. We included measures such as emergency admissions, length of stay, excess bed days and multiple attenders, and also indicators pertaining to end of life care and patient satisfaction.

In just the first few months of the Virtual Ward being in operation, we started to see some really encouraging results in

3 the






improvements in several indicators for things like asthma, coronary heart disease, heart failure, atrial fibrillation and falls.

The data

showed that heart failure was a particular area of concern and a specialist heart failure nurse now works across the whole CCG area as a result.

It will obviously take some time to

change behaviours across the spectrum of care providers but initial results have been encouraging and we’ve started to see the awakening of fresh ideas.

Recently the community matrons, who lead the process, have wanted to see some more tangible results at an operational level, and so we developed an additional dashboard for their use. This one includes summary detail about their own caseloads as well as feedback from patients about their experience of the Virtual Ward.







questionnaire, which asks simply how much a patient understands their condition and feels able to manage it. Patients rank this upon admission to the ward and again on discharge.

As the

community matrons are not too familiar with the use of data, this can provide at-a-glance results and simple motivation where results are often intangible.

The Virtual Ward concept is not unique to Surrey Heath but they have worked to adapt the model to the needs of their local population using local services. It is recommended that patients remain on the ward for 12 weeks but the Surrey Heath team will continue to focus on their care going forward if deemed appropriate.

There are obvious cost benefits in this kind of focussed care being provided in the community, rather than an acute setting. However the principal aim here is on improving a patient’s quality of life. During their time on the Virtual Ward, patients will receive education on how to self-manage their long-term condition, thereby reducing their anxiety and hopefully enabling them to stay in their own home.

This has been a great example of data being put into action on the front line. We’ve seen how data can obtain engagement from a variety of providers and stakeholders which in turn drives improvement in patient care. It has been fantastic to see the team’s hard work pay off by being nominated for an award, and an honour for the QO to play a part in that. At the time of going to press, we are waiting with baited breath to see if we can take home the prize…!


Asthma UK—Compare Your Care by Adam C. Cook

The hospitalisation of people with asthma is something that many people are concerned with. Proper management and care of the condition should significantly impact upon the numbers of people who actually go to hospital. To help understand how this happens from area to area Asthma UK asked people with asthma about how their care was managed. The Compare Your Care quiz was launched on the Asthma UK website in May, and when we got the data for analysis in September there were already over 6000 respondents. This covered the whole of the UK. Questions on the online quiz were across several topic areas, all based on clinical guidelines: •

Overall rating of asthma care

Asthma prevalence and diagnosis

Routine asthma care (split into adults and children)

Non-routine asthma care

The data was detailed enough to be broken down for comparison into a number of geographical areas. At the most detailed level some measures could be looked at by CCG for England and by Health Board for Scotland, Wales and Northern Ireland. For some measures though this would have made the numbers too small, and so the information was clustered up into three alternative groups for comparison – Local Area Team, Region and ONS Cluster, meaning that the results could be interpreted at NHS Surrey Heath CCG political, geographical and socio- Region: South East Everyone who has asthma should be given: • An asthma action plan to help them manage their own symptoms (downloadable for demographic level. Routine care free at 35%

A dashboard was created, covering the aforementioned topic areas, which pulls together the results from the quiz so far enabling us to see how different areas are coping with the management of asthma. The Compare Your Care project is ongoing, and the quiz is available online for people with asthma to complete. This is part of the long game to create a comprehensive patient focussed asthma study, which will in turn help improve the care and management of asthma in the UK

• An inhaler technique check to make sure they can use their medicines properly • An annual review to monitor their asthma and make sure their treatment is still right

30% 25%

People who are given an action plan are four times less likely to go to hospital because of their asthma, and those who can’t take their medicines properly or who are no longer taking the right treatment could be at risk. With the right routine care and selfmanagement, it is estimated that 75% of hospital admissions could be avoided.

