Quo vadimus?
Where indeed? This is the time of year when the media urge us to look
forward at the prospects for the year ahead. The device has its uses: it
fills two or three pages at a time when there is not much news about, and it
might perhaps break into the post-Christmas torpor by sparking argument
about conclusions around the family fireside.
Can so-and-so really ‘win’ Big Brother? Who will win the Rugby World Cup
this autumn (sadly, probably not England)? Into how many fragments will Dr
Reid break the Home Office (incidentally, after the Treasury, one of the
oldest Departments of State)? At what date will Gordon Brown (or such other
person as the Labour Party may from time to time see fit to determine) be
allowed to enter No 10? And, in some respects, more important than any of
these, how will the National Health Service emerge at the end of the year?
In one sense, there has almost never been a time when the National Health
Service has not been thought to be ‘in crisis’. Even as early as the mid
1950s there were grave concerns about rising costs. Since then there have
been an irregular procession of ‘crises’: nurse numbers, too few, then too
many; doctor numbers, too few, and now (it is alleged) too many; and —
always — money.
For politicians, and ministers, it is money that is the conundrum. How
can it possibly be that, over the last nine years, having almost doubled the
amount of money spent on it, an ungrateful Health Service is still failing
to ‘perform’? A successful businessman in Blackburn says that the Service
should be taken out of politics. The Leader of the Opposition suggests that
the emphasis should be changed from quantity to quality. The leader of the
BMA firmly asserts (or so the papers say) that by the end of 2007, the NHS
will have run out of money — whatever that may mean.
Like the fireside speculations about Big Brother, or the Rugby World Cup,
time alone will tell whether the current NHS ‘crisis’ is mortal. Certainly,
the Service, burdened with myriad targets, frequently hamstrung by
restructuring, is not a happy place; and, for a Service that relies so very
greatly on the goodwill of its employees, that is a very bad sign — one of
which even the thickest of politicians should take note.
What has all this got to do with healthcare informatics? Sadly, almost
everything. Whatever one may think about its methods, its relationships with
the field, its many shortcomings, NHS Connecting for Health offers the
Service in England a way to computerise the information systems upon which
its daily operations depend, and to facilitate its response to the many
proper challenges ahead. To attempt that for an organisation as large as the
NHS in a stable environment would be a massive, but not impossible, task. To
attempt it in the chaotic structural conditions that currently obtain
borders on the foolhardy. Worse, much worse, ‘failure’ will hazard the
central money set aside — £6.3bn taken back by the Treasury for other
purposes. That would condemn NHS computing to painfully slow organic growth,
a splendid vision irretrievably lost.
Perhaps, however, all is not yet lost. Perhaps, as Mr Micawber would
assert, something might turn up. Certainly there is much activity and plenty
of experience upon which to draw.
In our first article Patrick Davis, of the Northern Irish Department of
Health Social Services and Public Safety, describes the intriguing approach
to electronic prescribing adopted there. In their article, Roderick Beard
from Sunderland Royal Hospital, and Carol Candlish from the University of
Sunderland lay out their comparative study of the effectiveness of
electronic prescribing, barcoding, manpower and planned work on dispensing
error rates by pharmacy staff. And Anna Mieczakowski and her colleagues from
Keele University School of Computing report their findings on a survey of
303 PCT websites, sites that in many ways are in the frontline of providing
healthcare information; and they propose a method by which they might be
improved.
There can be no doubt that, whatever becomes of the National Programme
for IT, those involved in clinical delivery, and in supporting it, will
continue to see and to explore the massive potential that ICT has to offer
healthcare. England’s National Programme has at least the potential to
combine those benefits, and to derive a substantial synergy from them. In
what seems to be a movement to return some ownership of it to the field,1 it
may be that some of that potential might finally be realised. Perhaps, after
all, Mr Micawber was right: perhaps something will turn up.
Michael Fairey
Reference
1. Department of Health. The NHS in England: the operating framework
for 2007/8: guidance on preparation of local IM&T plans. London:
Department of Health, December 2006. |
