The year to come: 2010

As 2009 went on there was mounting concern about how the credit crunch would affect NHS spending and the National Programme for IT in the NHS. Sarah Bruce asked politicians what 2010 will bring and asked primary care IT leaders to set out their wish lists for the year ahead.

Quick links

• Mike O’Brien, health minister with responsibility for NHS IT
• Andrew Lansley, shadow health secretary
• Stephen O’Brien, shadow health spokesman
• Norman Lamb, Liberal Democrat shadow health secretary
• Dr Simon Eccles, medical director, NHS Connecting for Health
• Dr Gillian Braunold, clinical director for the Summary Care Record and HealthSpace
• Dr Grant Ingrams, co-chair of the BMA and RCGP’s IT Committee
• Dr Brian Fisher, national public and patient involvement lead, NHS Alliance

Mike O’Brien, health minister with responsibility for NHS IT

The recent party political knockabout around the future of the National Programme for IT in the NHS has settled down, as politicians realise the government’s firm commitment to delivering its vision.

I expect delivery to continue to pick up pace in 2010, particularly with the Summary Care Record and the Electronic Prescription Service, as well as in the acute sector. Coupled with the work we are doing on mobile technologies and telehealth, potentially 2010 should be a year of great progress, establishing informatics at the heart of delivering high quality, personalised care.

Giving patients and staff access to crucial information is also a priority for 2010. We want patients and service users to be involved in their care and confident about their choices. This means providing accurate and accessible information about outcomes. It also means offering channels for their feedback to impact directly on the services they use.

The Luddites on IT may well pretend the project is going to hell in a hand-basket and that somehow the NHS can survive disconnected, but political realists know the vision of a connected NHS is essential to its future.

Andrew Lansley, shadow health secretary

It is clear that 2010 will be a year in which we see a fundamental re-evaluation of the implementation of the NHS IT programme. The independent review [that the Conservatives commissioned from Dr Glyn Hayes and which reported in July], gives us a sound basis for this.

As part of this, we think it is time for the government to abandon the flawed local service provider contracts. Whilst the contracts remain shrouded in ‘commercial confidentiality’, we suspect that it would now be possible to abandon them without penalties in either direction, because the costs of fulfilling the contracts to the companies would exceed the value of the contracts to them.

We want to see hospitals choosing their own software within a framework of interoperability, innovating locally to deliver IT solutions tailored to the needs and wishes of their community. This will require a level playing field for software and hardware suppliers, and a commitment to open source solutions across the NHS.

Taken together, these measures would free the local to focus on developing quality IT systems that deliver local accountability to patients, and empower clinicians to focus on improving the results of patients’ treatment.

Stephen O’Brien, shadow health spokesman

A pressing issue that I would like to see resolved in 2010 is where the £600m spending cut recently announced by [health secretary] Andy Burnham will hit the NPfIT. At the top of my wish list, however, would be a transparent renegotiation of the programme’s LSP contracts.

The public has a right to assess whether these contracts offer value for money and I think it is high time the government returned to the negotiating table to ensure that NHS trusts can access competitive, innovative and flexible IT solutions.

If the government is going to persevere with the current LSP arrangement with BT and CSC, I would like to see hard evidence that the Lorenzo and Cerner systems are making a real difference to patient care at the grass roots.

I would also like to see a more detailed explanation of the local costs incurred by trusts installing these systems – it emerged this year that both the Royal Free and Barts and the London spent over £4m implementing Cerner.

The final item on my wish list would obviously be that the Conservatives earn the chance at the next election to implement their localised, interoperable vision of IT, so that innovation and choice can finally get the chance to flourish.

Norman Lamb, Liberal Democrat shadow health secretary

As a result of the Pre-Budget Report there is a complete lack of clarity around NPfIT. Nobody knows the details around the LSP contracts, and this is something that I will take up with the Secretary of State for Health personally. Nobody can plan anything without that clarity.

Beyond that, there needs to be a radical shift away from centrally imposed systems. NHS Connecting for Health’s central operation needs to be dismantled, as does the effort to secure national databases. There should also be changes to Choose and Book, recognising its limitations and the problems with its robustness.

I’m not in the school of thought that says you can scrimp on IT. I think that more efficient health systems depend on IT, but there is a need to move away from this nightmare of the national programme in order to improve care for patients. I would also like to see much smarter use of resources and a lot more investment in telecare.

Dr Simon Eccles, medical director, NHS Connecting for Health

Few doubt that the coming year will be a year of significant change for NPfIT. However, I am still very clear in my own mind that there is an overwhelming need for high quality, joined up information systems throughout the NHS. I was interested to note that even the British Medical Association spoke publicly in favour of the programme when the frontline requirement for IT was questioned by Alistair Darling.

I believe that 2010 will bring us a whole heap of good news alongside the inevitable changes. We will see the Summary Care Record roll out to most of England and start to see it being seen as ‘part of how we work’ in many urgent and emergency care settings.

I also hope that the Summary Care Record will act as a disruptive technology, encouraging patients to manage their own healthcare and increasing their expectations of receiving coordinated care. Evidence suggests people get better health outcomes when they feel in control rather than receipt, of their care.

The visible success of the SCR should help clinicians feel confident in demanding more from coordinated IT. This can only be a good thing. Happy Christmas!

Dr Gillian Braunold, clinical director for the Summary Care Record and HealthSpace

We should see good progress towards safer, more joined-up care for patients over the next year as the national roll-out of Summary Care Records picks up pace. Among the emerging benefits is evidence of patients’ wishes about their end of life care being respected in Bolton and Bury, where this information has begun to be added to SCRs.

The ability to enrich SCRs with such key information will be extended into areas such as mental health and multiple morbidities, leading to more personalised, responsive care. I am also looking forward to seeing clinicians increasingly using IT to innovate and support patient delivery, for example by making use of NHSmail and web technology to support interpreting services.

The confidentiality and security of patient records are crucial, but there are also rising expectations among patients that information should follow them wherever they are treated. Similarly, I hope to see healthcare staff having more confidence about sharing information appropriately over the next few months.

Dr Grant Ingrams, co-chair of the BMA and RCGP’s IT Committee

I predict that during 2010 the government will have a ‘Road to Damascus’ experience and finally recognise that a detailed health care record across a whole health economy will not improve healthcare. Sharing of data electronically can never replace continuity of care with a doctor or service; nor direct communication between two clinicians regarding a patient’s care.

Patients should have an absolute right to privacy, so we should move to individual informed consent before uploading to any shared health record. I believe that GPSoC has proved to be the long-term solution for General Practice, and that all LSP contracts for GP systems should now be scrapped.

Future IT developments must be driven ‘bottom up’ to deliver the tools that clinicians need to provide the ever more complex healthcare that patients want and deserve. These concepts will ensure IT for NHS healthcare becomes patient and not politician or management centered. Wishing all E-Health Insider readers a happy and productive New Year!

Dr Brian Fisher, national public and patient involvement lead, NHS Alliance

2010 is likely to be a significant year for NHS IT solutions, although a recession and an election will certainly slow things down for CfH. Nonetheless, CfH is likely to deliver on more of its promises for clinicians – and it will be about time. There will be an increasing emphasis on the interoperability of national systems with existing grassroots solutions from experts in the field in close touch with the realities of clinical work.

Real, interactive access to GP health records for patients is likely to spread. This will save time, especially for hospital clinicians who will have access to data that has been impossible for them to get hold of up to now.

These products will begin to offer patients the ability not only to integrate their care, but also to make decisions based on good personalised information directly related to the data in their record, which will become a portal to a range of facilities.