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What is Value-Based Health Care?

NHS Wales aims to get the very best outcomes for patients with the resources we have. To achieve this, we are working with patients and clinicians to gain a deeper understanding of the value we get. We view value from a patient perspective, striving to deliver what matters to the people who use our services.

In practice, this means defining the results we want – according to what matters to patients – and collecting Patient-Reported Outcomes Measures (PROMs). To achieve this, NHS Wales is focused on data-driven decision-making: we are collecting PROMs data and using it to make services better and more efficient.

By deepening our understanding of how we use resources, NHS Wales aims to:

• Operate clinics more efficiently, making better use of patients' and clinicians' time
• Identify and address clinical and quality of life needs that matter to individual patients
• Offer patients insights into the likely outcomes of available treatment options
• Use large datasets for research purposes to learn about medical conditions, how well treatments work, and how we can further improve services
• Invest in services and interventions that deliver value; discard low-value practices; and reduce unwarranted variation in care

Value-Based Health Care (VBHC) encourages us to focus on meeting the goals and preferences of our patients by involving them in decision making, supported by the best evidence to hand. To improve patient outcomes and their experience of healthcare, we are working to improve our communication systems and to embrace digital technology.

Why is VBHC right for Wales?

Our population is changing. People in Wales are growing older and living longer, and some are developing complex health needs. Our services must adapt to the needs of the population to ensure the sustainability and health and social care. 

Wales is committed to investing in meeting these needs as efficiently as possible. This requires changing how we work and being smart with the resources we have. It means developing new, personalised approaches to delivering care at the right time, to the right people, in the right places.

'We want to know what matters to patients. We're asking which treatments and care keep people well; what interventions affect their quality of life in ways that they value.

By completing questionnaires about their health and wellbeing, patients are helping us to learn how best to deliver care that improves their lives in meaningful ways

Dr Sally Lewis, National Clinical Director for Value-Based Healthcare

Building on the principles of Prudent Healthcare, NHS Wales is embracing Value-Based healthcare. This fits with the ambition of A Healthier Wales – the government's long-term plan for our health and social services. Our National Action Plan for VBHC, published in the autumn of 2019, sets out a roadmap for delivering on our vision of data-driven care.

We are working with international organisations, including the OECD and ICHOM, to apply the latest technologies and knowledge as we reimagine our health system together. In the process, Wales is becoming recognised as a global leader in VBHC and building the knowhow and information tools best suited to our population.

How will VBHC help Wales to get better value?

We do not know enough about how the services we deliver contribute to the best outcomes for patients. To find out more, questionnaires have been carefully designed to learn about patient-reported outcome measures (PROMs).

The assessments draw on international expertise and surveys developed with patients and clinicians in each therapeutic area. Patients in Wales are asked to complete questions that were selected by our clinical teams. This will guide their immediate care while also revealing what works best for people with their condition. As we learn more about the kinds of care that offer the best value, we can do less of the things that do not help and reinvest that money to do more of what works. Our goal is to enhance our capacity to meet the needs of patients now and into the future.

How is it improving patient outcomes and experiences?

Access to data on what works best empowers patients and clinicians to make informed decisions. In building systems to collect and analyse this information, NHS Wales has invested in technologies that radically improve communication with patients. Using smartphones and tablets, patients can communicate with clinical teams remotely about their health. This presents opportunities to access care quickly if needed. It also saves patients the time, inconvenience and expense associated with travelling to unnecessary clinic appointments.

Find out more

What does it mean for clinicians?

Our clinical teams can review PROMs before a patient visits the clinic, helping to make appointments more efficient and to identify areas in need of attention. Our data specialists are working with clinical leaders to build data dashboards that help our busy frontline staff to visualise key PROMs data for individual patients.

PROMs data can be used as a triage tool and can help to prioritise patients with the greatest need, helping to make the best use of clinic time. This allows urgent cases to be identified and fast-tracked while easing pressure on services by reducing unnecessary in-person follow-up appointments.

Equipped with data about service needs and the value of available interventions, clinicians can refine how they deliver care and make the business case for investment where needed.

Find out more

What are PROMs?

Patient-Reported Outcome Measures (PROMs) are a form of digital health assessments that have been designed and tested with patients and clinicians for either specific diseases or for your general health and quality of life. They look for changes in people's health before and after treatment and/or overtime to understand changes in people's quality of life. They are validated questionnaires, usually condition-specific, developed by research academics following extensive research.

