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Because contracting is a secondary use of the data and healthcare is the primary use, clinical discussions can make use of all relevant data at patient identifiable level whilst contracting and payments cannot, even if the contracts and payments data might be throwing out interesting healthcare data.
e.g. increasing A&E attendances don't just increase emergency admissions (which you would expect) they also effect elective admission and OP attendance volumes even from areas in other teaching hospital catchment areas as patients with a good A&E experience seem to exercise choice.
Commissioners were looking at activity growth in separate silos and couldn't see (or couldn't understand) it was the same patients driving it.
dubtap
Ah well that is fucking shit then. More so because the blood and guts workers are sharing information so, in theory, it should be feasible to pull that path of interactions out of the shared data.
Well actually it's already been done for you on a handful of the worst cases in the form of a serious case review. All of the involved agencies will have submitted a chronology for that.