DH refuses to release IT savings report

The Department of Health has turned down a Freedom of Information request from Digital Health News to see a report that purportedly shows how technology can save the NHS billions of pounds each year.

Tim Kelsey, NHS England’s national director for patients and information, told a meeting of the National Information Board in June that savings of between £8.3 billion and £`13.7 billion were available by 2020.  

If accurate, these savings could account for around half of the £22 billion in annual efficiency gains that NHS England is looking to make by 2020, to help fill a £30 billion gap between funding and demand that could otherwise open up by then.

The rest of the money is set to come from the government, with the Conservative Party manifesto pledging to find £8 billion for the NHS over the next five years.

Kelsey did not disclose the evidence behind these figures. But Digital Health News understands that they are based on an  unpublished report ‘Modelling the potential of digitally enabled processes, transparency and participation in the NHS’, created by McKinsey on behalf of NHS England.

Digital Health News has requested to see this report under the FOI Act. In its response, the DH acknowledged it had this information, but declined to share it under Section 35, which provides protection for the information that relates to the formulation or development of government policy.

Digital Health News has challenged this refusal, arguing that there is significant public interest in seeing this report, considering the references that senior figures have made to it, and the significant investment that NHS providers are being urged to make in digital services. It expects to hear back from the DH this month.

The McKinsey report was mentioned last year at the Health and Care Innovation Expo in Manchester.

Christine Outram, then NHS England’s director of intelligence and strategy, said the Cabinet Office, Treasury and individual trusts “need persuading that it’s worth investing in empowering patients and the power of technology.”

The report was due to support NHS England’s ‘Transparency and Participation Call to Action’, which was set to be published last summer. This has since been superseded by NHS England’s ‘Five Year Forward View’ and ‘Personalised Health and Care 2020’, the framework that is guiding the work of the NIB.

It’s now unclear if the McKinsey report is likely to be published. However, Dr Philip Scott, a senior lecturer in health informatics at University of Portsmouth, has argued that the PHaC framework contains few other references to supporting evidence.

In an academic paper published earlier this year in the Journal of Innovation in Health Informatics, he argues that the framework sets out “many laudable and common sense ambitions” but is “light on evidence to support its aspirations, or plans for its evaluation.”

For instance, he notes that it fails to include the evaluation studies conducted in the later stages of the National Programme for IT.

He also notes that the unpublished McKinsey report was commissioned specifically to support the framework, which he says “inevitably raises questions about its objectivity.”

Speaking to Digital Health News, Scott said: “There seems to be an excessive reliance on this single McKinsey report which for whatever reason is not in the public domain, which is very strange given all the emphasis on transparency.

"You would think an organisation that wanted to be transparent would present its case in a logical way.”

He added that there have been several studies, such as the EHR IMPACT study funded by the European Commission and the 2013 RAND Corporation report on physician satisfaction, which suggest that use of EPRs can improve quality but don’t necessarily lead to efficiency savings.

“It’s very naive to assume that all these billions of pounds are going to happen from having electronic health records.”

Scott added there are high volume efficiencies that the health service can gain from computerisation and that there are areas where PHaC 2020 is very strong, such as its focus on the patient and its emphasis on using standards.

Work on the cost efficiencies of the framework are also currently being carried out by one of the NIB workstreams focused on assuring the best value for taxpayers and opening up existing infrastructure.

A spokesperson for the DH said that this roadmap is being developed over the summer period and is expected to be available in the autumn.