20% 15% 10% 5% 0%

G C C d r o f sh A S H N

G C C e l a V yr u b s le y A S H N

G C C t co s A & ll e n ck a r B S H N

G C C e v o H & n o t h g ir B S H N

G C C l a st a o C & ry u b r te n a C S H N

G C C n r e tl i h C S H N

G C C x se s Su ts e W l a ts a o C S H N

G C C y le w ra C S H N

… … y G rd G e C l C n C fo C a y a t r Se o Sw re r & sp & u o S m t m G a sa a h & sh E s e S ila m v H a a H r N e h re G n r a d r u F o o S f H tb N rt s a a D E S S H H NMedian N

G C C y le r ve a W & rd o f ld i u G S H N

G C C r e h t o R & s g in st a H S H N

G C C s n e v a H s e w e L d l a e W h g i H S H N

G C C x se s Su d i M & m a h rs o H S H N

G C C t h g i W f o e ls I S H N

G C C y a w d e M S H N

… G G m G a C C C h C C C n y re r re e a i i F sh rr sh & p Su d r e m st fo ir a x H e O sh h W p t h S r t H m o r N a o H N N S st S a H H E N N h rt o N S Quartile H N

G C C s e n y e K n o tl i M S H N


G C C tc rit is D & ry u b w e N S H N

G C C g in d a e R ts e W & h tr o N S H N

G C C h t u o m st r o P S H N

G C C h g u lo S S H N

G C C e ri h s p m a H n r te s a E h t u o S S H N

G C C ts a o C t n e K th u o S S H N

G C C g in d a e R th u So S H N

G C C n to p m a h t u o S S H N

G C C s n w o D y e rr u S S H N

G C C h ta e H y e rr u S S H N

G C C e l a Sw S H N

G C C t e n a h T S H N

G C C e ri h s p m a H ts e W S H N

G C C t n e K ts e W S H N

Upper Quartile

G C C d a e h n e id a M & t o cs A r so d in W S H N

If your area has a low score for routine care, it may mean that some support is needed to help improve proactive asthma management in primary care. If QOF scores for annual reviews are very much lower than patient-reported scores in your region, it could be due to a high exception-reporting rate – you could consider checking whether people are missing out on reviews unnecessarily.

G C C m a h g n ik o W S H N

Asthma action plans: adults (18 and over) 60%

Asthma regular reviews 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

50% 40% 30% 20% 10% 0%

s d n la id M st a E

d n a l g n E f o ts a E

n o d n o L

ts a E th r o N


ts e W h tr o N

ts a E th u o S

ts e W h t u o S

Lower Quartile

s d n la id M st e W

e h T d n a e ri h sk r o Y

r e b m u H

d n a tl o cS

Upper Quartile

s le a


d n a l re I rn e h rt o N

le Is / s d n n a la M Is f l o e n n a h C

s d n la d i M st a E

d n la g n E f o ts a E

n o d n o L

st a E h tr o N

st e W th r o N

st a E h t u o S

Reported by Patients

st e W th u o S

s d n la d i M st e W

r e b m u H e h T d n a e ri h s rk o Y

d n a tl o cS

s e l a W

d n la e rI n r e h rt o N

n a M f o le Is / s d n la Is l e n n a h C


To have a look at the results, view the dashboard, or to become part of the project yourself by filling in the quiz then go to


South of England Asthma Dashboard by Jo Congleton, Consultant Respiratory Physician Asthma is much more common than COPD with a reported prevalence of 5.65% in Kent, Surrey & Sussex. Some of the themes are the same as COPD (e.g. the necessity for correct inhaler technique to be taught and reinforced), but there are also important differences. In general the population is younger and are often less engaged (or not at all engaged) with healthcare services. Cost of prescription medication may be an issue for patients and, although hospital admissions are shorter, it is thought there is much more potential to reduce the frequency than in COPD. We have counted short admissions as it is likely that if the patient was able to be discharged very quickly the admission was not required in the first place. Attendances at A&E for asthma are common but we have not found a way to capture this information specifically (‘wheezy’ or ‘breathless’ isn’t really detailed enough!). The first page (Area Team - AT snapshot) allows comparison across all area teams in the South of England (formerly, NHS South East Coast, NHS South Central and NHS South West). If you select a region (e.g. South East) in the drop down box at the top, the data for the relevant areas, will be highlighted in green. Recent asthma review rates are pretty high at 78% and 76% respectively, but some of the other Area Teams are achieving higher. Smoking cessation achievement (albeit the flawed 4 week quit rate) is high for the KSS ATs at 94% and 93% which is excellent, but on the battlefield it feels like more than 6% of our asthmatics are current smokers and perhaps this emphasises the problem with QoF4 indicator data. Perhaps a local audit of proportion of asthmatics who are current smokers would be helpful here, and it goes to show how important it is to bring local knowledge alongside the data available. The CCG snapshot page shows that there is little variation between CCGs for the metrics that are QoF indicators. However, in Kent for example, the rate of admission varies from 5.4 per 1,000 asthma population in Thanet CCG, to 15 per 1,000 asthma population in Canterbury and Coastal CCG, and the reason for this apparent difference in rates needs to be understood.

