Change
This issue of the Journal continues our look at of the way in which
different countries and places are tackling the computerisation of their
healthcare systems.
Our previous issue covered developments in Canada, the USA and the
Netherlands, as well as the English programme. Articles this month describe
plans in two of the other home countries (strictly speaking, one home
country and one autonomous Crown possession — but, interesting though it is,
this is not the place to enter into an explanation of the Manx
constitutional position), and two further articles describe events in
England. All four articles exemplify the change processes that are
encountered as ICT systems are put into place. Those processes are the same,
whether the field to be covered is small (Isle of Man: population 76,000) or
large (England: population 50.5 million), and they can be approached in ways
that are quite markedly different. In his article, Dr Gwyn Thomas,
Director of the Welsh Informing Healthcare Programme, describes the approach
in the Principality. Paul Harper, Director of Strategic Information and
Development for the Isle of Man Department of Health and Social Security and
Sean Brennan set out the plans for a major extension of the Island’s
computing capacity for its healthcare and socialcare services. Brian Derry,
Vice Chairman of ASSIST, summarises forthcoming changes in targets proposed
by the English Department of Health, and the consequential demands on
information systems, existing or nascent. And William Payne, a science
writer, looks at measures to create an integrated record for services for
children in Rotherham. What are the themes that recur amongst these
apparently diverse projects? There are two, both of them central to the
management of change: the approach to implementation, whether by increment
or by big bang; and the engagement of the end users (and payers) in the
process. In Wales, the approach is incremental, building on, and sharing,
existing strengths and information systems, through a corporate, not a
centralist approach. In Rotherham, where the integration of child services
encompasses healthcare, local government and the voluntary sector, work has
been carried forward one service at a time, preceded by entire system
re-engineering.
In the Isle of Man, the plan is again incremental, starting with updates
of existing hospital and GP systems. The English situation is one in marked
contrast: four major systems are under way together — a national data spine,
the Choose and Book system, an NHS care record, and an electronic
prescribing system, and all are for implementation over the whole country.
The participation of major players shows similar differences.
In Wales, active stakeholder engagement is seen as crucial to success,
with considerable emphasis on the participation of clinicians and other NHS
Wales representatives in agreeing key design principles; and, in a most
interesting development, major comparisons will be made with progress in
other countries of a similar size. In Rotherham, given the number of
agencies involved, it has been vital from the start to engage in widespread
discussion with all those involved; and, in another interesting approach,
children themselves have been involved in determining the shape of the new
services that, in turn, have decided what data should be collected to fulfil
their needs.
In England, by contrast, as the recent National Audit Office (NAO) report
points out, “wider engagement and mobilisation of the NHS was not started
until [it was] judged that procurement had reached a sufficient state of
maturity ... to have done so earlier might have raised expectations that may
not have been met”.(1) And, as Brian Derry’s article explains, changes are
still in contemplation of which the information consequences seem not to
have been considered. What can be made of these markedly different
approaches? On the positive side, the NAO has commended the English approach
for the rapidity of the procurement process, for its tight control over
contractors and for the savings (in procurement terms) that it has already
achieved.
On the other hand, the NAO report indicates three major challenges ahead:
keeping suppliers to systems that meet NHS needs and to agreed timetables
without further slippage; ensuring that NHS organisations can and do fully
play their part in implementing the Programme’s systems; and winning the
support of NHS staff and the public in making the best use of systems to
improve services. The latter two challenges in particular are areas where
Connecting for Health (CfH) could with advantage take note of what is being
done elsewhere. On 26 June, CfH officials were to appear before the
Parliamentary Committee on Accounts in a session devoted to the NAO Report.
It will be of particular importance to the NHS for that Committee to take
the same broad view as the NAO: a return to the Committee’s previous views
on NHS computing would be little short of disastrous. Michael Fairey
Reference 1. National Audit Office. Department of Health: The National
Programme for IT in the NHS. Report by the Comptroller and Auditor General.
HC 1173 Session 2005–2006. London: The Stationery Office, 16 June 2006. |
