Mind the gap

Brian Derry

Brian Derry was appointed executive director of information services at the NHS Information Centre in November 2008. Before that, he had a short secondment to NHS Connecting for Health, to lead initial implementation of the Health Informatics Review.

Ahead of a session at E-Health Insider Live ’09, he talks to Lyn Whitfield about the health service’s changing financial circumstances, the role of informatics and the role of the IC in helping the NHS through the turbulent times ahead.

Politicians of all stripes may be promising to “protect” the NHS from the full impact of the banking crisis and the subsequent recession, but the prognosis is not good.

In September, the King’s Fund warned that even a ‘tepid’ (2-3%) increase in real funding in the five years from 2011 would leave the health service far short of the money that Derek Wanless said it would need to cope with ageing and other pressures.

The think tank said “historically unprecedented” efficiency savings would be needed to close the gap. NHS chief executive David Nicholson had already warned that the NHS might need to find £20 billion between 2011 and 2014.

Brian Derry, executive director of information services at the NHS Information Centre, acknowledges that the looming financial crisis is now the starting point for any discussion of NHS policy and IT’s role in delivering it.

“The newspapers are saying there are signs the economy is picking up,” he says (speaking just before official figures showed that the economy shrank by 0.4% between June and September, and for the sixth quarter in a row).

“However, that has only been achieved by borrowing. Borrowing is now 80% of GDP and we will have to pay that back. So whatever colour government we get, it is going to be looking for savings, and the public sector will be expected to play its part.

“The essential thing is to get the money that is available to the right places, which means to effective frontline services.” This is where information – and the IT systems needed to generate, analyse and distribute it – comes in.

QIPP talking

Over the summer, health ministers and Department of Health officials have been pushing the message that the NHS cannot afford to cut as it did in the ‘cash releasing efficiency savings’ days of the late 1990s, when waiting lists lengthened and hospitals became grubbier.

Instead, NHS management is being told follow the QIPP (quality, innovation, productivity and prevention) agenda, to eliminate waste, re-engineer pathways, improve efficiency and keep people out of expensive acute care – and preferably out of health services altogether.

“The important message from David Nicholson is that change must be evidence based. We cannot do this by salami-slicing; a few bits off everything,” Derry says. “That will not work if we are going to maintain quality.

“QIPP identifies innovation and technology as one of the most important things to be doing. But the further you get from the specialists and into general management, the less clear that message gets. So one of our tasks has got to be to make it clear.”

Starting now

Derry stresses that with the health service’s comprehensive spending review settlement with the Treasury due to run out in just 15 months, there is no time to develop entirely new responses.

“We need to be talking about things that are already in use in other industries,” he says. “Even if we wanted to be cutting edge, the research and development is not going to be fast enough. If it is not available now, it is going to be too late.”

Derry says the IC is developing new information products that bring together data that already exists in new ways. “There is an important range of information on quality of services, for example safety measures, patient reported outcome measures,” he says.

“We are trying to make sure there are some effective indicators in place, supported by professionals, with good methodology, that people can use quickly. We are also looking at efficiency, for example at where people are doing good things on streamlining pathways and reducing time in hospital.

“We are looking for more information on community, where it is very sparse, and mental health, where it is pretty much non-existent. But we have just produced some information to support commissioning for social care. So we keep trying to build things that will help and that not only tell people where they are starting from but how to make things better.”

More politics

On the commissioning front, the IC has also been supporting the government’s world class commissioning agenda by producing comparative information for primary care trusts on their performance on WCC competencies.

The DH has just launched ‘year two’ of its WCC quality assurance programme. Yet its future must be in doubt. The Conservative Party has indicated that if it forms the next government, it will be looking for big cuts in NHS “bureaucracy”, with strategic health authorities and PCTs in the firing line.

At the NHS Alliance conference in Manchester in October, shadow health secretary Andrew Lansley reinforced this direction of travel by saying it would renegotiate the GP contract to give significantly more responsibility for commissioning back to GPs.

Despite this, Derry says: “I cannot see how the NHS will move forward without really good commissioning. The parties may have different ideas about what that should look like, but nobody is talking about stopping commissioning altogether.

“Whatever the model, and whatever the language used, it has to be the way forward, which means that good information will be needed to support it.”

Bonfire night

Yet if the Tories are looking for a “bonfire of the quangos”, surely that might include the IC itself? Derry acknowledges the possibility, but doesn’t seem too worried about it. “The financial crisis means that everything will be looked at. If we make a good contribution we will survive, if we are not valued we will not,” he says.

“In a world where information is increasingly important, we think we have a role to play. But there are lots of people on the information provision table, so there is scope for rationalisation. None of us is owed a living.”

Derry also sees information provision changing, with more NHS bodies partnering with private companies and more private sector involvement. “We see ourselves working in partnership with the private sector,” he says.

“Some things we do well; some things they do better. We can collect information; the private sector might work on its presentation and on encouraging its use. It is now firmly established that healthcare is a partnership. Information services should be the same. We have to lose some of the attitudes that used to prevail.”