 An example of the EQ5D 5L general health/quality of life questionnaire.

PROMs questions are usually multiple-choice, with most questionnaires having a scoring system which converts answers into a single score. Each PROM may have a different number of questions, and scoring system, with answers to different questions being weighted according to their importance.  

VBHC in NHS Wales: Key milestones
 

• 2013: The Bevan Commission publishes Prudent Healthcare
• 2014: Prudent Healthcare policy launched
• 2015: ABUHB purses a VBHC strategy
• 2016: ABUHB scales up PROMs collection
• 2018: Dr Sally Lewis appointed National Clinical Director for VBHC
• 2018: Data dashboards produced for lung cancer and heart failure
• 2019: The Welsh Government publishes A Healthier Wales
• National Action Plan for VBHC launched (2019-2022)
• Post-COVID recovery support and the creation of a Communication Strategy, including the rebranding and launch of our Value in Health Programme

Information about patient outcomes and experiences is vital to Value-Based healthcare. Measuring standard sets of outcomes across Wales allows for comparisons that drive service improvements

Information about patient outcomes and experiences fuels data-driven healthcare. Data quality counts: an essential first step to using data well is to decide what should be measured and to implement a uniform approach across the country. This sets a common baseline with which to compare future developments. It highlights services performing well from which others can learn.

Selecting the right Patient-Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) is a crucial step. For many conditions, there are several existing sets of outcomes which have been developed globally.

‘The most effective way to collect PROMs and PREMs is to agree on a common set of data across Wales. Otherwise, you’re comparing apples with pears.’

Kathleen Withers
Senior Researcher, Cedar

These include standard sets from the International Consortium on Healthcare Outcomes Measurement (ICHOM) with which NHS Wales has an established partnership.

Experts at Cedar built a database of existing tools and worked with clinical teams to identify the most suitable set to be used nationally. Patient experience teams in NHS Wales Health Boards and Trusts worked with clinicians and patients to agree on a common point in the patient journey at which to collect data. The public was engaged through a series of focus groups. A set of universal questions was agreed for use with all patients. Additional questions on outcomes, specific to the patients' condition, can be added by clinical teams. Patients are asked to complete the questionnaires using an electronic platform.

This approach ensures a consistent method of data collection across hospitals and organisations in NHS Wales. Clinicians can use the data for peer-learning; local patient experience delivers appropriate improvement programmes, and the result can drive the Prudent Healthcare agenda by ensuring resources are used well. 

What is Cedar?

Cedar is an NHS-academic evaluation centre which is part of Cardiff and Vale University Local Health Board and Cardiff University.

Cedar supports decision-making in healthcare by providing information and recommendations on healthcare interventions, medical devices and diagnostics, and NHS service configuration.

Nationwide implementation   

Once common sets of PROMs and PREMs have been identified, the challenge is to embed them nationally. To ensure datasets are comparable, questionnaires should be completed at the same point in the patient journey and using the same format. The information can then be shared by health boards and analysed at the national level.

This national approach fosters a culture of improvement and raises standards across the country, without preventing local innovation. 'We take a national approach to everything we do,' explains Sarah Puntoni, Programme Manager for Value-Based Healthcare. 'We can still have early adopters of new initiatives which can be expanded nationally. The important thing is to have a common minimum set of data for the whole country.'

Future work

The power of the information collected across NHS Wales to improve services will grow over time. When a large, robust dataset is available, clinicians will be in a position to predict patient outcomes with increasing levels of confidence. For patients, this will bring empowerment about treatment decisions: information about the outcomes and experiences of patients like them in Wales will drive informed choices.

By combining data on patient outcomes and experiences with information about the cost of care, it will also be possible to select interventions and technologies that deliver the best value. For example, PROMs and PREMs, combined with information on the cost of care over a 10-year period will give a fuller picture of how various treatment choices contribute to the goal of improving patients' lives. In practical terms, it may influence decisions about which hip implant, cardiac stent or rehabilitation programme to fund.

Research potential

The wealth of high-quality data collected in Wales offers enormous potential for clinical and academic researchers. Health boards are working with universities and others to explore how fresh insights can be extracted from the large and growing datasets that are being developed through PROMs and PREMs collection.

