News
Darzi's NHS reforms can't succeed without National Programme for IT
1 May 2008
High quality information is crucial to the reforms of the NHS being
proposed by Lord Darzi, said Professor Matthew Swindells, the former
Interim Chief Information Officer for Health at the Department of
Health, in the keynote session at the Healthcare Computing conference
(HC2008) in Harrogate last week.
He said that "the transformation of the NHS depends absolutely on
informatics being a success" and the NHS providing "fantastic quality
data". High quality information is essential to support pathways that
protect patients as they move between care sectors and care providers —
including independent diagnostic centres — and cross-agency integration,
world-class commissioning, the ability of primary care trusts to set
standards for their communities, the ability to hold providers
accountable, and patient choice of provider.
"We need to use the National Programme and the informatics profession
as an opportunity to drive forward the use of information to save
people's lives and improve the quality of care. Success will be about
engaging with management, with our partners, transparency of information
we make available to the public and commissioners to improve quality,
fantastic data to transform processes, not just computerise care
processes," Professor Swindells said.
The informatics profession had to see itself as a core part of the
strategic changes in the NHS, not simply as enablers. He said that they
"needed to be at the top table, driving the initiatives and the
strategies".
Publication of the ongoing Informatics Review was delayed from its
original April target date to be aligned with the Darzi review, on the
request of Lord Darzi. He denied claims in the media that the review had
been censored and that the National Programme would be abolished —
"Absolutely not," he said.
The Informatics Review is looking at three elements: the underlying
information stored and processed by the NHS; the National Programme for
IT (NPfIT); and the role of leadership in the Department of Health and
how it affects the health informatics profession.
The NHS needs to produce central pools of data that can be
preprocessed, perform a service, inform the public and drive quality
across the NHS. Professor Swindells said there are three core leaders
for improving the quality of service:
- regulation — there will be a new regulator for health based on
the concept of risk-based regulation;
- patient choice, commissioning, the role of local primary care,
the ability of PCTs to set standards for their communities and to be
able to hold providers accountable, and the ability of patients
choose alternative providers if they are not happy with care they
have been given. The idea of 'world class commissioning' is
absolutely dependant on the ability to deliver world class
information to support it;
- the drive within the NHS to improve — this is often the least
valued aspect of improvement, but the most important. As an example
of its importance, Professor Swindells gave the example of the
comparative mortality figures for healthcare organisations published
by Dr Foster, which caused outrage in the medical profession when
they first came out, but are now seen as an invaluable aid to
pointing to where improvements are needed. He said there are people
walking around today only because of the performance data published
by Dr Foster and the resulting drive by organisations to improve.
Professor Swindells said he had challenged NHS Connecting for Health
to find problems in what they were doing and to diagnose solutions. A
thousand staff were sent to get feedback from the ten health authority
areas. The feedback was that there was "absolute support" for the
National Programme. However, there was also considerable concern whether
it could be made to work and a fear in organisations that they did not
have the skills or training to take advantage of the Programme.
He said that NPfIT had had some huge successes — N3, PACS, GP
systems, systems integration, security (an NHS-wide contract was
recently awarded to Macafee for security systems), etc. There had also
been many changes in the NHS since the programme was launched —
foundation trusts, payment by results, practice-based commissioning,
independent sector treatment centres, patient choice, consultants'
contract, GP contract, etc. This has made the situation more complex and
the problem for the informatics community is how to deliver the vision
of the National Programme in the new environment.
He said that the National Programme needed to change its body
language and its technical approach, but mostly it needed a
reinforcement of confidence. It needed the NHS to believe the programme
was about saving lives not just about using technology. Connecting for
Health needed to see its role as helping the NHS solve its informatics
problems, not simply delivering a set of contracts that were set up five
years ago.
Professor Swindells said he believed that standards were about the
need to protect patients. Patient lives are saved, he said, not by
standardising data, but by standardising what is seen on the computer
screen, so that when hospital staff look for a diagnosis, medication,
result etc, it looks the same, wherever they are in the NHS. He said
that at the moment there is no way of doing this other than by putting
standard products in their environment.
The NHS common user interface is a key part of this standardisation
and was on display throughout the conference. It was also presented in a
conference session by Dr Mike Bainbridge from the CFH Technology Office.
 The
mobile clinical assistants (MCA), the concept for which was developed by
CFH, are a key platform for the user interface. These have the form of a
tablet PC with handles, and include WiFi, Bluetooth, barcode readers,
speech and handwriting recognition, as well as the common user interface
software. The first MCA was launched in the UK by Intel (manufactured by
Motion Computing — see photo on right) at HC2007 and is now in use in
several English trusts. MCAs are now being manufactured by six
companies, of which three were on display in this year's exhibition:
from Philips, Motion Computing and Panasonic (whose MCA will be launched
later this year).
Professor Swindells also recognised that there is a need to protect
the systems that have been developed in-house by "information
enthusiasts" and that the National Programme had to offer these people
something to encourage them to support the Programme. He said that by
being able to offer access to a reliable patient database, integration
to laboratory results and pharmacy, a "bunch of enemies" could be turned
into a bunch of friends who could support the Programme.
Feedback the role of the Department of Health and the informatics
community was that "everybody said to us it looks like a mess" and that
"there is no joined-up at the top in the Department of Health, the
Information Centre, Connecting for Health". The post of Chief
Information Officer was created to solve this problem — the post has
been advertised and interviews will take place in a "couple of months".
The Informatics Review will recommend the developments needed to make
the informatics profession strong enough to carry out the reforms and
how to create informatics literates in both NHS management and other
staff. One problem was seen to be the large numbers of arts graduates in
management who don't think information is needed to be able to manage.
These need to be changed into managers that use evidence, data and
knowledge for decision making.
The challenge now for the informatics profession, Professor Swindells
said, is to prepare for the changes, engage staff and management, and
influence the strategic direction of their organisations. The key
message is to drive forward the use of information to improve the
quality of care and save people's lives.
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