Which “informs and supports the strategic planning of services and healthcare assets” – and explains how it is regularly updated to reflect new trends and needs against a fast-changing healthcare backdrop.
There is no doubt that the NHS faces a challenging agenda with the transformation of arrangements for public health, the shift to clinician-led commissioning, and the overall emphasis on Quality, Innovation, Productivity, and Prevention (QIPP). These themes will shape the future of healthcare delivery in the UK. Despite being just over 12 months old, the Coalition Government’s proposals have generated much debate. Pausing, listening, and reflecting, have led to several changes, alterations, and subtle deviations, from the original proposal; however one thing remains clear: rather than freeing the NHS from control, what is being proposed is more of a control shift, which will see more emphasis on quality, innovation, and prevention, and more health services delivered in local settings while meeting requirements for greater efficiency and productivity. In view of the (Government’s) ambition to deliver health services more efficiently and effectively, and to take decisions closer to the patients (and others) that will be affected by these decisions, the Strategic Health Asset Planning and Evaluation (SHAPE) application has recently been redeveloped to support clinical commissioning, Joint Strategic Needs Assessment, and the drive for efficiency. The Department of Health continues to fund and sponsor SHAPE, and encourages its use to support strategic planning and decision-making.
A ‘mature application’
Strategic Health Asset Planning and Evaluation (SHAPE) is a web-enabled, evidence-based application which informs and supports the strategic planning of services and assets across a whole health economy. It was originally developed by the Department of Health for estates professionals, but it is now managed by NHS North East. SHAPE has been available for six years, and is a mature application, providing evidencebased information to support all NHS professionals – from clinical, commissioning, public health, and estates perspectives. It links national data sets for clinical analysis, public health, primary care, and demographic data, with information on healthcare estates performance and facilities location. Site details and location information are sourced from Organisation Data Services, part of Connecting for Health, and this data is regularly updated. In relation to public health, SHAPE contains information that can be used by PCTs, clinical commissioning groups, and local authorities, to support Joint Strategic Needs Assessments, and to identify local priorities for health improvement. SHAPE is already configured to English SHA and PCT boundaries. The application is built around a mapping tool, and supports travel time analysis. Now SHAPE is also able to map at local authority level, and supports analysis by GP practice and GP commissioning groups. In addition, it will provide information to support clinical networks and clinical commissioning, and the deleivery of best practice care.
Effective strategic planning
We know that effective strategic healthcare planning is essential to supporting, informing, and managing, future service design and delivery. SHAPE’s functions enable health professionals to meet the current economic and policy requirements for optimum efficiency and delivery of services, including a shift of care from hospital to primary and community settings. SHAPE has the scope to support service location and asset management decisions relating to the integration of health and social care. The visual presentation of SHAPE can also contribute effectively to public consultation on proposed changes in pattern of service delivery. The added value of SHAPE is in its versatility. It has been intentionally designed and consistently updated as a multidisciplinary tool suitable for a range of roles and responsibilities. It is designed to encourage a variety of inputs which contribute to solving problems, as well as to meet the needs of particular professional groups, including:
• Estates maintenance and development personnel.
• Estates and risk managers.
• Capital planning managers.
• Support services managers.
• Commissioning and performance managers.
• Service improvement managers.
• GP commissioning groups.
• Public health personnel.
• Information managers and analysts.
• Medical directors, clinical directors.
• LIFT planners/managers.
Use by Trusts
The estates module within SHAPE is, indeed, currently being used by NHS London to support a London-wide review of service delivery and asset management. Elsewhere, SHAPE is being used to support a variety of clinical functions. The North of England Cardiovascular Network has used SHAPE to analyse heart failure re-admissions, the distribution of chest pain admissions by postcode, differences in average length of stay for chest pain admissions, and the incidence of stroke re-admissions. South West Essex PCT, meanwhile, has used it to assess access to primary care services in relation to planned housing developments within the area, and to explore the most appropriate location for a planned new facility, while County Durham PCT has used it to assess access to primary dental care, and to influence future commissioning of primary dental services. SHAPE has also been used by Avon, Gloucestershire, Wiltshire and Somerset Cardiac and Stroke Network, in conjunction with NHS Comparators (a free comparative analytical service from Connecting for Health) and as a programme budgeting tool, to examine differences in patterns of admissions and expenditure between PCTs, trends over time, and to analyse re-admissions in HRGs (Healthcare Resource Groups) within CVD. With regard to estates management, SHAPE is already being used to establish future requirements and opportunities for improved efficiency in support of national policy requirements. The estates module within the application contains an Organisation Data Services-based database of over 86,000 geocoded facilities, ranging from large acute hospitals, health centres, GP and dental practices, to ambulance stations and a range of other facilities. For a particular organisation, SHAPE can display all operational sites used by the organisation to deliver services, and service delivery sites operated by other organisations. Options are available to display a particular type of site or facility, and these can be easily selected by the user. It is vital that site data, in particular, is validated at local level, to help ensure that SHAPE maintains an accurate picture of the NHS and other estate. Estates professionals can input local data about site types and the range of services provided, and can also add site plans or photographic images of buildings to provide local context.