‘With a vast set of data like this, there is great potential to inform how we provide services in Wales. It could be used to study the value of implants or drugs and we are keen to collaborate with other researchers on this.’

Robert Palmer
Senior Researcher, Cedar

By completing questionnaires on their symptoms and well-being, patients can help clinical teams to improve their care and make services more efficient

Doctors and nurses begin most clinical consultations by asking patients how they are feeling. This gives patients a chance to highlight areas of concern and offers clinicians an opportunity to identify problems that should be addressed.

As clinic time is often limited, NHS Wales is enabling more and more patients to do this in advance of attending their clinic appointment. Some of our services are going one step further: using questionnaires to track patients’ health remotely. Clinicians can bring patients in quickly if their condition deteriorates while allowing others to avoid unnecessary trips to the clinic.

Experience to date suggests this new and innovative approach is a win-win. Patients can have increased contact with services – online, by phone and in person – and spend more time discussing what matters to them. By limiting the time spent on face-to-face consultations that do not improve patients’ health, waiting times are reduced for all and care is focused on those who need it.

Overall, this approach is helping to get better value for the time and resources that patients and services invest in maintaining good health.

Completing PROMs questionnaires

Patients and healthcare providers want the same thing: good health for service users. However, research shows that patients and clinicians sometimes have different definitions of good outcomes. Traditionally, the focus in healthcare globally has been on outcomes defined by clinical experts. In recent years, there has been a shift towards Patient-Reported Outcome Measures (PROMs).

NHS Wales is a world leader in embracing this patient-centred approach. PROMs are widely used in research studies to measure the value of healthcare interventions, including medication, surgery and rehabilitation. NHS Wales is going further by integrating PROMs into direct patient care as part of our Value-Based Health Care Action Plan (2019-2022).

‘People are used to online banking and booking tickets on websites – they expect the NHS to use technology to improve their experience.
Feedback from patients tells us they are happy to provide PROMs provided their answers are used well.
Sarah Puntoni,
Programme Manager,
Value-Based Health Care

Completing questionnaires can take time and effort, especially as patients get used to this new approach. Experience from pilot projects tells us that patients are more positive about PROMs assessments when they know their responses will be used by the doctors and nurses that care for them. Our data and IT teams are developing ‘dashboards’ that will present PROMs visually in ways that track patients’ symptoms and general wellbeing over time. Data will also allow patients to understand how people like them respond to the various treatment options available. This is the path to informed shared decision-making, resulting in better outcomes.

Case study: using PROMs in cardiology clinics   

Heart failure patients can complete questionnaires before clinic visits, saving valuable consultation time while being monitored remotely

Heart failure has a significant impact on the quality of life and is associated with poor long-term outcomes: 50% of patients die within five years of diagnosis. As the population ages, the number of people with heart failure rises. This leads to greater demand for services, including unscheduled care where patients are admitted to hospitals through emergency departments. All of this adds to pressure on the NHS Wales budget. It is vital for people with heart failure, and for the wider health and social services, that clinics offer the best value possible.

How it works

Heart failure clinics are embracing PROMs questionnaires to collect information prior to in-person consultations. The service introduced PROMs by asking patients to complete a questionnaire using an iPad in clinic waiting rooms before seeing the nurse. The survey consists of approximately 20 questions covering general wellbeing and issues specific to heart failures, such as fatigue, dizziness and breathlessness. This results in an overall score which gives the clinical team an overview of how the patient is doing, as well as details about areas of concern. This saves time and allows consultations to target what matters most to patients.

Patients can now complete these surveys before coming to the clinic. A text message is sent three days before their appointment. Patients click on a link and answer the questionnaire. Some patients are happy to complete the survey themselves while others need help from a family member or carer. The system facilitates telemedicine consultations if patients need support by phone or cannot travel to the clinic. Telemonitoring of blood pressure, heart rate and weight could also be used to trigger clinical teams to contact patients showing signs of deterioration.

‘PROMs questionnaires can take the pressure off clinic times while improving services to patients. Patients who need to visit the clinic face shorter waiting times, while others can be managed remotely but with the reassurance that we are keeping an eye on them.
Kathryn Roberts,
Clinical Nurse Specialist, Cardiology.

It’s important to educate patients about why we collect PROMs and how we use them. People are happy to complete questionnaires when they see it as part of their care.
Linda Edmunds,
Clinical Nurse Specialist, Cardiology.

