The NHS in Mid and South Essex is using data to better meet the health and care needs of adult residents with frailty, dementia and nearing end of life as part of an ‘Ageing Well’ stewardship programme.
The ICS’s strategic data and analytics platform, called Athena, enables health and care professionals to unlock the power of connected datasets in their delivery of frontline care.
The intelligence from the platform is providing a better understanding of the local population’s health needs including revealing health inequalities and gaps in care which were previously hard to identify. This information helps local health and care organisations to better plan their workforce and services with a more proactive and preventative approach.
Dr Sarah Zaidi - GP, Ageing Well Steward for Mid and South Essex ICS, and NHS England Regional Clinical Lead for Frailty - explained how the stewardship group has been using the data and analytics within Athena to support them in a recent ‘Lunch and Learn’ session.
“It’s so exciting to see more valuable data than we ever could before. Especially data helping us to identify populations, with improved accuracy, that were previously almost invisible to us, such as people living with frailty and dementia, and those adults nearing toward the end of their lives.
“Athena is a powerful research tool that enables us to see connected datasets from local health and care services and providers that gives us a much truer picture of our population’s needs so we can identify what we all need to do to make things better for them and for our whole system.
“This is a big step forward to help us to identify and tackle health inequalities and to help us to deliver more fit-for-purpose population health management.”
As part of the session Dr Zaidi delivered a live platform demonstration which included:
- How to marry Population Segmentation Modelling with activity demand data on services (including 111, ambulance calls, primary and community teams, emergency department attendances, hospital admissions, outpatient and elective care, and social care) and other performance dashboards for more powerful ICS intelligence
- The research capability of drilling down into different long term conditions such as cardiovascular disease, diabetes and cancer (including combinations of conditions)
- Analysing the wider determinants of health and risk factors.
Dr Zaidi also shared the Ageing Well stewardship dashboard which has helped health and care providers to explore variation in frailty, dementia and end of life identification, and the improved outcomes that can come with earlier identification as we deliver more proactive care to this population group.
Stewardship is an approach which establishes multidisciplinary, cross-organisational teams to act as responsible stewards or navigators of common resources. Having a ‘single version of the truth’ which can be accessed across the ICS is critical to understanding population needs and evaluating our collective performance.
Watch the ‘How Athena is advancing frontline care in Mid and South Essex’ video to hear more about the stewardship dashboard and the insight users are deriving to shape service development and quality improvement initiatives.