Cayton says legacy systems could have offered more

England’s NHS National Programme for Information Technology will lead to better patient care but greater emphasis on building on existing systems could potentially have delivered results faster and cheaper, according to the Department of Health’s national director for patients and the public, Harry Cayton.

The patients’ ‘tsar’ who is also chair of the Care Record Development Board said that in his personal opinion more could have been achieved, sooner and at lower cost by building on existing legacy systems.

Speaking at the World Health Care Congress in Barcelona, Cayton strongly backed the programme saying that will ultimately deliver better patient care to the 52m patients in England and will be of huge benefit to 1.3m NHS staff and over 36,000 GPs.

However, he also pointed out that the NHS was already making extensive use of IT before the advent of NPfIT.

“The NHS was and still is digitally enabled and, in my opinion, we could have thought more about using existing legacy systems, rather than spending all this time building new systems. It would have been faster, cheaper and possibly have been received with a better reception.”

Questioned about advice he would give to other European nations looking to invest in eHealth, the DH’s director for patients and the public said: “In my opinion, it is necessary to engage with clinicians, both sceptics and enthusiasts, from the very beginning.”

He also said it was important to ensure that new developments included a careful balance between things clinicians want, and the systems they may be less keen on but which are needed to better manage and administer the health service.

He suggested Connecting for Health should have gone down the same route as the Veterans Administration in the US, which used the technique of deploying bundles of developments that doctors wanted with those they were not so keen to adopt.

“So for example, if we brought in systems at the same time as Payments by Results – which acts as an incentive for staff – then it is possible the two would have come in together without disruption. Maybe you should think about mixing the two.”

Cayton stressed that it was essential for health services to move away from paper-based records to electronic records.

“Paper systems are not meaningful. At the moment, we are still using the post to send confidential information in some circumstances, and when you think that in the UK, the Post Office loses up to one million letters a year, that’s a huge risk for us to be taking. Loss of mail and overload of documents prove that even paper systems can crash – we are trying to achieve a health system supported by electronics. The creation of an electronic health record is not a technological exercise but a social one.”

He added that the National Programme for IT (NPfIT) would have a wide range of benefits from centralised records to prescription and medication errors being quickly resolved.

Outlining the progress made so far in England, he told delegates: “We have the Summary Care Record which will be of huge value to paramedics. It has enormous benefits in keeping people out of hospitals. With Choose and Book, patients are able to choose where they go for treatment. There are teething problems, but the system is making 16,000 appointments a day.

“We are slowly implementing new patient administration systems which are bringing enormous clinical benefits and the website HealthSpace, will allow people living in ‘Early Adopter’ areas for the NHS Care Records Service to view and review a summary of their health information, called their Summary Care Record.”

Looking ahead, he identified three main areas which needed addressing as NPfIT moves on – children, social care and research.

“We must look forward at issues such as how do we manage children’s records and when the time comes migrate them onto the spine. We need to think about how to share records safely and securely between health and social care and we need to work more with the research community. They are breathing over our shoulders for a way of a way in, but we are facing a lot of pressure on public confidence.”

Public acceptance of the proposals for the use, security and confidentiality of shared electronic records was an issue that must be addressed as quickly as possible, Cayton said.

“Acceptance is enormously important, hence we updated the Care Record Guarantee. It was important we cold prove that we were able to protect the confidentiality and security of patient records and were working within the guidelines of the Data Protection Act and the Human Rights Act.”

Cayton said that it was necessary for all patients to have an electronic record, and not stay with paper records.

“Patient and public consent is vital, however it is not appropriate for a patient to ask for their record to be stored non-electronically. They can choose to have their data not input onto the spine, but we believe that all patients should have data from a set point of time stored electronically.”

The future is the main reason behind the move towards NPfIT, providing a health service capable of effectively meeting new demographic pressures and healthcare demands, Cayton said.

“We have an ageing population. More and more people live into their 80s or 90s, and because of that we are seeing more and more multiple conditions. The World Health Organisation says that over the next decade, neurological diseases will be the most common problem increasing demand on health care.

“Children will want and expect a good health service when they are 50, 60 or 70. They are seeing all this new technology and are beginning to imagine and think about ICT, not just that but they are looking towards interactive healthcare and mobile telephone technology, things we are just beginning to imagine. The potential is one we need to allow people to recognise.”