This approach can give patients more choice and flexibility. For example, they can check in with us by phone using the PROM. PROMs data also help us, direct patients, to services they may need, such as counselling or physiotherapy.
Karen Hazel,
Clinical Nurse Specialist, Cardiology.

Lessons learned

Using PROMs in direct care requires a cultural shift from staff and patients. Training for staff and support for patients in the early stages can help to secure buy-in as teams and service users transition from the traditional medical model of care towards a more individualised approach with greater shared decision-making. Where this approach delivers clear improvements – such as reduced waiting times or earlier discharge – engagement increases. Getting newly-diagnosed patients to begin their journey with PROMs will add a new level of insights on how patient care can be optimised.

What’s next?
PROMs will be used in direct patient care for a range of chronic conditions (e.g. inflammatory bowel disease) and elective procedures (e.g. surgery). Patient-Reported Experience Measures (PREMs) will also be built into these questionnaires to gain new patient satisfaction insights and to improve service design. Continued support will be needed for staff and for patients, particularly older service users and those whose conditions affect their capacity to complete PROMs/PREMs surveys. This should help to increase response rates.

‘We want the PROMs collection to be integrated into the health system. As patients and staff become accustomed to generating and using this data, and as it brings benefits to direct patient care, this will become business-as-usual,’
Amanda Willacott, Programme Manager, Value-Based Health Care.

VBHC is helping to reorient health services to become focused on Patient-Reported Outcome Measures (PROMs). By defining and collecting PROMs via digital health assessments clinicians can improve direct patient care and make services better for the population.

Patients will contribute to this by completing questionnaires either in clinics or at home. These questionnaires are short, structured assessments that communicate how a person is feeling on that day in relation to their condition and overall quality of life. This data empowers patients and clinicians to make informed decisions. For example, it can influence the choice of treatment or determine whether a patient needs to attend a clinic in person. VBHC enhances shared decision-making and improved person-centred care.

In building systems to collect and analyse this information, NHS Wales has invested in technologies that radically improve communication with patients. These systems are used by some services to enable telemedicine.

Using smartphones and tablets, patients can communicate with clinical teams remotely about their health. This presents opportunities to access care quickly if needed. It also saves patients the time, inconvenience and expense associated with travelling to unnecessary clinic appointments.

Better services for all

VBHC will drive decision-making in NHS Wales. It will help to determine where investment adds most to improving patient outcomes, and where it does not. Using resources well is vital to ensuring services deliver what patients want in a sustainable way. By making services more efficient, the experience of all patients will be improved – for example, by reducing waiting lists and prioritising those with the greatest need first

Patient data can also be used for research purposes. While ensuring privacy and data security, large datasets can help clinicians and service planners understand the patient need and how best to deliver value. This contributes to a smarter, data-driven NHS Wales for everyone.

“We are not familiar with doing things online and completing a PROMs form by telephone is fun, interesting and a pleasure.  I do get comfort from the call and we feel we are treated with dignity

Cardiology patient, Swansea Bay University Health Board

Value-Based Health Care: What does it mean for clinicians?

Clinicians can maximise the impact of their patient contacts by reviewing PROMs collected remotely, use data to trigger behaviour changes, and highlight areas where investment will deliver value for patients

The tools used to collect PROMs are chosen by our clinicians to ensure they are well-suited to the needs of patients using NHS Wales’s services. Our clinical teams can review PROMs before a patient visits the clinic, helping to make appointments more efficient and to identify areas in need of attention.

PROMs data can help to prioritise patients with the greatest need, helping to make the best use of clinic time. This allows urgent cases to be identified and fast-tracked while easing pressure on services by reducing unnecessary in-person follow-up appointments. Opportunities to focus on necessary follow-up appointments offer greater job satisfaction to our busy clinical teams.

Data dashboards

Our data specialists are working with clinical leads to build data dashboards that help our busy frontline staff to visualise key PROMs data for individual patients. These dashboards are tailored to the needs of doctors and nurses who use them. In some disease areas, clinical teams prefer data to be presented in graphical form, with colour-coded information or as an aggregate score representing how the patient is doing.

Pooled data from large numbers of patients will offer insights that can drive patient-clinician conversations about treatment options or lifestyle changes. Using data from Wales, it will show the patient the likely outcomes for a typical person like them. This can guide patient expectation and motivate some to take actions that would improve their outcomes – such as smoking cessation, exercise or improved diet.

