Regional Stop Smoking Service Database Pre-Implementation Update Cumbria and Lancashire

1. Regional Stop Smoking Service DatabasePre-Implementation UpdateCumbria and Lancashire Tina Williams Performance Improvement and Delivery Manager October 2010

2. Smoke Free North West • Smokefree North West manages the NHS collaborative programme to work towards a tobacco-free future for everyone in the North West. • Jointly funded by all 24 NHS Primary Care Trusts (PCTs) within the region • Chaired by Julie Webster (who replaced Dr Janet Atherton). The team, led by Director Andrea Crossfield, is based in Manchester and hosted by Sefton Primary Care Trust • The Smokefree North West team works in partnership with the four sub-regional Tobacco Alliances across Cheshire & Merseyside, Cumbria, Greater Manchester and Lancashire and the three sub-regional Public Health Networks. • Together, we support local tobacco control activity and the implementation of regional and national tobacco control plans at a local level

3. LSSS Activity – what’s required? • Local Stop Smoking Service (LSSS) performance is currently assessed against targets • These targets are based on local smoking prevalence and previous performance: • Public Service Agreements (PSA) • SHA Delivery Plans • NHS Operating Framework • Local Area Agreements

4. LSSS data – what’s required? • LSSS must currently collect data related to service activity • The number of smokers accessing the service • 4-week quit rates • CO monitoring outcomes • Socioeconomic status • Submit a quarterly Monitoring Report to the NHS Information Centre

5. LSSS Activity – what’s required? • More importantly - Services need to maintain effective relationships with their clients to: • Provide a locally valued service • Manage treatment • Track progress • Maintain client motivation • Prevent relapse • Enable those who relapse to re-engage ‘Manage Customer Relationships’

6. Activity 2009 / 10 • Regional Target – 57,126 quitters • Regional Outcome - 57,850 smokers quit • Success…

7. Activity 2009/10 • Regionally 17 / 24 LSSS achieved their outcome targets • In Cumbria and Lancashire 3 of 6 LSSS achieved against targets

8. What’s the problem? • Despite our successes many LSSS struggle to collect, manage and report on accurate Local Stop Smoking Service (LSSS) activity • 21% of those who set a quit date were lost to follow-up • 20% were un-coded against socioeconomic status • Regionally 7 x services failed to meet their annual outcome target for the year

9. What’s the Problem? • Few of the data collection systems currently in place allow for a real-time view of activity either locally or regionally • This prevents the early identification of problems, at either local or regional level and the implementation of timely, considered, appropriate remedial action • And many services find it difficult to effectively manage customer relationships and maintain low cost, regular, effective contact with their client group

10. Regional LSSS data - where are we now? • A variety of systems are in place - few are paperless • Many LSSSs report difficulties with their existing systems • Many are cumbersome, time consuming – and therefore costly • Inefficiencies lead to • Inaccurate or incomplete data • Under-reporting of outcomes • Increased lost to follow-up • Difficulty in meeting targets • Poor customer relationship management • Experienced, highly qualified and therefore expensive staff are frequently drawn away from client activity to contribute to reporting activity • Difficult to track clients effectively • Difficult to re-establish contact with those who have accessed the service in the past

11. LSSS data - where are we now? • Monitoring the details and progress of smokers accessing level 2 services across the full range settings e.g. Pharmacies, Children’s Centres etc, is undertaken manually in the majority of cases: • Increasing workload for participating healthcare professionals – leading to reluctance to participate • Further increased risk of under-reporting, lost to follow-ups, and the difficulties in reaching targets • Leading to the breakdown of valuable relationships with both L2 providers and their clients • ‘WORKING HARD – NOT SMART’

12. LSSS data - what’s the solution? • Modernisation of the infra-structure through the provision of a web-based, unified system for the collection, monitoring and reporting of LSSS activity at local and regional level is the key to: • The successful future development and progression of stop smoking services • The quality of the clients experience • The meeting of smoking cessation targets • Effective performance management • Effective relationship management and client retention • WORKING SMART

13. The Evidence “The old database didn’t help us monitor clients over time or our effectiveness. The new web-based system enables our administrative and specialist staff to know what each client had received and when. It is making it possible for the PCT to manage the service actively and evaluate every aspect of what we do,” Director of Public Health South Birmingham PCT

14. How will this be funded? • Before discussing the funding it is important to recognise that some PCTs already have a database which delivers to the required Core Standard which they will wish to continue using therefore: Two funding options are available

15. Proposal - Option 1 • SFNW will provide £5K of funding per PCT to enable them to work with the appointed provider to install the core database • Participating PCTs agree to: • Match fund £5K for the installation • For Cumbria and Lancashire this cost will be covered by the Tobacco Alliance • Funding at this level available for • Cumbria, North, East & West Lancs and BBwD • Pay £5K maintenance contract from year 2 • if they choose to continue the contract

16. Proposal - Option 2 • SFNW will provide a £5K funding per PCT to: • Enable work to be undertaken with the chosen provider to link an existing comparable database to the new Regional Database • Funding at this level available for Blackpool • Who already have a web-based system supplied by N51