The CCG trend worksheet is useful for looking at impact over time. As with COPD, there is a seasonal variation in asthma admissions (peaks in Quarter 3 or 4 depending on the year) which is why we show the rolling average. There are important differences between CCGs, with some showing an increasing number of admissions and 90day re-admission rates, and others the reverse. The dashboard also contains useful information on key acute trust indicators for asthma as well, hopefully providing a full picture of asthma services across the southern regions. Another tool that may be useful to you is the INHALE Website developed by the DoH. The spine charts are helpful in seeing where each CCG is benchmarking for each indicator and you can generate a report for your CCG which lists whether you are performing above or below the national average for each indicator. However the data is not as up to date as the asthma dashboard and at present you can only view data up to 2011.


Developments in the World of Insight By Samantha Riley, Director Of Insight, NHS England Back in February, work commenced on the development of a new resource called the Insight Dashboard which utilises data from a variety of sources to provide a triangulated view of: •

the experiences people have of NHS services and care (viewable for England and by NHS Trust);

views/conversations people hold or are having about the NHS (at England level only)

A web-based beta dashboard was developed in the spring which has been tested over the past few months with a variety of people to ascertain the usefulness of measures included, the presentational format of the data and to gain views on whether additional work needed to be undertaken to make this a useful resource for patients and the NHS. A commitment was made by the NHS England board that the dashboard would be publicly accessible from August this year. The Insight Dashboard made its public debut on 30th August. What’s in the dashboard? A summary of data sets currently included in the dashboard, appear below. Many of the data sets used have been available for some years and most of them are annual (which isn’t ideal – but that’s the reality at this point in time). Other data flows are new and in some cases have been put in place to support the dashboard: Experiences of NHS services and care (Viewable for England or NHS Trust) •

Friends and family test monthly scores;

Comments that patients are making about the NHS (from NHS Choices, which includes comments patients make through other routes, such as Patient Opinion);

What patients are complaining about (from the annual complaints return);

How satisfied patients are with NHS services (a selection of questions from patient surveys are rotated on a regular basis); and

Whether staff would recommend services to friends and family (from the annual staff survey and monthly data collected by YouGov);

Views/conversations about the NHS (Viewable for England only) •

Healthcare related tweets;

Positivity/negativity of conversations being had about the NHS on social media;

How satisfied citizens are with NHS services; and

Public perceptions of the NHS brand


The dashboard can be found here

Initial feedback received on the dashboard suggests that it is useful as it provides a never before seen view of experiences and views about the NHS from patients, the public and NHS staff, and so produces a 360 degree full circle picture. These data sets have historically either been difficult to find, poorly presented or not available at all. And, as Knowledge Matters readers of course know, there is great value in triangulating different sets of data. Next steps for the Insight Dashboard Over the coming months we will be undertaking a range of engagement activities to encourage structured feedback prior to undertaking the next stage of development. In particular, I would be keen to obtain feedback from Knowledge Matters readers on the following areas: 1. 2. 3. 4. 5. 6.

Potential audiences for the dashboard; How different audiences would use the dashboard; Functionality that it would be useful to incorporate; Data sets/functionality that is missing; Additional data sets that could be incorporated that we are unaware of; Suggested changes to current format and structure

Options with regards to the longer term future of the dashboard will be informed by the feedback that we receive. One thing which is already clear is that we need to expand the dashboard to cover all health care settings rather than just hospital services – one of the challenges that we have in doing this is the availability of national, timely data sets to describe patient experience in all areas. I’d be really keen to hear the views of Knowledge Matters readers on the dashboard. You can email me directly ( , email Ruth Hudson who is the project manager for the dashboard ( or you can email our generic email address