PROMs can be invaluable to help optimise outcomes at several levels:

For an individual patient, they enable the clinical team to focus on what matters to the patient. Aggregated PROMS data can offer an individual patient a basis for decision-making about their own care, based on the experience of others suffering from a similar condition.

For a patient cohort, they give data which may form the basis of improvements to patient pathways, the outcomes of specific treatments, and the appropriate selection of patients for such treatments.

At the health board & population level, PROMS data could enable more efficient & effective care and reduction of expenditure on low-value interventions. Opportunities would be created for further investment in treatments that do demonstrate value in health care.

Dr Susan Goodfellow, Clinical Improvement Lead for Value-Based Healthcare

Clinicians will also benefit from a deeper data-driven understanding of the services and interventions they provide. Equipped with data about service needs and the value of available interventions, clinicians can refine how they deliver care and make the business case for reallocating resource or for further investment.

What are PROMs?

Patient-Reported Outcome Measures (PROMs) are questionnaires that have been designed and tested with patients and clinicians for either specific diseases or for your general health and quality of life. They look for changes in people’s health before and after treatment and/or overtime to understand changes in people’s quality of life.

 An example of the EQ5D 5L general health/quality of life questionnaire.

PROMs questions are usually multiple-choice, with most questionnaires having a scoring system which converts answers into a single score. Each PROM may have a different number of questions, and scoring system, with answers to different questions being weighted according to their importance.  

Interview: Dr Sally Lewis, National Clinical Lead for Value-Based and Prudent Healthcare, explores how the pandemic could be the catalyst for a new era of care

Background
The COVID-19 pandemic has added pressure to a stressed system, generating new demand and prompting a rethink of how services are delivered. Dr Lewis says that by focusing on patient outcomes and embracing proven telehealth technologies, Value-Based Health Care offers a route to towards new and more sustainable models of care.

What is Value-Based Health Care (VBHC) and why is it now in the spotlight?

The main premise is to achieve the best health outcomes we can for the Welsh population with the resources we have. We have been applying this approach in several therapeutic areas in recent years. Our VBHC team has worked with clinical teams and patients to collect Patient Reported Outcome Measures (PROMs) in clinics or remotely on mobile devices.

How has this approach been applied in response to COVID-19?

In our response to COVID-19, we have moved to remote triage for all patients in primary care and have seen a rapid rise in the use of video consulting to support safe decision making.

Change has happened at great speed through the application of both workforce and digital enablers. Some of this system change in healthcare delivery is positive and should be captured and adopted for the longer-term benefit of everyone.

What has been the impact of the pandemic on the healthcare system?

A huge amount of healthcare stopped abruptly at the outset of the pandemic due to the need for strict infection control measures, and to create capacity for a huge expected surge in cases of COVID-19. Essential services for life-threatening or life-changing conditions must be maintained throughout.

Achieving good, equitable outcomes for people presenting with the non-COVID disease is of equal importance to improving outcomes from COVID-19 (and preventing the spread of infection). Maintaining essential services for life-threatening, life-changing, or time-sensitive conditions is therefore important but challenging and should be prioritized.

What role will VBHC play in the post-COVID recovery?

A focus on outcomes and value is a helpful aid to decision making as we get the wheels back on the wagon of healthcare, ensuring that we use the opportunity to ‘reset’ the system and do not return to lower value ways of working. Lower value ways of working may include outpatient follow-ups that are not strictly necessary from the patient’s perspective and also consume clinical time or interventions of low clinical value.

Post-COVID recovery will be a difficult time for healthcare as we strive to address a backlog of demand and growing need in the community. VBHC helps us to direct resources to where we can prioritize the greatest need first – and achieve the best outcomes that we can for the people of Wales.

By focusing on outcomes, we can avoid harm in non-COVID disease and ensure equity across the system.

Are decision-makers more open to VBHC?

Prior to the pandemic, we knew there was a lot of low-value activity happening that wasn’t using resources in the best possible way. VBHC is a way to identify what works well and what doesn’t – and to ensure we do more of what works.

Rising demand for services meant it was already imperative that we find sustainable ways of delivering care to patients, particularly those who are living with multiple conditions. Now, COVID is adding new pressures to a stressed system so there is fresh urgency about embracing VBHC. If there’s a silver lining to this catastrophe, it’s that we’ve been forced to press the reset button. The challenge is to ensure we have a total reboot of the system rather than slipping back into our old unsustainable patterns.

