The burden of responsibility
The most important question before the NHS in England at the moment is
just how the National Programme for IT can be made to work. Forget about the
boxes and the wires, whether they are fast or slow, or if they arrived when
they were expected (not that those are not all vitally important questions):
when installations are complete, will the NHS use them?
In one sense, it is encouraging that those responsible for the National
Programme have come to a similar point in their thinking, a recognition
marked by the Programme’s incorporation in a new umbrella organisation: NHS
Connecting for Health. The whole aim of the Programme is to improve
healthcare. The boxes are important, but the intended users far more so.
What are the obstacles that need to be overcome to ensure proper
implementation?
That the potential obstacles ahead are legion is self evident. Some of
them are organisational — for example, constant structural change. Most,
however, are human: apprehension about potential change that is not fully
explained or understood; a lack of certainty about what technology can, or
cannot, achieve; and an entirely understandable desire to maintain existing
methods that, whatever their faults and limitations, are tried and tested
and do what is asked of them. And at the core of these anxieties lies the
paramount need for involvement in a process that, whilst it may well propel
the NHS into the 21st century, will do so through radical change to
established comfortable methods of working. Is that level of involvement
possible in an organisation as large as the NHS?
The events of the last 30 years show that the NHS can cope with enormous
changes of structure and organisation. The 1974 reorganisation, the
introduction of general management, the appearance — followed by the equally
rapid disappearance — of the internal market, have all shown that the
Service has a remarkable resilience and an astonishing tolerance of the
latest political fashion. Very few of these changes, however, have had any
direct impact on the way patients are treated: many clinicians would argue —
rightly — that it is only the stability of their practices that has enabled
the NHS to continue functioning at all in the face of constant tinkering by
governments whose overall understanding of the Service is minimal and whose
vision for it is all too often determined only by tomorrow’s headlines.
The changes that are now to be enabled by the National Programme are of a
totally different order. For the first time, information technology is to
impact on the basic working practices, not just of organisations that have
developed a hard practical core of experience over the years, but of every
organisation in the Service.
Motivation, positive explanation, a feeling of involvement — all these it
will be vital to achieve. This issue of the Journal examines some aspects of
this crucially important topic.
In her article, Andrea Jones, a Senior Research Fellow at the Social
Informatics Research Unit of the University of Brighton, accepts the
difficulties — perhaps even the impossibility — of ‘consultation’ with users
in a Service as large as the NHS, but proposes ways in which those
responsible for implementing nationally determined systems at local level
might yet be able to achieve a degree of local involvement, and with it
acceptability.
In their article, Drs Peter and Gillian Tyerman analyse information
gathering in the clinical setting in the light of anthropological
archetypes. Drawing on this analysis, they then propose criteria upon which
to base a redesign of computer-user interfaces for use in consultations with
patients that distract neither the clinician nor the patient.
It is greatly encouraging that these articles, besides looking at some of
the difficulties ahead, propose ways in which they might be overcome.
This is a positive atmosphere upon which those charged with implementing
the products of the NPfIT, and ensuring that they are actually used, can
build. Despite the tensions and irritation that the NPfIT has occasionally
caused, nobody wants it to fail. It offers too good an opportunity for the
National Health Service to provide that first-class service to patients that
it has done in the past, whatever the political slant of the day. Those
charged with the implementation ahead have an enormous responsibility. They
have a desire from within the Service to succeed. We must all hope that they
can capitalise on it.
Michael Fairey |
