Geographic information

Mapping healthcare

In recent years geographic information has become increasingly important in enabling public services to share information and to plan and deliver services more appropriately for the populations they serve.

Approaches to geographic information have grown up in piecemeal fashion across the NHS and, until last year, the NHS remained the last of the major public sectors to be working without centralised provision of geographical data. For many years parts of the NHS had been heavy users of geographical information, but as ambulance trusts were the only area of the NHS to have a collective agreement, there were considerable cost implications and issues involved in data sharing.

In November 2005, the Information Centre for Health and Social Care (IC) launched a ground-breaking NHS (England) agreement with Ordnance Survey (OS) to supply digital mapping data to the NHS on a pilot basis until March 2007. Ambulance trusts joined the pilot in April 2006 on the expiry of their own agreement. During the pilot, provision is centrally funded by the IC for the majority of users (apart from ambulance trusts) to encourage organisations to explore the potential of geographical information systems (GIS) ahead of longer-term procurement of products and services.

The portfolio encompasses small-scale mapping of regional areas to more detailed coverage of local areas including street level, postcode and spatial address data as well as products based on new-generation OS MasterMap data, which are specifically designed to be managed as a fully integrated corporate database.

The pilot aimed to unify mapping across the NHS and to mark a starting point from which the future provision of digital mapping products to the NHS could be developed. The agreement gives all NHS trusts, primary care trusts, strategic health authorities and cancer registries access to the national mapping agencys archive and provides support, technical help, advice and guidance in the use of geographic information previously unavailable to most users.

Common access to OS data under the pilot agreement means that geographical information can be shared more freely within the NHS and with other public sector organisations, to enable the use of data to support strategic decisions on investment priorities, resource allocation, estate planning and the provision of public health advice. The pilot has been used to help identify health inequalities, to record changes to patient catchment areas, to carry out epidemiological analysis and to target services to clinical hotspots.

Figure 1  Geographic positioning and accuracy. Material supplied by Simon Chant, Senior Information Specialist, East Devon PCT.

The success of the pilot

Uptake

The uptake by NHS organisations has been much higher than expected. At the end of 2006, almost 80% of eligible organisations had applied to join the pilot and over half had requested data for local use. Membership of the pilot continued to increase, despite the upsets of widespread organisational change from June to October 2006.

Competition

The pilot cannot be judged successful by numbers of users, however, it must be seen to be making a difference to NHS services. To help assess the value of the pilot, in July 2006 the IC and Ordnance Survey launched the Every picture tells a story competition to find the most innovative uses of geographic information in the NHS.

The competition winner was Luton teaching PCT for its work on improving the uptake of child immunisations (see page 27). The PCT used mapping to identify those most at risk a high priority, as Luton had a low immunisation uptake. The presence of an airport, a large immigrant population, areas with high levels of deprivation and a transient population who do not settle permanently are all factors that increase the risk of an outbreak of a major communicable disease in Luton and make it difficult to track immunisation uptakes.

Lutons first step was to establish a complete picture of childhood immunisations in the Luton area using GIS. This enabled those involved in the immunisation process to move from an isolated way of working to one in which the complete picture of care could be reviewed and streamlined.

A key result was the improved identification of children who had not been immunised. The conse­quent monitoring and implemen­tation of follow-up procedures for non-attenders, helped in ensuring children did not get lost in the health system and gave greater assurance of child protection.

Case studies

In parallel, Ordnance Survey have used the pilot to compile case studies highlighting business benefits which can be used to share best practice and encourage new users. Three examples are presented below.

The theme of the first example was managing resources and meeting targets. The OS MasterMap Topography Layer has been used by East Devon PCT to improve the accuracy of centre-point symbols for practices and hospitals. Before the Pilot NHS (England) agreement, East Devon PCT were unable to work below a 100-metre accuracy. They were unable, therefore, to map services in detail across their area, which in turn might lead to inadequate healthcare provision. The Pilot NHS (England) agreement has given East Devon PCT access to better data sources for use in mapping and analysis. The use of more accurate data leads to improved decision making, resulting in the targeted use of resources.

