The UK's Health Secretary, Jeremy Hunt, made a rather bold statement last year. He declared that by 2018 he wants the National Health Service (NHS) transformed into a paperless organisation supported by new digital technologies - which if successful, could save taxpayers a whopping £4.4 billion a year. This gives an organisation that is now over 65 years old and which is sprawled across the country just four years to overhaul legacy systems and hop on the digital bandwagon.
A key milestone in this paperless agenda was revealed this week – NHS England pushed out a strategy document that outlines how itplans to invest £230 million in 'high quality' IT systems for General Practices. Something it hopes will go a long way to achieving Hunt's vision. But, before we get too excited about this, let's just remind ourselves that the government's last attempt to overhaul IT in the NHS was a complete and utter disaster. Not only did it waste billions of pounds with suppliers, which frankly have failed to deliver bugger all, but UK taxpayer is still set to dish out hundreds of millions of pounds despite the project having being 'canned'.
Not only this, but more recently the NHS has faced a backlash over controversial plans to extract, store and sell on 'unidentifiable' patient data from GP systems – a subject that Stuart has been following closely for a while now. Needless to say, health IT in the UK has a chequered past and the government has a lot riding on getting it right this time round.
Aim: Bettering the patient experience
The plan, or the 'operating model' as NHS England puts it, states that the money is going to be used to improve the quality of GP care by enhancing patients' experience of services, support and encourage greater integration of care and provide efficiency benefits for practices by reducing paperwork, freeing up more time for the patients. All good in theory.
The general idea is that the £230 million GP funding for IT will be distributed to Clinical Commissioning Groups based on patient population size (CCGs are groups of Practices that work together to plan and design local services across England). NHS England claims that this will ensure “equity across all parts of England based on a core IT service offer”. Alongside this, there will be a range of 'add-on IT services' which can be tailored and implemented to fit with local service improvement strategies – but more on that later.
Beverly Bryant, director of strategic systems and technology at NHS England said:
“Digital systems are the foundation upon which to build a modern, efficient and responsive health service. Enabling information to flow between care providers and between providers and patients will help achieve a safe, convenient and personalised health service for all.”
It is hoped that the investment will create online transactions for patients that include booking appointments, ordering repeat prescriptions and accessing individual health records online. It also supports the aim of implementing integrated digital care records across the NHS – the main stumbling block with previous projects – which should give health professionals access to patient information they need, without patients having to provide the same details to multiple agencies.
A push for localisation?
One of the most interesting points to be taken from this announcement was highlighted by Tracey Grainger, programme head of Primary Care IT at NHS England. She said:
“These arrangements will continue to give general practice providers a choice of high quality clinical IT systems that are tailored to local requirements while enabling the flexibility and innovation we recognise the service needs. This is underpinned by an on-going commitment from NHS England to continue to support and encourage the development of a world class IT infrastructure across health and care.”
The salient point here being one of localisation. The strategy plan outlines that the IT investment will be split into 'core' IT services, which includes things like infrastructure, disaster recovery, service desk, training support, and 'add-on GP IT services' – which are discretionary and to be aligned with local CCG strategies. For me, this is the smartest thing I have heard so far.
One of the biggest mistakes from the previous National Programme for IT (the multi-billion pound disaster) was that the government tried to implement a monolithic, standardised system from the top down, with complete disregard for local requirements. Although all Practices and health services fundamentally provide similar care, they are also bound to have different business processes, capabilities and needs – as is the same with any other sector.
In fact, former NHS chief executive Sir David Nicholson said exactly this to a group of MPs last year when questioned on whether he thought it was possible procure a national IT project for health. His exact words were:
“The idea of ruthless standardisation has proved illusionary...the idea of managing change of that nature, from the top, centrally, simply is not possible.”
- Although I'm wary of being too optimistic – given that this is an IT health project in the UK – there are some things I like about this. Distributing money based on population size makes sense. Giving the money to CCGs to spend based on local requirements makes sense. Splitting the services into core and add-on makes sense.
- However, I do think that the Health Secretary's 2018 target for a paperless NHS is unrealistic. This is an organisation that is incredibly unique and incredibly complex. Not to say that good work can't be done in the next four years, but let's not rush it and let's learn from mistakes of the past. The last thing we need is another few hundred million pounds of taxpayer money down the drain.