ASSIST says idea NHS like a bank ‘fundamentally flawed’

"We reject the notion that the NHS is analogous to a bank."

NHS informatics professional body ASSIST has published a paper saying the original NHS National Programme for IT plan based on a one size fits all “does not work”.

The paper says attempting to treat the NHS as if it were a bank failed to understand the structure and characteristics of the health service.

ASSIST says there has been too much focus on standardisation of systems rather than standards. The paper says both national and local systems have a role to play but cannot succeed if they are imposed.

The ASSIST document says a revised strategy must reflect the shift to a pluralistic, federated model of care delivery, in which information follows the patient.

The paper calls for changes to NPfIT to take account of the changed policy environment, for mistakes to be acknowledged and lessons learned.

ASSIST, which is affiliated to the British Computer Society, says the standardised systems approach of the original NPfIT strategy, emerged from a “misguided attempt” to see the health service as analogous to a big business.

“We reject the notion that the NHS is analogous to a bank (especially in the current ‘credit crunch’!), a global telecommunications company or an airline, and this believe that focusing on their ICT models for a healthcare environment was fundamentally flawed,” says the report.

The paper has been produced as ASSIST’s evidence submitted to the independent review of NHS IT being undertaken to inform Conservative party policy. The document says priority should now be given to getting the IT basics sorted first, with a focus on deploying clinical systems based on common standards.

Counted among the notable successes are: primary care computing, electronic records transfers and prescribing, picture archiving and communications (PACS), digital patient monitoring and the secure NHS broadband network.

The paper says other important parts of NPfIT have failed. “It is generally accepted that deployment of ICT in acute hospitals through the national programme has not gone well for a variety of reasons.”

“We observe that IT-imposed solutions have always tended to failure, while IT-enabling solutions have tended to be more successful.”

As a result of the NPfIT ASSIST says there has been a “radical” change in the supplier marketplace. “There has been a shift from a very wide range of small to medium sized suppliers, to one where there are a few very large suppliers with relatively constrained supply chains.”

While the shift to reliance on larger suppliers is largely welcomed, the ASSIST report expresses concern this may have swung too far. “We observe that this has reduced the speed of innovation, responsiveness and flexibility.”

The health informatics body says the successful exploitation of IT to improve health and social care “relies on an innovative, robust and competitive supplier market.”

The document calls for pragmatic flexibility on systems: “The experience of the members of the group suggest that simple systems, which offer flexibility to be configured to meet local processes and circumstances, can achieve greater success than more sophisticated systems which bring rigidity.”

The submission, based on a meeting of 28 ASSIST members on 28 September, offers a snapshot of members’ views on the future direction of policy on use of IM&T in the NHS, health and social care in England.

The paper observes securing public confidence in ICT developments is vital, and calls for a mature debate on how to maximise the value of ICT. “The pursuit of media point-scoring and personal vendettas has masked the many informatics national and local successes and contributions to better services.”

For all the changes in society and prevalence of technology the paper notes that the basic concept of an encounter between a carer and a patient or service user has not changed. ASSIST says that technology and information flows need to support and inform these basic encounters.

“We see this concept of the encounter as the fundamental platform upon on which to build a large part of the health informatics ecology.”

The report says that there is little benefit from having just islands of information. “The efficient and effective flow of information along a patient pathway requires balance; there is little value, for example, in having rich, high quality data from primary care, if there are gaps in hospital, community or social care.”

One of the observations made by ASSIST is that there is currently incoherence caused by “inconsistencies in national policy”. They call for far greater clarity about responsibilities, particularly around foundation trusts’ greater independence on IT “which sits uneasily with national, centrally-directed delivery programmes such as the national programme”.

“That coherence is currently lacking but we think is best addressed through the adoption of mandatory standards rather than systems solution standardisation, and through investment decisions which take account of the value of money for the whole NHS, as well as for the individual organisation.”

The paper adds: “We believe that adopting a standards-based approach offers the best opportunity to accelerate successful implementation of ICT solutions which are accepted and embraced and which open up the market to new entrants and more rapid innovation.”

It calls for this to be embedded within a clear national framework set by regulators in which all care providers – public and private, health and social care – “should be expected to meet a minimum set of ICT standards in order to be permitted to operate.”

The paper stresses that health policy and delivery has become much more pluralistic since the current National Programme for IT was established in 2002, which “focused around the process of procuring and deploying systems solutions that support those state-owned care providers.”

The move to a far more pluralistic model of health and social care calls for a very different, says the paper: “We believe that the time has come for the national programme to redress the balance and focus more on ensuring that ICT is in place that supports publicly-funded care, regardless of the ownership of the organisation that delivers that care.”

ASSIST recommends:

• Focus on the basics before trying the ambitious

• Do not lose or threaten hard won successes

• Focus on standards not standardisation

• Achieve a balance between technology, systems, people, process and culture

• Ensure much earlier and more integrated policy planning at both national and local levels

• Invest in a systematic health informatics research and development programme

• Avoid structural change

• Avoid stand-alone data demands

• Avoid insular systems development

• Invest in developing informatics skills, leadership and the profession