Better data, better decisions, better NHS by Prof. Moira Livingston, clinical director for Improvement Capability, NHS Improving Quality Our health and care system requires radical and far reaching change to enable us to make things beer for paents. Tough decisions need to be taken by senior managers and clinicians, and these decisions must be based on data, not anecdotes. Improving care will be driven by intelligent commissioning, which is guided by understanding the variaon that lives within our data and linking improvement strategies and taccs that are based on these data. At NHS Improving Quality (NHS IQ), we have just delivered an innovative and engaging measurement masterclass series for senior clinical leaders. The series was designed to strengthen understanding amongst clinicians of the principles of measurement for improvement, and equip them with the confidence to hold influential discussions with policy makers, data collectors, and other clinicians across the health sector. This approach to using data for improvement is not new, and our ambition now is to drive a significant increase throughout the NHS. We wanted to offer senior leaders the opportunity to really explore with national and international experts why data measurement is critical to successful transformation, and help them to ensure greater certainty about the data upon which much of their decision-making is based.

The masterclass series The programme started with a launch event, which was followed by a supporng series of webinars before a final ‘impact summit’. This process was designed to create a journey from theory and global comparisons, through to praccal applicaon.

We developed the programme alongside established global experts, including Dr Robert Lloyd, director of performance improvement at the Instute for Health Improvement (IHI). It covered: An overview of the crical milestones in the quality measurement journey Understanding why you are measuring (for improvement, judgement or research) Steps for building a dialogue based on data and results Interpreng variaon in data (common versus special causes) and making decisions based on these paerns Transforming the system through measurement for improvement The challenges of improving quality and safety, and how data and intelligence can help to drive system change Understanding data quality, and ensuring it is ‘fit for purpose’ in the current NHS context of decision making.


Sharing global expertise The interactive webinars were designed to explore, compare and contrast different approaches from around the globe, focusing on topics such as using national data to drive improvement at all levels; complex indicators to drive improvement; and issues around transparency. Each webinar featured presentations by international colleagues, including Göran Henriks (Chief Executive of Learning and Innovation The County Council of Jönköping Sweden) and Alide Chase (Senior VP Medicare Clinical Operations and Population Care, Kaiser Permanente US). The talks were followed by panel discussion, featuring UK-based experts such as Dr Carol Peden (Quality Improvement FellowHealth Foundation Consultant in Anaesthesia and Critical Care Medicine, Royal United Hospital Bath ) and Veena Raleigh PhD (Senior Fellow, The Kings Fund). Recordings from all the webinars, including that with the two doctors, are available to listen again on the NHS IQ website.

The final impact summit of the series was designed to share learning and applicaon as well as connue the process of embedding robust measurement for improvement within the NHS. Feedback from delegates Professor Sir Bruce Keogh commissioned NHS IQ to develop and deliver the masterclass series, and he worked with us to launch the programme at the initial event. He says: “There is growing public interest in clinical data, and an increasing need to make sure people are able to understand and contextualise that data. Measuring what we do, acting on those measures, and sharing them freely, is fundamental to achieving successful improvement. This series has been hugely helpful in providing us as leaders with a much greater understanding of how to appropriately measure, analyse and act upon our data.” Delegates at the launch event were asked to complete an evaluation form on their departure, which asked, among other questions, for them to sum up in one word how they were feeling. Despite it being 5pm on a rainy Friday afternoon after an intense full-day session, the completed forms are full of superlatives such as ‘enthused’, ‘revitalised’, ‘inspired’ and ‘energised’. The appetite for learning more about measuring for success is clearly there, and the format of the series has been successful.

Looking to the future The masterclass series has not been a means to an end – for those who aended, it is the beginning of a journey in which they will connue to build their skills and understanding of measurement, and use the techniques they have learned to help inform decisions they make every day. I want to see others benefing from the programme too there is a wealth of resources available on the NHS IQ website (hp://

measurement-masterclass.aspx) which I hope you will look at and share with your colleagues. Understanding measurement and using it effecvely is a vital tool in all of our endeavours to drive system change and to improve quality of care for paents throughout the NHS.

10 Friends and Family Test News by Samantha Riley, Director Of Insight, NHS England Hello everyone! Since my last article in August, I am pleased to confirm that the Friends and Family Test went live in maternity services from 1st October. We are expecting the first submission of data from all Trusts in November and we will be publishing the first data for maternity services in January 2014. In terms of the timetable for roll out to other NHS services, the commitments that we have made appear below. We are encouraging providers to introduce FFT to services prior to these deadlines – and from my experience of visiting Trusts and meeting with colleagues at regional and Local Area Team level, there are indeed many providers who have already introduced FFT to a variety of settings and for whom the benefits of FFT are already being realised. •

staff from April 2014;

GP pracces from January 2015;

community and mental health services from January 2015;

outpaents and hospital day case paents from April 2015;

pharmacies, densts and opcians from April 2015.

