Leadership key to paperless NHS

They say that television presenters should never do live features that involve children or animals.

The equivalent for politicians is probably talking about their families or launching large scale public sector IT projects. Yet, in both cases, this advice is often ignored.

Attracted to the grand vision

Jeremy Hunt is the latest politician to be attracted by the siren calls of a large IT project. The aspiration of a paperless NHS is hardly new, but a firm date – 2018 – is.

Hunt outlined his commitment to having electronic records and communications in place across health and social care last week, in a speech to the think-tank policy exchange.

In his speech, the health secretary joked that the pledge had been described as “brave.” This, of course, is a Sir Humphreyesque euphemism for “foolhardy.” Well, brave it is.

So why has Hunt gone down this path? And is there cause to think that the fate of this announcement will be any different to that of previous ones?

I think there are three reasons why he has chosen technology as the theme for a big announcement in the middle of winter, when others may have been tempted to do something more topical, such as act on emergency pressures.

Firstly, the need is as clear as ever. In support of Hunt’s speech, the Department of Health put out a report from consultants PriceWaterHouseCoopers, claiming that the NHS could find £4 billion of efficiency savings by adopting a short list of big technology measures.

The NHS probably didn’t need PWC to tell it that successfully digitising the health service could unlock savings on this scale (£4 billion is less than 4% of NHS expenditure, so not as ambitious as it first sounds).

However, the financial case alone doesn’t explain why Hunt has put his name to this particular cause in such a public way.

Shifting control and personal interest play a part

The second reason is that power has shifted since the Health and Social Care Act that enacts the ‘Liberating the NHS’ reforms set out by Hunt’s predecessor, Andrew Lansley, back in 2010.

With the health secretary’s hands now legally removed from many of the levers of control in the NHS, promoting innovation is one of the few areas of policy where the DH has a clear role.

In announcing the milestones along the way to 2018, Hunt said: “Today I can confirm that the NHS Commissioning Board have agreed that hospitals should be able to share digital data from April 2014, and to adopt paperless referrals from April 2015.”

So the substance of the announcement was, in effect, that the NHS CB had agreed to do something. Contrast this with the number of times we have heard ministers say: “Today I have instructed the NHS to…”

It is a subtle, but important, change; which explains why this is now fertile ground for ministerial attention.

The third reason is that Hunt is both passionate and knowledgeable about technology. For a former culture secretary, this is home turf and it shows.

For someone relatively new to health, much of his portfolio must appear daunting, with many hidden pitfalls. Yet, having spent the past few years grappling with 4G, intellectual property and the like, digitising public services must appear, at least superficially, to be less disaster-prone territory.

So this announcement is more than just another announcement on another issue. It does offer an insight into the health secretary’s personal priorities.

Over to you, clinical leaders

Of course, caring about something and feeling you have something personally to contribute are very different from being able to deliver.

Yes, lessons have been learnt from the National Programme for IT in the NHS and, undoubtedly, the technology is now more advanced than when the programme was a twinkling in Tony Blair’s eye.

But there is no new money to fund this commitment; and the NHS will be somewhat distracted by reorganisation and retrenchment in the years to come.

One thing we have learned from the last decade is that this will only work if it is clinically-led. When I asked Hunt how he would promote this, he pointed to the personal enthusiasm many clinicians have for technology.

This is undoubtedly true. However, enthusiasm for consuming technology in your personal life is somewhat different from a willingness to lead and shape it in your professional life. Enthusiasm alone – from either clinicians or indeed the health secretary – is unlikely to be enough.

Initiatives such as the EHI CCIO Campaign, now backed up by the CCIO Leaders Network to support the chief clinical information officers that are being put in place, and to encourage more to be developed, show there is an appetite for clinical leadership on information.

Hunt will need health professionals to buy into the clinical case for a paperless NHS. Moreover, he will need them to be convinced that such a vision is deliverable in a way which supports – rather than hinders – high quality clinical practice.

For this to happen, clinicians rather than politicians will have to make the case and then lead its implementation. Over to you, CCIOs…

About the author: Mike Birtwistle is Managing Director of MHP Health Mandate, a specialist health policy and communications consultancy.