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an Economist Intelligence Unit business healthcare

Cystic Fibrosis



East Midlands Specialised Commissioning Group



‘Service designation’ describes the rational selection of a provider or providers of a service for a defined local population. The process needs to be both evidence-based and consultative and is critical to the efficient commissioning and delivery of health services. If done robustly - by systematically collecting and analysing epidemiological, market and effectiveness data relating to the service, and with stakeholder input - it allows commissioners to drive improvements in quality and efficiency. It enables commissioners to develop transparent, clinically-credible and quality-focused procedures to identify and work with the best providers and collaboratively agree the future direction of a service.


The problem

EMSCG commissioned Bazian to provide an analysis of potential demand for service, an assessment of local activity data and an evidence-based review of the literature concerning quality of service to allow service benchmarking. This work was to inform the process of designating cystic fibrosis (CF) services in the East Midlands region.


Our solution

Bazian undertook a multipart analysis to address the needs of the EMSCG. A systematic review of the evidence was undertaken to generate a picture of the ideal service model. This was assessed in relation to the current model of service provision in the region, defined through consultation with specialists and third party sources. We also conducted a health needs assessment and epidemiological review and modelling exercise to estimate the current and future demand for CF services. We provided a set of draft quality indicators and service standards (grounded in the evidence), including recommendations for information reporting, which could be used to help inform commissioning decisions.

Our work suggested that, when measured against national standards of the CF Trust, a high quality cystic fibrosis service was being provided by the two specialist providers in the East Midlands. Recommendations for structural improvements were made, including dedicated inpatient and outpatient facilities and increases in medical, physiotherapy and nursing specialist staff. In addition, we suggested that the ongoing monitoring of selected key outcomes should become a requirement for designation, so that commissioners could assess whether proportionate increases in staffing and the level and quality of service is matching the expected growth in the adult CF population.


The outcome

In order to ensure that the cystic fibrosis service in the East Midlands remains of the highest possible standard, we encouraged the EMSCG to involve the two specialist CF services and other stakeholders in the consensus process to agree on a set of quality indicators and standards using our suggestions as a framework.