We are currently finalising the draft guidance for staff FFT and in the next edition of Knowledge Matters I will describe our approach in some detail. If readers can’t wait until then to learn more please do get in touch!


In terms of other FFT news, I think I mentioned last time that we would be reviewing the Friends and Family Test after six months of data had been collected from acute inpatients and patients discharged from A&E. The purpose of the review is to understand what has worked well during the first six months of the Friends and Family Test, and what might be improved and how. In doing so the review will consider the methodology, implementation and reporting of the test, the use of the test for service improvement, and the wider reception and use of the test by NHS staff, the public, and other stakeholders. Every Trust will have the opportunity to feedback their experience to us.

The review comprises three strands: Quantitative Review of Data and Data reporting techniques This strand of work will review the Friends and Family Test data in detail and consider areas such as the scoring metric and data reporting techniques. We will seek to understand the validity, reliability and comparability of the data. Qualitative Review of the Friends and Family Test This second strand of work will review the implementation, reception and use of the Friends and Family Test, incorporating feedback from NHS trusts, the public, stakeholders and experts. The overall aim of the qualitative review is to understand how successfully the Friends and Family Test is achieving its goals. We are keen to understand best practice in the implementation of the test and use of the data, and where things can be improved, and how. Literature Review In this strand we are looking to review existing international research and literature on the Friends and Family Test/net promoter score methodology, particularly where this has been implemented and used in other healthcare settings. As a result of the review, we will seek to make some recommendations with regards to how the Friends and Family Test can be even more effective in driving improvements in patient care. I will update you on how the review progresses over coming months.

Finally, some of you may have seen in the HSJ or on Twitter that some changes are being made to the Friends and Family Test data presentation on NHS Choices. The highlighting of Trusts in the top and bottom quintiles is standard practice in the presentation of statistical data on NHS Choices. However, FFT is a new way of collecting patient feedback and its presentation needs to reflect this. The purpose of the Friends and Family Test is to improve patient experience. It is about much more than a score. It acts as a catalyst to ask “why – why have patients awarded us this score?”. The Friends and Family Test data is not comparable in the same way that other surveys are and we need to reflect this in how we present the data. So, from the next publication (which I am sure you all know is 31st October), Trusts will no longer be categorised as in the top or bottom quintile for their FFT scores on the NHS Choices site. Users will still be able to see how different trusts, sites and wards score and can use the data alongside other sources to understand the services provided. That’s all for now folks – I look forward to seeing you next time (in a suitably festive outfit I am sure!) As always, I’d encourage Knowledge Matters readers to contact me directly with any comments, queries or ideas!


Mapping it—an idiot’s guide to putting things on a map by Rebecca Matthews, Analyst Everyone loves a map – it’s a very visually powerful way of presenting data, easily comparing different organisations or geographical areas and instantly highlighting problem areas. Here at the Quality Observatory we get lots of requests to show data on a map. So to produce a map of your data you might think that you need a huge amount of training and technical expertise plus a load of expensive software – well not necessarily. Although these might be an advantage for some of the more sophisticated mapping techniques, it is possible to produce very professional looking maps, easily and using free, Open Source software. To illustrate this, it is helpful to look at a real example. In the 19th century, John Snow plotted cholera cases in London on a map to demonstrate that a public water pump on Broad Street was the source of the cholera outbreak (map shown to the left). So how would you go about doing this using modern day software? There a number of different stages to this, and they don’t necessarily have to be carried out in the order. The first step that we’re going to look at is getting the data for the location of cholera cases into a format that can be put on a map (this assumes that you have your data by postcode). To start, you need to geocode your postcodes so they can be plotted. One (free) way to do this is to use the Ordnance Survey ‘Code-Point’ file from the OS Open Data website: This file is available in a number of different formats including .TAB and .CSV files and contains a list of all the current postcodes in Great Britain along with the geographic references for those postcodes. This is a huge file though, so not something you could just open in Excel and browse through for the information you needed even if you had the time! So you’ll need a spatial database to put the data into, for example PostGIS which is the












website: Importing the Code Point file into this database will give you a look-up table, allowing you to geocode any data with an associated postcode, creating a new table containing the geocoded data. Detailed instrucons on how

to import data into and work with PostGIS are outside the scope of this arcle, but please do get in touch if you want any further informaon. Note that the CSV version of this data is split over several different files and working with these has been covered in a previous Skills Builder.


