Tag Archives: information management

How better information management could minimise disasters

The following article was submitted by Katharine Schopflin.

Image c/o Eric the Fish on Flickr

I recently attended a talk given by Jan Parry, who provided information and research support to the Hillsborough Independent Panel, which, in 2012, oversaw the disclosure of public documents related to the 1989 disaster. Their website provides very clear background on what happened on 15th April 1989, as well as outlining the work they did to gather related documents and make them publicly available. I should state that the following is entirely my own interpretation: Jan’s measured, even-handed talk was essentially factual and did not offer up any opinions on either the disaster or the work of the Panel. But it made me think about the information public organisations hold, how they use it, and its value for preventing disasters and revealing facts. I’ve selected a couple of things from Jan’s very fulsome talk, and any mistakes in reporting are my own misremembering or misinterpretation.

Jan began by showing us the map of the Hillsborough ground which was used on the day. This plan both showed and lacked information pertinent to what happened. Much has been written about the power of maps to give and withhold information: they are representations and a choice is always made about what is included and how it is shown. This map shows how space was constricted at the Leppings Lane end of the ground but is limited in representing how confusing the divided inner concourse was for supporters, nor exactly how uneven the distribution of turnstiles was, things which had they been more apparent might have encouraged different policing decisions.  Jan also mentioned information that was available about previous (non-fatal) crushing incidents at Hillsborough and the results of the report into the Bradford City ground, which identified the dangers of using ‘pens’ in football terraces. These were not considered as part of plans for crowd control during the match.

As well as information which was available, but was ignored, some information was out of date. The police Operational Plan, which exists for every football match, had not been updated since the two teams last met at the ground the previous year. From a knowledge management point of view, both teams having met at the same ground for the 1988 semi-final could have provided useful learning points to inform a new Operational Plan, but if there was a debrief of police officers present at the previous match, it was not added to it. And in this case, knowledge transfer was vital, as the Match Commander in 1989 had no experience at Hillsborough. Other information could have been added to the plan: roadworks which made many Liverpool fans late are thought to have contributed to the crowding which built up at the Leppings Lane entrance. I’m not in a position to judge whether having a better map of the ground, an up-to-date operational plan, or more shared experience about managing a match at the ground, would have prevented the disaster. But these seem to me to be vital pieces of knowledge which needed to be expressed, and once expressed, shared and made explicit.

Jan also talked at length about the evidence gathered in the lengthy series of inquiries and investigations which followed the disaster. The stated purpose of the Panel was to allow documents related to the disaster to be released into the public domain ahead of the usual 30 years, but in the process an enormous amount of information was assembled together for the first time. Each contributing organisation: the government, police authorities, coroner’s service and NHS were asked to scan, digitise, redact and catalogue these documents with Home Office support. Some of the documents had always been available, but not read as significant. South Yorkshire Police happily released material which illustrated that some police statements had been edited before being made public, but did not see that this might have damaged earlier investigations. Many of these documents are now being used as new evidence and cases are being reopened.

One of the recommendations from the Panel was that public bodies such as police authorities and the coroner’s office should have a mandate to manage and keep their records (something which surprised me was not already the case). South Yorkshire Police had been going to dispose of some of the records which they instead gave to the Panel, and were within their rights to do so. Of course there are limits to ‘just in case’ record-keeping, but these public sector bodies could, if they had wished, destroyed information pertinent to new investigations. If the suggestions are followed, they will have a responsibility to keep records and manage them in a way that enables them to be found again. This seems essential to me if we want to be able to prevent or subsequently investigate significant events in the future.

However, I think this alone is not enough. Public sector information also needs to be joined up and exposed to analysis, in a way that modern technology now makes possible. Take the absence of information about road works in Operational Plan for the match at Hillsborough in April 1989. Modern data analytics tools enable police to combine public domain data about planned roadworks, standard traffic flows and their own knowledge of expected crowds to build a clear picture of what the outside of any stadium turnstile will look like just before a match. And this isn’t a theoretical picture, an actual map illustrating anticipated road and person congestion at any time of the day could be generated without difficulty. The guidance on policing football matches is undoubtedly more sophisticated now as a result of lessons learned from Hillsborough. Whether or not they have these kinds of tools at their disposal I do not know, but it is surely vital that they do.