Adopting a value-based approach across NHS Wales will require investment in people and technology but will ultimately allow us to use our resources – professional time, clinical space, and money – in the best way possible.

Has the appetite for VBHC grown among patients?

Most people are not thinking about Value-Based Health Care, but vulnerable patients are certainly very positive about technologies that ensure they are cared for without unnecessary clinic visits. The pandemic has seen massive adoption of digital technology to support remote consulting and there is now a huge interest in PROMs as a way to remotely assess and communicate with patients. The pressure to change is often met with inertia. But now there is a real appreciation of how PROMs data can improve the patient experience and make services more efficient.

PROMs will help clinicians to prioritise patients and work through the backlog efficiently – without having to phone every patient individually, which is not practical. To be clear, face-to-face contacts will always be needed. The key is to treat those with the greatest need first. For example in eye disease clinics, you want to target those with glaucoma who are at risk of blindness, or people for whom cataract surgery would be life-improving.

How will COVID-19 increase demand for services?

A recent paper on by Ruth Crowder, Chief Therapies Advisor to the Welsh Government, offered striking insights into the medium to longer-term needs. It groups patients into four categories: those recovering from COVID-19 in the community; those who have further deterioration in their function due to delayed intervention; people who avoided using services during the pandemic and are now at increased risk of disability and ill-health; and socially isolated or shield groups for whom the lockdown has had a negative impact on their physical or mental wellbeing.

We’re talking to the Therapies group about how we can use VBHC as a method for supporting the vast number of patients affected in various ways by the pandemic. Outcome measures that can help us assess their needs – including the EQ-5D quality of life tool, PROMIS 10 which is already used in primary care, and the WHODAS disability assessment tool. We need to collect data on samples of patients to assess their needs so that we can plan services to cope with a tsunami of rehab needs resulting from COVID 19.

Might investment in prevention, early intervention, and rehabilitation be postponed given that waiting lists have grown and budgets are stressed?

The fact is that if we don’t support people through prehabilitation and rehabilitation, they will end up at the hospital door sooner or later – often with even more serious needs. Similarly, we need to direct resources in ways that minimise inequality. All of this comes against a backdrop of a system under pressure. To me, that only strengthens the case for taking a value-based approach to ensure we invest resources wisely. The goal must be to use a robust methodology to determine which investments deliver value in terms of improved patient outcomes and reduced overall healthcare utilisation. 

Background 

The Advanced Analytics Group for Wales (AAG) was set up in 2019, aiming to accelerate and highlight the development of advanced analytics capability across health and care in Wales. The group is made up of over 30 of Wales’ leading data science and informatics professionals, including representatives from NWIS (NHS Wales Informatics Service), Welsh Government, ONS (Office for National Statistics), Health Boards and local authorities.

Co-ordinated by the Digital Health Ecosystem Wales (DHEW) and the National Data Resource team, the group was established to support and drive progress across Wales’s digital health ecosystem, with a view to meeting the strategic priorities set out in the Welsh Government’s Statement of Intent: Better use of health and care data for safe, effective care and efficient service.

This aims to promote a more data-driven health and care system, focussing on enhancing data collection and quality, improving skills and resources, developing digital solutions to support implementation and management, and developing a framework for managing, using, and sharing data. The Advanced Analytics Group was created as part of the National Data Resource work programme to achieve these aims.

Aim of AAG 

The AAG aims to streamline, organise, and refocus priorities to enhance efficiency across Wales’ health and care ecosystem. With numerous stakeholders making up the healthcare sector across Wales -, Welsh Government, NWIS, clinicians, social care providers, hospitals, GP clusters and more -  communications between these groups can quickly become complex. 

The transformation of health and care delivery through digital technology relies on increasing amounts of data and analysis. Analysts and teams across health and care have been developing exciting and innovative ways to improve sharing data, supporting clinicians and care professionals and improving patient outcomes and it was identified that sharing of projects, experience and best practice was a priority.

Alongside this, there is a growing chasm between clinicians and those in patient-facing roles, and the data science community – both of whom are reliant on health and care data but could communicate more effectively in order to utilise it fully.