The next step is to take this geocoded data and plot it on a map. To do this you’ll need a GIS application – again free ones are available, for example Quantum GIS which can be


ed from the QGIS website: You can link QGIS directly to the geocoded tables you created in PostGIS, so allowing you to plot your original list of postcodes on a map. All you have at the moment though is a blank page with a few dots on. Although these dots will be plotted in geographically the right place on the page, this isn’t particularly useful in terms of displaying the data. What you also need to add is a background map to give some context to your geocoded dots. Again, these can be downloaded for free from the OS Open Data website where a number of options are available including OS Street View, 1:250 000 Scale Colour Raster and Miniscale. A screenshot of the OS Street View is shown, covering



same geographical area as John Snow’s original map (although some of the



changed, the street layout looks much the same as it did)! Follow


ington Street in the centre of the map and turn left onto Broadwick Street (previously Broad Street) and you will be close to the site of the old water pump. This map would provide an appropriate backdrop for plotting the dots we’ve already created to represent cases of cholera. Once downloaded, these files can be imported directly into QGIS and used to provide some context to the postcode data that you already have. Now you have all your data and background maps set up in QGIS you can start to customise your map to make it even more useful e.g. different coloured or sized dots according to the number of cases of cholera they represent (as a simple example). There are endless possibilities!

Contact if you have any queries on this.


Health Informatics Diploma by Jackie Smith, Health Informatics Development Manager

A new Level 3 Diploma in Health Informatics is now on offer! As with the Level 2 Award, Certificate and Extended Certificate in Health Informatics, this new Diploma has been developed as result of a partnership between the Developing Informatics Skills and Capability (DISC) within HSCIC, NHS Wales Informatics Service, Skills for Health and Awarding Bodies, including City & Guilds. Each qualification is nested inside the next one, so that learners can accrue credits towards the next size of qualification over time if they wish, or each can be taken as a standalone qualification. Learners may also undertake individual units from any of these qualifications for continuing professional development. Who is this Diploma for? This qualification may suit people who are just starting out, or are already working in health informatics and looking to progress. It is for learners who are on, or aspiring to the CF4 Assistant Practitioners level on the Health Informatics Career Framework ( It can also assist those looking to progress their career to CF5 Practitioner and perhaps have no formal qualification in this area. What are the benefits of this Diploma?. It provides learners with the ability to handle and manage electronic and paper based data and information, using IT and manual systems. This could include day-to-day management of patient records, validation and coding of data and the analysis, reporting and use of data to support the quality information. The mandatory units of this qualification have been kept to a minimum in order to provide maximum flexibility around the choice of optional units and the path undertaken through the qualification to best meet the needs of learners, employers and the roles. Learners will gain knowledge and skills in such areas as: •

Promoting good practice in handling information

Communication skills

Managing health informatics

Maintaining quality

Analyse and present data and information

Contribute to decision making

Structure of the qualification To achieve the Level 3 Diploma in Health Informatics, learners must complete a minimum of 52 credits to gain the full qualifications. To do this they must attain 17 credits from the mandatory units and a minimum of 35 credits from the optional units available. 20 credits must come from optional group A. Learners can take 15 or more credits from optional group B but it is not mandatory. Find out more Full details of the units can be found in the handbook, together with further information on the City & Guilds web site: The Level 2 Extended Certificate in Health Informatics underpins the Intermediate Health Informatics Apprenticeship Framework and it is the intention that this new Level 3 Diploma in Health Informatics will underpin an Advanced Health Informatics Apprenticeship Framework which is currently under development and we hope will be available early next year and will push health informatic professionals from being the faceless ones in the background to a more visible role. Watch this space!


