Setting the benchmark
You have been warned: I am about to indulge in a little bit of myth busting. First about that touchy subject – public sector cuts. Through much of the discussion of public sector spending cuts we have heard over the summer, particularly when the unions were marching, there have been several claims that it will lead to job cuts and that this will hit women hardest, because women are proportionally more likely to be employed in the public sector. This is rubbish. Do you know what sector has seen women losing their jobs most? It’s retailing. Then air pollution.
There was the report published in the British Medical Journal in September which suggested that people who spend a large amount of time in traffic are more likely to get heart disease. From that you might expect that people who go to work on public transport, and so breathe in all these fumes getting on and off buses, are also more likely to be at risk. If you thought that, you would also be wrong. Looked at across the country on a local authority basis, the two boroughs that come out best for having high levels of public transport use and low levels of heart disease are Lambeth and Southwark in inner London – hardly the kind of places you would expect to find the freshest air.
How do I know these things? Because I have been speaking to Judy Aldred, managing director of SSentif, an online data analysis and management company headquartered in Leeds that has developed the UK’s widest range of fully analysable public sector data – around 35,000 different indicators going back more than 10 years and covering every local and health authority area in the UK.
She is a geophysicist by training who drifted into IT management for the NHS, but since she started SSentif in 2004 has found she really enjoys analysing data as well. She admits that the correlation she has found on pollution isn’t perhaps ideal.
“You clearly cannot say that the percentage of people on public transport is the same percentage who are suffering,” she says, “but you have got to start somewhere.” Nor, she insists, is she pursuing a particularly right-wing agenda, claiming that the fuss about public sector job cuts is nothing.
“Those cuts are going to happen,” she says. “It’s just that I know from my experience in the public sector that when the Government says it will make job cuts, sometimes those people don’t get made redundant immediately. They just put them in another place.”
Something similar in fact happened with the NHS Information Authority, the body Aldred was employed by when she was building the nhs.uk website, now known as NHS Choices. It was part of the reason why she ended up being moved up to Leeds from the Midlands, as it was consumed by the much larger NHS Connecting for Health programme.
She is particularly proud of the work she did setting up nhs.co.uk, the first time there has ever been a one-stop-shop website detailing all the services that are available in every different part of the country on the NHS.
When it was complete she had a personal email from Tony Blair congratulating her. She later heard something via one of his spin doctors that really pleased her. “He apparently said that out of all the different public sector projects he had seen, not only did ours come in on time and on budget, but it exceeded his expectations – and we were in fact the only public sector project he could say that about.”
He would no doubt be chuffed to hear another little statistical titbit she has uncovered since New Labour was swept from power. Not long after the coalition Government came in, it announced that it was scrapping the target that had been set for every hospital trust in the country to be seeing 90% of patients within 18 weeks of them first being put on the waiting list.
This would still be a target, the new Government said, it would just not be monitored. At the time the decision was greeted with relief by many who said the NHS had become obsessed with targets. Only a small minority pointed out that what isn’t monitored doesn’t get going. But Aldred says she has proof that those naysayers were absolutely right.
“The figures have started plummeting,” she says. “Some trusts are already down to just 35 to 40% of patients being seen within 18 weeks, and that’s in just over a year.” Some might say that is ample proof of why more competition needs to be introduced into the NHS, or at least more publicly accessible information. While Aldred was running nhs.uk, the site only featured ancillary information such as visiting times and car parking facilities. With the advent of foundation hospitals, much more comparative information has been introduced, but by that time Aldred had long since left.
In fact, there is something of a love story behind her decision to leave. While she was running the website, a very junior wannabe web developer from New Zealand called Pete Owens came to work for the organisation. Formerly a fitness coach with New Zealand Golf, he had designed his own database which allowed him to compare different golfers’ performances easily.
“Because it was all in one place you could cross-reference to see when and how they were getting best results,” says Aldred. He had come to England to learn how to expand his ideas onto the web.