Specific sites
For a specific site location, SHAPE can provide catchment analysis based on either peak travel time or travel distance (see Fig. 1 and Fig. 2), enabling identification of opportunities for estate rationalisation, and assessment of the relative accessibility of site options for new developments, as well as to support decisions about the best location for additional community-based services transferred out of hospital settings. “Drive time analyses” are based on peak flow travel times, and the boundaries defined by whole lower super output areas (LSOAs). Distance analyses can be used as a proxy for walking time. Additional drive time and distance analyses can be added locally. The travel time tool will also provide a demographic and deprivation profile of the population within a defined catchment population. This feature can be used to relate levels of service need to levels of access to services in particular locations. SHAPE intends to gather and present as much information as possible at lower super output area level, to enable information to be presented at numerous boundary levels, supporting clinical commissioning groups, clusters of PCTs, sectors within SHAs or local authorities, and other forms. Indicators can then be displayed within the relevant boundaries at LSOA level, or for specific site locations. Specialist indicators can also be developed. SHAPE has recently been configured to be able to present eight minute and nineteen minute drive time catchments for ambulance service locations in order to reflect current performance standards for immediately life-threatening cases. The SHAPE application has the potential to differentiate between ambulance hubs, spokes, and vehicle stand-by locations, to assist strategic asset management within the service. It could also incorporate site location details for other emergency services, to support partnership working and asset rationalisation in the context of QIPP and other public sector efficiency objectives.
Use of ERIC data
SHAPE includes key performance indicators from ERIC data (Fig.4). It also allows users to benchmark their estates performance against peers and other organisations within the current SHA boundaries. In mapping existing facilities, it may be possible to identify gaps in service delivery, or to identify clusters of unsuitable accommodation that indicate a need for new, replacement facilities. SHAPE can add significant evidencebased support to that process as well. In terms of mapping GP facilities, SHAPE can separately identify main and branch surgeries, and other prescribing centres. It also includes the locations of pharmacies, dentists, and optometric services, and has recently incorporated the site details of prisons, care homes, and private sector facilities. These data sets have been included to reflect the fact that services can be commissioned from, and delivered in, non-NHS locations. In the course of the application’s development, we have been able to reflect the fact that independent healthcare providers, such as care homes, play a significant part in some care pathways, and acknowledge that private sector providers may play a growing role in delivering NHS services. The intention is to allow all aspects of care delivery to be taken into account in strategic asset management. SHAPE is currently working with NHS London and NHS South East Coast to develop an extended database for strategic asset management, incorporating key data items that will help influence investment and disposal decisions. It has the potential to incorporate asset information from local authorities to underpin local partnership approaches to service and asset rationalisation – an approach that has already been tested.
Adding images
There is also the opportunity to add site images, site layout information, and other data items that can be locally specified. As strategic estates advisor at NHS London, Simon Greenfield points out in this article (see panel opposite) that SHAPE can add significant value, particularly as it has the potential to extend its scope for estate data to include information about tenure, backlog maintenance, information collected in facet surveys, and other data that has a bearing on strategic decision making. SHAPE would also be able to separately identify sites surplus to requirements, or available for alternative use. SHAPE is a strategic application, and supports high-level decisions about patterns of service delivery, and accessibility of services, and provides a spatial view of assets for a particular area. In terms of estates management, it is not intended to provide detailed information about the day-to-day management of buildings. Its value is its ability to complement other tools that do contain that type of information. When combined with operational estate management tools, it will enable estates professionals to get a full picture of the entire estates offering, to ensure that it matches local requirements. Built on careful analysis and up-to-date information, SHAPE provides an excellent starting point for local strategic planning development. It can inform the vital dialogue that commissioners may wish to have with providers and other stakeholders, including patients, which lies at the heart of any service redesign initiative. SHAPE can help service commissioners to determine the service configuration that provides the best affordable access to care.