Analysis Ancient and Modern by Rebecca Matthews, Performance Analyst, Quality Observatory

Ada Lovelace: “Enchantress of Numbers” October 2013 marks the 5th Ada Lovelace day, an international day celebrating the achievements of women in science, technology, engineering and mathematics. She was one of the pioneers in the crusade for women in science and technology. Ada Lovelace was born in 1815 and her education (unusually for women of the Victorian era) included much around science and maths. One of her works was a translation of a lecture transcript concerning Charles Babbage’s design for an Analytical Engine, an automatic counting machine designed to evaluate any mathematical formula. Ada added notes of her own to the lecture transcript, expanding on the original writings and detailing how the Engine could be used. They included an algorithm for using the Analytical Engine to calculate Bernoulli numbers, describing how the process for calculating the numbers could be broken down into small formulae and then coded into punched cards enabling them to be processed by the machine. Her Notes on the Engine also anticipated future developments for the machine, including computer-generated music. Babbage was impressed with her work and mathematical skill and gave her the nickname “Enchantress of Numbers”. Although the Analytical Engine was never completed, so Ada’s algorithm was never tested, her place in computer history was assured and she is often described as having written the world’s first computer programme.

Image representing Ada

Lovelace’s algorithm for the Analytical Engine


Conditional formatting with calculations Application: Excel 2010 Dear Ask an Analyst We’ve recently moved from Excel 2003 to 2010 and I’m having trouble understanding how to set up conditional formats that use formulas. I’ve seen it done in 2003 but can’t see the option in the 2010 menus! If the value in column C divided by the value in B is larger than the value in A, I want to apply a red flag. If less I want a green flag . Can you help please!

Nicholas Kendall Public Health England

Solution: Complexity 2/5 — Adding formulas to conditional formats The first thing to do here is to understand the calculation that you want to use. The evaluation is broken down into two parts: • •

value in C divided by value in B, i.e. “(C14/B14)” evaluated against the value in A, i.e. “A14<“

The formula that you would need for this is : =A14<(C14/B14) There are now two options that you can use: 1. Use the formula inside a cell with an IF statement and evaluate the conditional format against the output 2. Use the formula in the conditional format directly. Option 1: Use an IF statement in a cell With this method you can construct a formula with an IF statement to output a flag that you can use with the conditional format e.g.: =if(A14<(C14/B14),”high”,”low” ) This should output something like:

17 Now you can navigate to the conditional formatting screen and select: “Highlight Cells Rules” > “Equal To…” In the Dialog Box type in the evaluation (in this example it is either “high” or “low”) and use the “with” option to set the colour scheme.

Option 2: Use the formula directly In the conditional format There is also an option to create your own formula to use in the conditional format. To start off, select the cells you want to highlight. Navigate to “New Rule….” and from the formatting dialog select the last option “Use a formula to determine which cells to format” In the formula bar you can add the evaluation formula: =A14<(C14/B14) Use the “Format…” button to set the colour scheme and hit OK!

Thanks for the advice. I have tried it out but it’s still not working as expected! Can you advise? Well this is interesting! When we looked closer at the sheet we noticed that the first column was left adjusted. This gave us a clue! Having a look at the cell format showed that it is set as “Text”. While the values look like numbers Excel thinks they are text and then can’t use them in the formulas! Change the format and all should be well. Also check under “Options > Formulas” In the Error Checking Rules sections check that all the options are selected .


It’s not goodbye, it’s au revoir

I really can’t believe it’s been over 3 years, seems just like yesterday I was writing my “welcome to Fats” article – a few people approached me after that article asking if it was really ok to call me “Fats”.

I had what could be considered as an unusual first day with the Quality Observatory team. Having received an e-mail invite to Sam’s tropical-themed birthday party, I had a decision to make; could I possibly meet the team for the first time wearing a Hawaiian shirt and flip flops?

As mentioned in my intro article back then, my core work has been supporting the Enhancing Quality & Recovery programme (EQR), delivering the analytical services for the programmes. The programme has and continues to deliver improvement in quality of care for patients across the region and there are some exciting pathways on the horizon. Over the last year, I have been working with the EQR team but this time in the capacity of Enhanced Recovery Project Manager.

My web development and online analytics skills have also vastly improved over the years and I have helped developed a few online tools during my time here including leading on the online QOF Analytics ( Hb5jak) – I am currently in the process of updating this tool so look out for an update very soon.

When I look back over the 3 years, I can truly say that I have thoroughly enjoyed my time here. Really difficult to pick a single highlight but winning the SHA table tennis competition would be amongst them.

If there’s one thing I could have done differently, it would be to have been brave enough to wear my inferno coloured sleeveless shirt and Peter Andre style flip flops to Sam’s party – would have fitted right in. So team, if anyone ever decides to have another tropical-themed party, you can count me in.