“But he quickly realised he is an inventor,” she says, “and that he would never get the skills to build it up.” She hadn’t really known him until they both started jogging in the lunch hour at work.
“I was his boss’s boss’s boss’s boss, I think,” says Aldred, with a smile. But he started telling her about his ideas; she could see the potential, one thing led to another, and – well, they are now married. In fact, they started employing developers to help work up the database out of their own wages while they were still employed at the NHS.
“But to do things properly you have to give the day-job up,” she says. “So we did. We left the NHS, sold our house, car, everything really, and moved into rented accommodation.” Although they have a satellite office which employs four technical staff in Redditch, the two of them and Owens’ brother now work out of that rented accommodation, which is the top half of a house in Moortown. It might have a beautiful garden, maintained by septuagenarian landlord who lives downstairs, but it has no central heating and has windows which are falling out.
“We wear lots of jumpers,” Aldred quips. So what was the potential of Owens’ database that so persuaded her to take such seemingly drastic action? Primarily, it was its expandability.
“What we have built is expandable in all dimensions, time, and range,” she says. “It’s a humdinger of a clever part.” They initially thought that, as the database had been designed for golf professionals, they should target the sports market.
“We actually stopped working entirely for the NHS after London got the Olympics bid,” she says. “So we thought that was great. But there isn’t any money in sport. A lot of sporting organisations deal with companies that give them stuff for free. As an up-and-coming business we couldn’t do that.”
Moving back into health, a market Aldred was clearly more familiar with, they had initial success selling the system to a programme to measure obese children’s BMI. As part of this they were using a specially designed scale that the Department of Health had assured them was crown copyright. Only the true owner of the scale soon contacted them to say they were infringing his intellectual property, and the department then admitted it had made a mistake.
“We came very close to going out of business because of that,” says Aldred. “I got a letter from the then health minister Caroline Flint, saying that we could not get any compensation for their mistake because we were a commercial organisation. That taught us to be careful, but also to see what we could do with the system that was not going to be relying on other pieces of information.”
In fact it was shortly after that that she had what she describes as her “ping moment” and thought that instead of trying to sell the product as an empty database, why didn’t they sell it as an online package complete with data already loaded? “I spent a week trawling various places, looking for data,” she says.
“Initially we had 175 indicators, all from primary care trusts. But since then new laws about data transparency have made everything open up. And because we are so far ahead of the game, it doesn’t matter what data they give us, our flexibility means we can put it in.” She showed the new SSentif product to one primary care trust on a Tuesday, and by Thursday they had made an order.
“I knew that meant we were on to something,” she says, “because the NHS does not usually turn around purchasing in that time. We now service primary care trusts, mental care trusts, hospital trusts, and we have just started with local authorities who I think are the best.
“It’s really important to them, having all the data in one place. They already have access to financial information in one place, and to benefits over here, and crime somewhere else, but we take all that data plus financial information and any performance data and put it together. So you can see, for example, what percentage of pupils are absent, and how related that is to the drug crime rate in your area.” In fact, one council – Durham unitary authority – specifically chose to start using Ssentif because of its benchmarking abilities.
“They said there were benchmarking clubs available, but they had a fixed number of indicators, and you could only benchmark among other members. They said nothing has the range of data that Ssentif has.” She isn’t particularly worried about public sector cuts having an impact on her business. Although primary care trusts are coming to an end, GP consortiums are now running as shadow authorities.
“And there are three times as many of them as there were PCTs,” she says. Hospital trusts are also increasingly keen to use a system that allows them to benchmark against anyone else, partly because messages coming from Government suggest that those who appear in the top ten in terms of performance will get extra funding.
“We have had two new orders from them this week,” she says. The only challenge, she says, has been making people aware that the kind of database they all want to use is out there.