17. Progress to date • Board level agreement • DPH agreement – Frank Atherton for C&L • Funding secured • Regional Steering Group establishes • Representation from all sub-regions • Scoping of requirement • Identification of core functionality • Development of Service Level Agreement • Procurement • The Provider – AN Computing • The Contract • SLA • Economies of scale • Regional Roll-out • Completed in Greater Manchester • Next Steps • Cheshire and Merseyside implementation currently in progress • Development of Regional / Sub-regional reporting arm in progress

18. Scoping the Requirement • Review of provision by leading web-based providers in the field • Discussion with services who currently have web-based systems • Identification of required core functionality • Identification of need • Identification of essential functions • Identification of gaps

19. Core Data Set NHS Standards Gold Standard Monitoring The Client Journey Maintaining Client Contact Email Mail merge Mass text Reminders to advisors Monitoring and Reporting Gold Standard Monitoring Local Reports Dashboard Specific - locally created Export of data to Excel Users and Access Locally managed Access levels Password setting No limit on the number of users Training Train the Trainer x 1day End user x 1day Import of existing data From 1st April 2010 only Lead and Referral Management Development of the Sub and Regional Reporting Arms Implementation management and support to PCTs Hosting Software License Fees Project Management Help Desk Support Development of the SLA

20. Procurement • Competitive Quotation Process • The three identified leading providers were invited to submit a proposal and quotation • Interview panel – 8 x members of the Steering Group • Applicants assessed and marked against 40 criteria • Financial Assessment – by Heart of Mersey Partnerships • Information Governance Assessment – by Sefton PCT • Appointment of provider: • Lead scorer • Proven track record • The solution – user friendly • Ability to supply to the required SLA • Competitive quote – matched to budget

21. The Provider • AN Computing • Unanimous choice of the panel • Outstanding solution • ‘Quit with Us’ • History • National NHS Systems for Infection Control • Creators of the FagEnds Smoking Cessation Database

22. The Contract • Held by SFNW • Standard NHS Contract • SLA • Standard - provides all core requirements • Not negotiable at PCT level • One-year duration • Based on the ‘go live’ date for each PCT • Renewal after year one – local decision

23. The Contract • Market Value per individual PCT = £20k • Cost negotiated (economy of scale) = £10k • Additional funding secured to enable N3 hosting if required • Cost per PCT – year one • No financial contribution required

24. Post Year 1 – Recurring Costs • Hosting Fees • Help desk support • Changes and fixes • 1 core upgrade Total £5k per annum Payable by individual PCTs Local contract arrangements

25. Regional Roll-Out • Phase 1 began in Greater Manchester – May 2010 • 10 PCTs • 3 with pre-existing web-based databases • Implementation within 7 x PCTs • Completion date – 31.10.10 • Phase 2 Cheshire and Merseyside – current • Completion 31.12.10 • Regional and Sub-Regional Reporting Structure currently under development • Phase 3 – Cumbria and Lancashire • Completion March 2011

26. Next Steps

27. Getting the groundwork right • Each PCT to establish an ‘Implementation Group’ to provide: • Liaison with AN Computing and the Sub-Regional Tobacco Control Lead (Fay Watson) • Lead and support the implementation process • Facilitate communication within the PCT and across the LSSS • Provide high level technical expertise • IT • Information Governance • Smoking cessation expertise

28. Getting the groundwork right • Suggested Implementation Group Membership: • LSSS Co-ordinator / Manager • LSSS Commissioner • LSS Administrator • IT Representative • Information Governance Representative

29. Getting the groundwork right • Before the installation process begins AN Computing will meet with the PCT Implementation Group • This will enable: • Fact finding • Planning • Communication

30. Participation • Time to decide…

31. FAQ’s • Can PCTs negotiate additional functionalities as part of the current contract / SLA? • No the contract and SLA agreement provide a fixed solution at a very competitive price and is therefore non-negotiable • Can PCTs negotiate additional functionalities under a separate independent contract? • Yes – but costs will be incurred locally and the any additional work negotiated locally must not delay the regional roll-out timetable • Would PCT-A have access to / or the option to view PCT-B’s data? No – each PCT database stands alone and access is controlled by that PCT. • Would a level 2 service provider, for example a pharmacist, be able to view the data of other provider’s clients e.g. the specialist service? No – access is controlled at PCT level

32. FAQ’s • Will members of the public health intelligence teams be able to down load and interrogate the data at will? Yes, the solution provides a facility to enable designated users to download data into an Excel spreadsheet for local purposes • What is the likely cost of additional training, beyond that which is offered as part of the proposed package? The average cost of training of this type is £450 per-day for a maximum of 14 participants. PCTs would negotiate this locally with the provider. However as the standard SLA provides for the training of trainers it is unlikely that additional training would be necessary

33. FAQ’s • Will it be possible to audit success rates for different pharmacotherapy’s against age gender or other criteria - to be able to identify the most appropriate products based on local data? Yes, this function is provided as part of the reporting suite • Will Commissioners, whose role it is to performance manage the service, have access to the database for this purpose Yes , each individual PCT would control who is able to access the system and at what level. This would be a decision taken locally. • Will it be possible for a smoking cessation web-based data base to interface with other NHS systems such as those used in GP Practices? Technically yes – but this would require further development and additional locally incurred cost.

34. FAQ’s • An extensive list of additional FAQ’s has been provided within the ‘Implementation Pack’