Similarly, every investigation into a large-scale disaster or act of violence that I have read about has indicated that joining up information at an earlier date could have prevented death or injury or at the very least found answers to questions asked by victims or their families. Once disparate information is brought together it becomes clear if something in the situation is or was ‘not right’. Indeed, it was with these ideas in mind that the Home Offices large-scale IT systems, HOLMES and HOLMES2 were introduced across police services in the UK in the 1980s and 1990s. Many local authorities are to be lauded for releasing data into the public domain, but it is by no means mandated across all public bodies. Technology has created great possibilities for manipulating data, but it needs to be available to begin with. This requires public bodies to maintain their records and, within reasonable and compliant limits, make them available as early as possible. The technology and analytical expertise exist. Opening up the data also needs to follow.

Do you Care for your Data? What care.data means for NHS patients in England

The new care.data database has prompted much debate about its impact on healthcare and patients.
(Image c/o Jamie on Flickr.)

The following post was written by Informed team member, Elly O’Brien.

NHS England’s new database, Care.data, will be populated with data collected by the Health and Social Care Information Centre (HSCIC) from different care providers such as General Practitioners (GPs). The HSCIC already collects Hospital Episode Statistics, which details admissions, outpatient appointments and accident and emergency department attendances. The concept behind care.data is to create a single database with information spanning primary care (e.g. GP surgeries) and secondary care (e.g. hospital admissions), to enable this “big data” to be used to help understand and treat diseases, inform how local services are organised, identify people at risk of conditions and improve the “pathway” of treatment a patient follows.

We are frequently told that we are living in an age of “information overload”, where we are bombarded with information which can lead to an “information paradox” in which there are so many sources of information, that knowledge becomes hard to find and this superfluity of information can make it harder to reach a decision. Care.data is a perfect example of this in action, having created a flurry of media coverage and commentary from all sides.

The aim of this blog post is not to add to this excess of information or to try to sway anyone’s opinion, but to signpost sources of information from various organisations and viewpoints.

The HSCIC has background information on care.data, NHS England has a range of information specifically for health professionals. NHS Choices has information tailored for patients including an electronic copy of the leaflet that has been distributed to all households in England and a video.

So what are some of the issues that have been raised about care.data?

Anonymisation

NHS England has stated that the records will have identifiable information removed but the HSCIC has conceded that there is a small risk that records would be potentially identifiable as records will be pseudonymised rather than anonymised.

How the data will be used

The data will be used within the NHS nationally to inform research and improve practice, as well as by the NHS locally to understand local needs and for the NHS to commission services accordingly. It will also be made available (for a fee) to insurance firms and private organisations such as pharmaceutical companies. Some people are fundamentally opposed to this, but NHS England has sought to reassure patients that the data will not affect insurance premiums or be used for marketing purposes. NHS England has in place information governance measures designed to ensure that it complies with relevant legislation with regards to how care.data will be shared, stored and used. The same laws will apply to any non-NHS organisations using care.data, however, some critics have are concerned that any misuse of data would only be apparent after the fact and that law in itself is not necessarily a deterrent.

Having to opt-out

The new database is based on an opt-out system and patients who do not want their data included in the database are instructed to contact their GP in the leaflet being posted out. This has been criticised on principle by some, because people may not opt-out (perhaps due to laziness or lack of awareness) but in doing so are not necessarily positively consenting. Others have criticised that an opt-out form has not been provided, although some GP surgeries have created opt-out forms for patients on their websites (such as this Durham-based practice). To opt out you simply need to contact your GP surgery (not your actual GP), you can phone them or write to them (medConfidential has an opt-out form you can print out and send to your GP surgery).

The decision is yours to make, but a little reading can ensure that it is an informed, empowered decision rather than an unwitting opt-in.