“It’s not like setting up a greengrocer’s,” she says. “We had to sell something people didn’t know they needed. Yet so many people have said, “This is the tool that I always wanted to see, but I didn’t know it existed. It’s hard when you can’t use somebody else’s experiences to see how you go.” That could be changing, however, partly in thanks to Ssentif signing up with Leeds PR firm The Right Agency, who, after just two PR shots, has managed to get Aldred and Ssentif in the Sun, the Mirror, Sky News, and all BBC local radio stations. The media has been interested in the statistical stories Aldred can bring up, like the ones at the start of this article, so she is looking for more.
“We are expecting expansion this year and next year because of the interest we are getting,” she says. And yes, they have “already had a sniff of a big organisation” interested in taking them over. And from venture capitalists too. But Aldred is not interested.
“We decided early on there were two different routes to go down,” she says. “You can take it slow and build the business up yourself, or take the venture capital route. We have chosen our route. We want to keep control.” Similarly, while she does eventually want to move out of their current premises, she sees no reason for moving into anywhere expensive and glitzy, as clients rarely come to see them in person.
Thanks to being close to the broadband exchange in Leeds, she can do everything from pitching to training online. She can even do it from New Zealand when they go back there to visit Owens’ family.
“Business is definitely changing,” she says. “Now if our clients are going through cuts, they can’t afford to spend £120,000 on a programme. It makes more sense doing it online. I’m just a face on a big screen to them.”
And finally...an explanation of why connecting for Health ‘wasn’t connecting’
Given Judy Aldred’s background in the NHS IT department, you might expect her to have something to say about the ill-fated Connecting for Health project.
The ambitious project, originally conceived by Tony Blair in 2002, to have the whole of the NHS connected up via one database has been dogged by controversy for years, mainly because of the huge cost involved and the endless delays.
In September this year, in fact, the Government announced that its national structure would be to all intents and purposes disbanded, and local health authorities would be freer to make their own IT decisions.
Not surprisingly perhaps, the Daily Mail was up in arms, pointing out that the total cost of the project – estimated at £12.7bn, but possibly higher – would have kept 60,000 nurses employed for a decade.
Aldred certainly does have her views – after all, for a short time she worked on the project - although them putting forward is obviously something of a delicate matter.
“Some parts of Connecting for Health were excellent,” she says, with a big sigh. “Like electronic of prescriptions. You can’t say it wasn’t a success.
She thinks the central problem was the way the point of the project was communicated.
“The concept – a single database – is so obvious,” she says. “But the NHS is massive, with a lot of senior people who are very highly qualified in their own fields. They need to be taken into account in what you do.
That sounds to me like a case of vested interests trying to keep the hoi-polloi out. Aldred says it was more a case of big egos.
“You can’t railroad people of that calibre into doing something they don’t want to do,” she says. “You have got to keep people happy to a point where they are not going to dig their toes in. Some people can really put barriers in the way if they want to.
“They had developed spec for all these different hospitals, but each hospital could be different, and some might have even more detail than was required in some areas, and less in others.”
That, she says, is where the rising costs came in. “Each hospital needed something different, so the people who won contract claimed this was scope creep and wanted more money.”
There was also the whole issue of the sensitivity of data. “It was patient data you were dealing with, and people can be concerned about who owns it. With a single database anybody can access it. You could say that people can’t see certain parts of it without permission, but then what’s the point of having it at all, because that piece of hidden information might be the one piece of information that saves a person’s life?”
Security – the aspect of the project she briefly worked on – was also something of a hot potato.
“They developed a card system that you had to swipe in and swipe out,” she says. “But nobody swipes out, and on top of that front line staff have to be very quick. Swiping out just adds time onto their day.”
Looking back, she says, it would have been better to have adopted a less centralised approach.
“The easiest way would have been to have a central database, and say to people you need to make sure your system can talk to it. You would still have had issues, but you would not be telling people how to use it.”
A lesson, surely, for another day.
Published: 01 September 2011