DMICs - from embryo to secondment
12 November 2013

This is the first in a three-part history of data management integration centres in 2012 and 2013 by John Wilshaw, DMIC service lead. It is a rollercoaster ride. Sit back and enjoy.

From embryo to secondment

I was appointed DMIC Service Lead in February this year after having spent the previous 12 months grappling with the emerging data management integration centres concept from an office in Oxfordshire. DMICs are the nine brand new data warehouses that were to replace the data processing part of the 150-odd PCT data warehouses, the systems that managed secondary uses service (SUS) data. They were branded ‘sub-nationals’, children of the one ‘national’ system data repository organisation, the NHSIC. The NHSIC would pass national data to sub-nationals; sub-nationals would collect local data flows and reconcile with SUS and pass them back to the national system, thus greatly enhancing the Department of Health (DoH) view of the cost of care across the NHS. This supports the Power of Information, which itself underpinned the commissioning intelligence model of clinical commissioning.

The DMIC Technical Group, consisting of techies from all nine DMICs, met, shook hands and started collaborating on an ‘at-scale’ commissioning data warehouse architecture. We submitted a data interaction standard to the ISB (standards board). We started work on a pseudonymisation standard, a data validation standard, implementing best practice from across the country. Each DMIC worked altruistically for the good of the NHS.

Then the full impact of the 2012 Health and Social Care Act became apparent. Remember, the Act had been delayed by a year as David Cameron ‘paused’ the new legislation. The passage through Parliament may have been paused, but the milestones had not. The Act had restated the new Health and Social Care Information Centre (a merger of NHSIC and Connecting for Health) as the only organisation in the country that could load and link patient identifiable data (PID) without the patient’s consent. Sub-nationals (DMICs) needed to load and link local data flows containing PID to create integrated care pathway datasets from national and local data flows. Without a legal basis for access to PID, DMICs could not do the job they were created to do. 

At exactly this time, NHS Commissioning Board staff were re-applying for their jobs. Media and DoH attention was on various crises in hospitals. Change was everywhere. Work continued on closing down PCTs and authorising CCGs and nursing CSUs through their checkpoints. The DMIC technical group collaboration work ceased as we discussed ways of operating on a legal basis. Everybody knew someone who was giving evidence to Dame Fiona Caldicott’s review of the way patient data was managed in the NHS, worrying about the outcome.

Christmas came and went. Finally, a joint recommendation of the HSCIC and NHS England, both brand new organisations, proposed about six options to overcome the problem. The first three options involved a tweak to the organisations with associated regulatory change. All possible options were considered, even unlikely ones like number four, which was to second DMIC staff and functions into the HSCIC, thus providing the necessary legal basis.

Senior NHS England executives chose option number four and the necessary authorisation came out on 4 February, the day I moved to Yorkshire as DMIC service lead.  The HSCIC had to incorporate, with no extra funding, nine sets of infrastructure, systems and staff. There were HR implications. There were IG implications. The HSCIC has policies, procedures and protocols inherited from the NHSIC, but now they needed to be extended for about 200 extra seconded staff. The DMIC technical group continued to discuss how to make it work.

Against this backdrop, the PCT transition work was reaching a crescendo. Everybody was working hard and making extraordinary efforts to make the system work. What would happen on 1 April? The next instalment will take us from March to June 2013 and will be entitled “Phoenixes and section 251s”. 

West and South Yorkshire and Bassetlaw Commissioning Support Unit

West Yorkshire office:
Douglas Mill
Bowling Old Lane
West Yorkshire

Tel: 0845 1115000

South Yorkshire and Bassetlaw office:
722 Prince of Wales Road
South Yorkshire
S9 4EU

Tel: 0114 3051000

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