As such, the AAG aims to provide a strategic and technical focus to bridge this gap, and support stakeholders in becoming more organised, coordinated, and efficient in how they work. The AAG works to ensure Wales’s health and care sector has the right experts looking at the right problems, and ensuring the right problems are being dealt with the right resources. 

Issues 

One of the main issues identified by those involved was the lack of organisation and coordination among Wales’s health and care analytics ecosystem. 

Dave Pearton (Senior Business Analyst at NWIS) said: “There are a number of organisations, governance groups, individuals and teams, regional health boards and hospitals involved. When you look at how they interact, there are different teams who reach out to different organisations and it becomes complex. 

“There’s a lack of prioritisation, requests might go into the team as a priority, but because it hasn’t been through a prioritisation process there is no way of determining that. 

“That resource could be looking at something more important. AAG allows you to take a birds-eye view and streamline the process for those involved.” 

Chair of the AAG, Dr Sally Lewis (National Clinical Lead for Value-Based and Prudent Healthcare at Aneurin Bevan UHB), also identified a lack of communication between health service professionals and the data science community as a major issue. 

She said: “There was a bit of a disconnect between the data science community and health service professionals who need to be asking the questions of the data. That meant there was frustration on both sides. 

“The health service professionals need the information to make decisions, but don’t know who to ask, or how to ask the question. 

“On the other side, we have a talented data science community who are hungry to receive the questions but don’t have that exposure.  

“We recognised the need to build a bridge between those communities and create a common language, so that we could ask the right questions to the data science community, and generate information and knowledge so that we could have a truly data-driven decision-making process.” 

Dave also added that the coronavirus pandemic had led to the displacement of numerous patient procedures, which was now impacting service prioritisation and efficiency. 

He said: “We switched off a lot of services as a result of COVID - the wave of a pandemic saw people displaced, with pre-planned operations delayed. Due to coronavirus, we’ve closed down services and now we need to start opening them up. 

“So, the challenge is how do we open them up, which do we restart, what services do we open first.  

“That has inevitably been having an impact on service planning and resource prioritisation as we start to resume some resemblance of normality.” 

Progress 

The first priority for the group is to create a catalogue of health and care data innovation across Wales, including advanced analytics, data science, machine learning, AI and big data.  

 Once this has been created the group will then examine the priorities and see how these can be supported, to ensure resources and expertise are properly allocated.  These priorities can also inform the technology, standards and infrastructure needed to implement AI and data science in a consistent and scalable way, which the AAG plans to look at.

Sally commented on this stage saying: “We have initially been tasked with cataloguing any data science or advanced analytical activity going on across Wales while recognising pockets of excellence and expertise. By highlighting the necessary skills, the AAG can accelerate progress in this area.” 

Lessons 

One of the most vital lessons the team identified as part of the AAG was the importance of using the high-quality data provided to influence clinical decision making. 

Both Dave and Sally said it was crucial that health services learned how to utilise advanced analytics techniques to support their service implementation, or it would devalue, and detrimentally impact the data collection process. 

Sally said: “That’s really important because if we as clinicians, managers, etc. are not seeing the value of the high-quality data entry, we won’t do it well, and we will devalue the NDR because we won’t have access to high-level data, and won’t be able to do these advanced analytical techniques anyway.“ 

Evolution 

As the AAG is at the start of its developing work programme, Dave said that as they progressed it was crucial that the AAG became more regimental in its approach to communication across Wales’ health organisations. 

He said: “Sometimes there’s too much emphasis on technology, we need to organise ourselves better and get a bit more regimental in the way we plan and communicate with each other. 

“With better organisation and communication, we can be supporting and resourcing projects and initiatives a lot better and more efficiently.  

“Population health is also a priority as that what will manage and drive our services in a post-COVID world.” 

Sally said that going forwards she would like to see more “high-profile” work being created to emphasise the possibilities of AAG. 

She said: “I would like to see high impact pieces of work coming through that generate enthusiasm for this at every level of the system, so people can see the art of the possible. 

“We started a lot of engagement activities in policy healthcare management and with clinicians, to enable that to happen. The pandemic accelerated that in a way, people are beginning to understand that we do have data and we can turn that into very useful information that has high value. 

“I would envisage a widening of this, and a network of advanced analytics groups and work communicating and learning from each other across Wales, to help us drive this forward.” 

Visit our Advanced Analytics Group page for more information on the work of the group and how you can get involved