October revolution

In opposition, health secretary Andrew Lansley promised NHS staff and patients an “information revolution” to support quality, promote choice and deliver accountability.

July’s white paper, ‘Equity and excellence: Liberating the NHS’, said an information strategy would be published to help to bring the revolution about.

Last week, a 68 page consultation emerged from the Department of Health. Yet analysts and professional bodies are struggling to find anything terribly revolutionary about it.

There is also considerable skepticism about whether its proposals can be carried through. A major cause of concern is that there will be no funding for any of the initiatives proposed.

Instead of money, ‘Liberating the NHS: an information revolution’ focuses on the need for a “culture change” in attitudes towards recording and using information.

However, Frances Blunden, senior policy manager for NHS Confederation, tells E-Health Insider: “They are talking about a culture change, but there is no indication on how that’s going to happen or the levers and processes that need to be in place for that step change.”

Vague and lightweight

Blunden also raises the key point that the document talks about the importance of the patient record as the foundation for information in the NHS, and about empowering patients by giving them access to their own records.

However, it never mentions the National Programme for IT in the NHS, which has spent ten years trying to create detailed and Summary Care Records for the health service and, indeed, barely mentions IT systems at all.

“The aspirations are spot on, but what is problematic is how we put it all into practice,” Blunden says. “Primary care does have an online care record which could be shared; but we are still far from having something where GPs can talk to acute providers and social care.”

She adds that while the white paper talks about a greater role for community services in supporting an ageing population, the information consultation “fails to recognise that IT solutions in community services are very poorly developed. If they are going to play a much bigger role, that’s a really big gap that needs to close.”

Verging on fantasy

Jonathan Edwards, research vice president, healthcare providers, at Gartner elaborates on these points. He says the document is vague, lightweight and that elements of it are unrealistic; not least because they are not funded and there is no roadmap for achieving them.

He also points out that while it says there is “no need to start from scratch” it completely ignores previous NHS information strategies, including the Korner report of the 1970s.

“It voices a lot of principles that everyone can agree are a fine thing, for example patients having access to copies of their medical records,” he says. However: “The document omits a host of existing systems and initiatives, as if the authors were unaware of them.”

In particular, he says the consultation “skirts the awkward problem that before you can give patients access to a credible comprehensive health record, you have to establish such a record.

“This requires hospital electronic patient record systems – a topic barely mentioned – as well as extensive work on security, privacy and interoperability.”

The right place but the wrong time

Blunden and Mik Horswell, spokesperson for UKCHIP and ASSIST, point out that the ideas in the consultation would require a huge degree of engagement from NHS managers and frontline staff.

They wonder if this will be forthcoming, given the financial pressure the health service is under and the huge reorganisation that is being imposed on it.

Horswel says: “It’s hard to see how a real revolution can occur without the highest level of clinical and managerial support and this has not been obvious to the service yet.”

Blunden adds that the NHS Confederation’s biggest concern is how the transition is going to be managed.

“How can you can make changes around culture when you’ve got such big changes in management structure coming through by taking away the strategic health authorities and primary care trusts?” she asks.

“There’s an assumption that everyone will come to the same approach, but realistically that is unlikely to happen.”

No money to ease the way

Both point out that this is an area in which money might help. Horswell says: “We have significant concerns about the issue of funding for the information revolution.

“The comprehensive spending review limits NHS funding and reduces capital availability. IT usually requires funding up front before ROI [return on investment] can emerge.”

Edwards also feels that the document fails to take account how much the proposals are likely to cost. “All these things cost a lot of money, yet the document states that no money is available and that the changes proposed should pay for themselves,” he says.

“In this light, statements such as that by 2015 ‘analytical data will move from ad hoc collections driven by policy to automated derivations from electronically stored care records using rigorous and standard transformations and aligned to outcomes’ are little more than fantasy.

However, Jeremy Nettle, chair of Intellect’s health group, says that having to ‘make do’ may be beneficial.

“We fully understand the need to cut spend to address the deficit, and that, consequently, the information revolution needs to ‘pay for itself’,” he says. “It will be a challenge. However, there are lessons from other industries – especially consumer practices – that we need to play in.”

The nature of consultation

The consultation document says that over the next three months the DH will “seek views on the journey we will all need to take so that information is managed for the benefit of all.”

However, Horswell said he was disappointed that it was framed as a set of ideas and questions, rather than as a strategy. Again, Nettle disagrees. He finds the consultation a breath of fresh air.

“In many respects, it is refreshing to see the government talk about the outcomes it wants to achieve instead of a fixed focus on the strategy to get there,” he said.

“The strategy looks to the market to come up with innovative ways to deliver these outcomes, all under the ‘plural choice’ and ‘open and connect’ environment.”

Julia Manning, chief executive of think-tank 2020health.org also welcomes the move to consult; although she wants some firmer outcomes.

“It is unclear how the resulting NHS information strategy will extend into shaping a clear and unambiguous vision, describing the use and governance of information and technology to deliver the clinical and business capabilities that the constituent parts of the NHS need for the future,” she says.

No reason not to get involve

Blunden says that she would like to see a focus on interoperability and data quality and educational programmes for electronic health records.

She would like to see real questions answered around data sharing and information governance “at a macro level” and for the power of other technologies – such as digital TV – to be taken into account alongside the focus on IT and websites.

Horswell, understandably, is quick to recognise the impact that the strategy could have on healthcare IT professionals.

“UKCHIP will be concentrating its response on sections 4.13 to 4.18 on Informatics workforce capacity and capability,” he says. “We are delighted with the apparent support for skills development, professionalism, and for regulation – the raison d’etre for UKCHIP.”

He adds: “It is unclear whether they are really open to suggestions, but it is vital that health informaticians take the time to read and comment, either as individuals or groups. This opportunity to influence will not arise again soon.”