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Primary care trusts in South Central England


Primary-Care-Trust

Nine Primary Care Trusts were set up to commission care from a wide range of organisations, but especially from Acute Trusts, i.e. hospitals. We studied the use these 9 PCTs made of business intelligence.

PCTs in South Central England, the Primary Care Trusts, now replaced with Care Commissioning Groups, were set up to commission care from a wide range of organisations, but especially from Acute Trusts, i.e. hospitals. We studied the use these 9 PCTs made of business intelligence.

It seemed to us that business intelligence should be assessed relative to purpose and to the key decisions that needed to be made.

What we found was largely problematical:

• Less than 1% of the effort and resource of PCTs was going into their core task of commissioning
• Commissioning directors said they did not have time to understand what they were trying to do
• Business intelligence was conflated by IT with big data and data mining techniques
• The politics was to inflate costs so as to justify centralisation across the 9 PCTs

The nub of the issues in the end turned out to be one stage more subtle.

The PCTs thought that their job was to drive down the cost of their most expensive contracts: to cost cut as productively as possible. Their most expensive contracts by far were with hospitals for common treatment packages. Their mode of operation was to find experience elsewhere that could be portrayed as best practice in that clinical specialism and was cheaper that their current contracts. For instance inpatient treatment could be achieved with less nights’ stay in hospital.

There is a severe organisational systems problem with this. If commissioners, holding the purse strings, are to intervene with a particular clinical specialism, they are going to be negotiating with middle level managers in the hospital. No matter what the outcomes this must destabilise the hospital management system: things that need to be balanced across the hospital will no longer be able to be balanced and the budget is no longer under control.

In the larger scheme of things both the PCTs and the Acute Trusts need to report to the Department of Health at the end of the year. Having spent the year trying to beat down costs at the Acute Trust, PCTs then have to level with their partners. If an Acute Trust is in financial trouble it cannot be relied on to provide the services the PCT must buy. So the PCTs and the Acute Trust go into a smoke filled room to shuffle their budgets to put the bravest face on for the DH.

We were able to show that a piecewise reduction in the cost of contracts often resulted in an increase in overall costs and in destabilisation of Acute Trust management systems. We showed that the appropriate focus was on the local health economy which PCTs did not understand how to model. Needless to say the irrelevant IT adventures were not impeded by our project!