A robust evidence base
The application is built on a robust evidence base. The Hospital Episode Statistics (HES) data incorporated covers all NHS Trusts in England, including acute hospitals, primary care Trusts, and mental health Trusts. Care provided to NHS patients by the independent sector, and care given to private patients in NHS hospitals, is also recorded in HES records. Inpatient, outpatient, and Accident and Emergency (A&E) data for 2009/10 is being added to the extensive database. This will be the first time that A&E data has been included in the application, and it will add an additional dimension to commissioners and providers of health services seeking efficiencies and flexibility in delivering urgent care. Quarterly data for 2010/11, and subsequent years, will also be included, to meet user requirements for access to up-to-date information. The data can be examined from either a commissioner or provider perspective, and will support analysis of different admission types across Healthcare Resource Groups or ICD diagnostic codes. Clinical benchmarking information is provided in relation to the following key indicators:
• Average length of stay.
• Excess bed days.
• Day case proportions.
• Pre-operative stay.
• Weekend discharging.
• Multiple emergency admissions.
As well as providing analyses vital for overall strategic planning across whole health economies, SHAPE can be used for many other specific planning purposes. These include:
• Siting of new facilities.
• Benchmarking of clinical services.
• Mapping local populations by medical condition, age, socio-economic, and public health factors.
• Investigating the performance of organisations on key estates indicators.
• Developing a repository of organisation and site estate information.
Keeping pace with change
In line with the scale and pace of changes within the NHS, a key focus of our work with SHAPE is ensuring that it is regularly updated with the most accurate and recent data available. We envisage that the application will continue to evolve, particularly throughout 2011-12. An important addition to SHAPE is that it now allows further information to be added locally where required. Work currently being undertaken by the SHAPE team marks an exciting new phase in its development. As we move forward to achieve greater efficiency and site rationalisation, SHAPE will also have the facility to identify potential sites for new facilities, and to assess the suitability of the location of those sites. It will also be able to compare catchment areas for potential sites, and to provide demographic and deprivation profiles for each, to support decision making. It is increasingly important to be able to demonstrate appropriate levels of need in the planning stage of new facilities, and SHAPE can delve deep into local demographic data to provide that analysis, after which it is for local decision-makers to interpret the data. The key to making the correct decision is having confidence that the data is accurate and up-to-date.
Reflecting changes
We know how important it is that SHAPE reflects the planned changes in public health and commissioning responsibility, and that it remains flexible and fit-forpurpose. Data within it is regularly being updated, and consideration is given to new data sources or weblinks that may enhance the application. Our intention is that SHAPE will be made available to local authority users with a role in public health and social care. We know that under the new, local commissioning structures, many groups of health professionals, including regional directors of public health, and local authority Health and Wellbeing boards, as well as clinical commissioning groups, will have a role to play in assessing local requirements. This is yet more evidence that a one-size-fits-all approach will not support local requirements going forward. The clinical data, public health indicators, QOF (Quality and Outcomes Framework) prevalence data, and demographic information within SHAPE, can all be combined with the mapping capability to generate well-presented information for GP patient forums, local HealthWatch bodies, and the proposed local Health and Wellbeing boards within local authorities. Collectively, Joint Strategic Needs Assessments will enable collaborative commissioning between clinical commissioning groups and authorities. This may increase the potential for partnership working in commissioning services, and rationalisation of delivery models and physical assets. SHAPE is willing to support locally-driven, bespoke development of data and functionality to suit local needs.
Free to NHS professionals
SHAPE is free-of-charge to NHS professionals. However, access to the application is by formal registration and licence agreement. Applications to use SHAPE can be made by visiting the current website (shape.dh.gov.uk) or by emailing the SHAPE help desk (shape@nepho.org.uk). The SHAPE team offers a number of regionally-based training events for all new and existing SHAPE users. If your organisation has a number of existing or potential users, we can also provide organisation-based bespoke training sessions on a cost recovery basis. For more information about SHAPE, and to register for upcoming training events, please email the helpdesk. The SHAPE team also very much welcomes feedback or suggestions from new or existing users. This approach has underpinned the application’s continued development and improvement.