The theme of the second was planning and publicising services. GIS provided Croydon PCT with the ability to show clearly the prevalence of smoking amongst over-16s and to identify where advisers should be located. Before the agreement Croydon PCT did not have access to accurate postcode data and were consequently limited in their GIS analysis.

Figure 2  Smoking prevalence for people aged 16 and over. Material supplied
by David Osbourne, Public Health Information Analyst, Croydon PCT.

The agreement has provided data with a higher degree of accuracy resulting in more detailed demographic analysis. By locating advisors strategically, the study has allowed maximisation of limited resources. The prevention of smoking-related disease, now and in the future, will lead to an indirect saving in costs incurred in treatment for smoking-related illness.

NHS trusts are increasingly responsible for transporting patients who are in their care. By using OS MasterMap ITN and Address layer data within the Cleric APTS system to calculate optimum routes, East Kent Hospitals Trust (EKHT), the third example, is able to collect, deliver and return patients to their homes in a more timely manner. As a result of this implementation, EKHT is seeing a 15% improvement in its service delivery.

Figure 3  Improving patient care. Material supplied by Irene Hayward, Head of Healthcare Transport, Facilities Directorate, East Kent Hospitals Trust. Image courtesy of Cleric Computer Systems.

OS MasterMap, now part of our logistical planning software has improved our essential flexibility to deliver a patient-led service at EKHT, says Irene Hayward, Head of Healthcare Transport, Facilities Directorate, at the Trust. The qualitative and quantitative data we are now able to access will enable the service model to be revised more readily to support patient choice and service reconfiguration as policy and patient needs demand.

User feedback survey

The IC launched a user feedback survey during September 2006 to get users views about the success of the pilot and to determine whether a future agreement was required. This had a very good response rate, with responses received from over 80% of user organisations. The IC also contacted a number of organisations that had not signed up to the pilot to establish the main reasons for non-participation.
The main messages coming out of the surveys were:

• the overwhelming majority of organisations were satisfied or very satisfied with the Pilot NHS (England) agreement and the products and services provided;
• the use of products in the agreement varied greatly by organisation type, ambulance trusts and PCTs making the greatest use of products. All groups intended to use all available products more widely in the future;
• users identified a wide range of additional products that should be considered for future provision; aerial photography was the most commonly cited. Almost a third also wanted data outside their area boundaries;
• half of the organisations reported having insufficient software to meet requirements and the majority felt that not all their geographic information requirements were currently being met. Lack of staff and systems were the most common reasons for this; and
• a number of non-user organisations reported a lack of resources as reasons for not joining the pilot.

Independent review

Evidence gathered throughout the pilot is now being used by the IC to help determine the future of a collective agreement for mapping data for the NHS. The IC is already planning to extend the pilot for three months until the end of June 2007 and will use this time to explore options for funding a future agreement.

A dedicated business case is being prepared for a future central agreement and collective procurement, building on the benefits demonstrated by the pilot. In the context of reduced revenue allocation and competing priorities for investment, however, the Information Centre will be unable to commit to the current funding levels in any future agreement.

The Information Centre remains committed to developing the use of geographic information to enable information sharing and the planning and delivery of services.

Further information

The following link provides further information on the current Pilot NHS (England) Agreement, at the Ordnance Survey website. This includes how users can register for the agreement and also what steps to take following the NHS re-organisation in 2006 to ensure users have access to the required data for their area covered by the new organisations:
www.ordnancesurvey.co.uk/oswebsite/business/sectors/health/

For further information on developments of a new digital mapping data agreement, contact the demography and geography team within the Information Centre via the contact centre,
0845 300 6016 or email:

Ian Bullard, Head of Population and Geography, The Information Centre for Health and Socialcare