The National Programme for
IT in the NHS
That The NHS plan will not succeed without a massive
information technology support cannot be doubted. Patient-centred care
alone demands it. Today, England’s Service has a structure involving
over 300 primary care trusts, some 250 NHS trusts, 28 strategic health
authorities, and a growing number of national strategic frameworks. Its
performance cannot possibly be measured, let alone directed or
controlled, without rapid electronic communication of a wide, and
increasing, range of data. For a Government committed to devolving
responsibility for the performance of healthcare services to authorities
at local level, but all within a highly detailed national framework, and
with a panoply of regulatory bodies to police it, ICT is absolutely
essential.
With the national plan for information technology, the Government has
embarked upon a determined attempt finally to make it happen. The
appointment some 16 months ago of the Director General, the emergence of
a new and forceful approach to purchasing and — perhaps most importantly
— the promise of £2.3bn of central (and centrally allocated) funding
shows an unprecedented determination at the highest level not only to
install ICT systems across the entire Service — but also to make them
work. Behind this thrusting approach, there is a vision and a clear
programme.
In his article, Richard Granger sets out some of the vision for the
Integrated Care Records Service and the timetable that is planned. He
calls particular attention to the need to integrate quality assured
information to be available to advance healthcare whenever, and wherever
it is required — an absolute prerequisite if patient-centred healthcare
is to be more than an empty phrase. In his address to participants at
October’s Autumn Forum he stressed two further points: despite the
considerable change of emphasis and role at the centre, the changes
ahead at grassroots level are to be gradual, building on what already
exists; and, as the programme proceeds, there will be increasing
emphasis on benefits realisation by NHS authorities, which will be
ploughed back into the expansion of IT that is needed — as my
grandfather observed, there is no such thing as a free tea.
So much for the vision. What are the road blocks ahead, and how can
they best be circumvented? For all the considerable central effort in
providing the basic infrastructure, the major burden of achieving the
advances that are so desperately needed will fall on field authorities —
more than 500 of them. All experience to date shows emphatically that
the successful implementation of clinical information systems turns
almost exclusively on the active involvement of doctors, nurses and
therapists very early on in the process. In his article, Professor Denis
Protti examines the vital role that this collaboration has to play,
drawing upon the experiences of New Zealand and Denmark. In their
article, Dr Roger Tackley and his consultant colleagues who have been
actively involved in EPR procurements in the West Country, draw similar
conclusions and stress the vital need for clinician buy-in if projects
are to be successful.
That buy-in can be achieved at local level, there is no doubt: over
the years, the Journal has published numerous reports where this
has been achieved. To achieve it nationally is a substantially greater
task, even when — as is the case now — the leaders of the profession
approve of the objectives. The recent Medix survey of a thousand
clinicians demonstrates the scale of the problem: 70% thought IT an
important priority for the NHS, but only 6% thought they had adequate
information about the National Programme, and only 1% felt they had been
consulted. There is a major problem ahead: substantial infrastructure
projects are being embarked on, with no immediate obvious benefit to
clinicians, and with little progress on the systems on the ground that
are to feed the national projects.
There is of course, as always in the NHS, the problem of money. As
Information for health pointed out, and as the Director General has
subsequently emphasised, central funding has to be complemented by local
funding for local systems. For many reasons, field authorities are
generally very bad at doing so. The disappearance in recent years first
of funds earmarked, and then hypothecated, for IT, was partly due to the
pressure of other central demands, but also to a reluctance to embark
upon projects that could be uncertain, and where the business case was
not always immediately clear. In their articles, Susan Clamp and her
colleagues and Ian Smith show how the evaluation method of the South
Staffordshire ERDIP has relevance for the ICRS programme (and thus to
future local users) and to authorities seeking to specify their own
requirements in a way that balances national and local aims.
The National Programme has in many ways got off to a flying start.
If, however, for all its early promise, it is not to grind to a halt as
it impacts on the day-to-day operation of the Service, it has a major
task ahead. Somehow, national projects have to be synchronised with
rapidly increasing local action that involves actual clinical
involvement and the expenditure of actual local money. That is going to
be an exceedingly difficult task, to which the solution is currently far
from clear. What is clear is that if it is not solved, The NHS plan
will not happen and the NHS itself will become increasingly threatened
by collapse.
Michael Fairey |