Of course this was never a goodbye article. I have made some great friends here. In addition to this, my new role is with the newly established Kent Surrey Sussex Academic Health Science Network (KSS AHSN) as the Enhanced Recovery and Information Improvement Manager, and a continued relationship with the QO is an integral part of it. So, till we meet again, this is certainly not a goodbye, it's just au revoir.


NEWS Unify Returns News

FMLM Conference

It’s that time of year again—the Daily Winter SitReps are due to start with the first collection being uploaded to Unify2 on Tuesday 5th November. All of the latest guidance documents, including the upload template, are now on the Unify2 website.

On the 15th and 16th October we sent Kiran and Simon to represent the Quality Observatory at the Faculty of Medical Leadership and Management’s Annual Conference in Edinburgh. Kiran packed into a van with all the QO kit while Simon took the more civilised option of fly-

It has been announced that there will now be no IPMR (Integrated Performance Measures Return) collection in 2013/14. Information on diabetes, stroke/TIA and NHS Health Checks will no longer be collected. It is now intended that maternity assessment and breastfeeding data will be collected via a new Unify collection in the new year from providers of these organisations.

ing. The FMLM is a UK-wide organisation aiming to promote the advancement of medical leadership, management

Healthcare Analyst of the Year The annual awards for the Centre Of Excellence for Health Care Analysis are taking place on the 7th of November. Among the categories included is Healthcare Analyst of the Year, and we have a vested interest in this one because our very own Nikki Tizzard has been shortlisted for this award because of her excellent work with Surrey Heath CCG. We all think it’s a well deserved nomination, and we’re supporting her all the way.

and quality improvement at all stages of the medical career, and their conference was billed as ‘Europe’s largest medical leadership event.’ The 2013 conference focussed on the evidence base for medical leadership and Kiran and Simon enjoyed speaking to a wide range of people from all over the country, with Simon even receiv-

HSCIC Strategy

ing an invitation to

The Health and Social Care Information Strategy are now inviting comments and feedback on their draft strategy which was published on 23rd October. The strategy draws together the HSCIC’s current activities and programmes and the opportunity for feedback will run from 29th October to 22nd November. Comments can be emailed or posted to Linda Whalley, Full details and the draft of the strategy can be found on the HSCIC’s website:

do a talk in China!

Despite couple





there was still time

to take in the sights of Edinburgh and sample the local brew.

Charlene’s Wedding Congratulations to Charlene who got married to Stuart Black on the 5th October this year. Many members of the Quality Observatory team (both past and present) were there to help celebrate this happy occasion. Much merriment was made, and a splendid time was had by all. We wish Charlene and Stuart much happiness and joy for the future.

Time And Relative Dimensions In Space Enterprise and Liberator just admit you're beat Even the Millennium Falcon really can't compete If you want to travel in space and time you need a wooden box.

It looks a little odd, but the chameleon circuit bust, But it's grown into a shape that everyone can trust, It wouldn't be the same if it weren't a wooden box.

The other ships will get you straight from A to B, But you'll miss out all the sights that you can see,

Bumped and bashed and battered even exterminated,

When you're travelling the universe in a wooden box.

But still unbroken, dauntless, travels unabated,

Dimensionally transcendental engineering at its best, Which means it's bigger on the inside, if you hadn't guessed. Just the thing for traversing through the vortex in a wooden box. It doesn't always land you where you want to be, But you'll end up where you're needed and back in time for tea, Such is the very nature of travelling in a wooden box.

Note from the editor Throughout the text of this issue I’ve attempted to hide the titles of eleven Doctor Who stories — one for each doctor. There are no prizes, but if you find all eleven then you can bask in the glory of your geekdom, and endure the raised eyebrows and heavy sighs of your colleagues! (Apologies to all whose articles I’ve had to shoehorn titles into!)

Solid, if unreliable, travel in a wooden box.

Wheezing and a groaning on take off and on landing, Daleks, Cybermen, and The Master notwithstanding, If you want to see the Universe you need a wooden box.

Simon says……. According to a recently published paper, by a team at Cornell University, all mammals regardless of size take about 21 seconds to pee.

Knowledge matters is the newsletter of the 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: Central Southern Commissioning Support Unit


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Knowledge Matters Volume 7 Issue 4  

This month's issue with articles on Asthma, NHS Friends and Family Test, National Insights dashboard, Virtual Wards, Mapping and conditional...