Features
Keeping tabs on the NHS IT planThe Department of Health web site contains the major proposals on the
An IT trade magazine that regularly covers the NHS National Programme, often from a business as opposed to a technical perspective, is A similar service exists at
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The overhaul of information technology in our national health service is critical for the future shape of health delivery in the UK. Electronic bookings, online prescriptions and telemedicine could be just around the corner, as Gary Flood reports
IT’s going to matter
A huge reorganisation of the health service is underway that’s seen
as a critical part of achieving the NHS Plan, and which will also result
in big parts of the NHS infrastructure being privatised.
If you said yes, that’s foundation trusts, you’re wrong.
A project hardly any less critical for the future shape of UK health
delivery is also underway.
But it seems very few people are paying as much attention to the £2.3bn
IT overhaul of the entire NHS as they are to other aspects of the Blair
modernisation agenda.
This is short-sighted – if you’re either an NHS worker or a
user of the NHS.
For not only will almost everyone in the health service be expected to
be much more computer literate; new IT systems are going to be built that
will affect the jobs of anyone involved in that new buzzword, the patient’s
“journey” through the health system.
Science fact?
If it all comes off, the NHS could by 2010 be once again the envy of the
world in terms of service delivery to patients, say supporters. Critics,
even before the project gets off the ground, worry openly that handing
responsibility for so much core NHS functionality to the same large, mainly
US, computer companies that have a questionable record running other parts
of the outsourced government systems is at least a risky move.
The National Programme for IT in the NHS (NPfIT), as it is currently
labelled, calls for nothing less than a revolution in NHS IT practices.
The government’s thinking, represented in a document called ‘Delivering
21st Century NHS IT,’ is that so far technology has been poorly used
in the health service, with local successes not being duplicated on a
big enough scale to get real benefit, and with IT budgets too often being
seen as open to pickpocketing by managers for other hard-pressed areas.
But if IT is used better, it argues, it could offer core applications
like an integrated record care system (ICRS) that could follow a patient
from cradle to grave, accessible by whatever health professional or clinician
they came in contact with, holding in one place case notes, X-rays, and
a wide range of other valuable data.
Another key system could be a national electronic appointment booking
system, which could save a lot of wasted resource from tracking broken
appointments, and an online prescription system that would mean patients
could click a few times to get their medication, rather than go back for
a new consultation each time.
Yet another application could be telemedicine – the aggressive use
of communications technology that would allow remote diagnostic and even
treatment of patients. Imagine an ambulance able to take important scans
of a patient and beam them down the road ahead of them to A&E, so
staff are ready to start work with the right information at once.
Science fiction? Not at all – the technology is almost all there.
But the government doesn’t want the NHS itself to deliver the ICRS,
electronic appointment and prescription, and telemedical services. It
believes these systems should be provided – and then maintained –
by third party specialist companies, in a system it calls “strategic
outsourcing”.
These IT system and service providers are going to be called Local Service
Providers (LSPs). England has been divided into five big areas –
London; North East, Yorkshire and Humberside; South East and South West;
East of England and East Midlands; West Midlands and North West –
and one LSP will be appointed to manage all IT and systems in each individual
region. Each region will group a number of strategic health authorities.
The first two LSP contracts are going to be awarded by the end of October,
one for London and one for the North East, Yorkshire and Humberside areas
– the other three contract winners will be announced by year end.
There are 27 big firms or consortia bidding for this job.
At the same time, big contracts are up for grabs to build the ICRS and
other core systems, with the bookings system contract scheduled to be
announced in October, too. Some 20 companies have bid to become so-called
National Application Service Providers.
At the same time there’s going to be a major overhaul of the NHS’
connectivity, with a broadband (high-speed) NHS Network, to be called
N3. Again, this will be run and maintained by yet another third party
commercial supplier, with one organisation running the whole NHS communications
network.
Consultation
But while all this is going on the Department of Health is looking for
a lot of input from NHS staff. Take the ICRS; where’s it going to
come from? There’s no plan to do this centrally. Instead, at a local
level, Strategic Health Authorities are going to have to organise both
Primary Care Trusts and Acute Trusts to work together to look at the way
patients are currently processed through the system.
They will work closely in co-operation with their LSPs to define a whole
new set of “business processes” that will have to form the framework
of the ICRS that they will have the responsibility to keep up to date
for the patients in their health communities.
Meanwhile, the new NHS University is going to have to offer a large range
of IT courses to NHS staff to enable them to cope – and there is
a call for a whole new department, of NHS Infomatics, so NHS staff would
be able to get new degrees specifically in healthcare information technology.
Given the huge scope of the project it’s surprising that more NHS
staff aren’t aware of the impact this will have on their jobs. Staff
will be expected to use these new core applications, for example, adding
information into the patient ICRS. They will probably have to learn new
IT skills as more automation is going into the entire system. And it’s
very unclear what it will be like to have these large outside companies
acting at such a critical level inside a public service.
Poor delivery
One possibly gloomy way of thinking about this is to see that EDS, which
has 20,000 employees in the UK alone, and which is the biggest supplier
of IT services to the government, including major systems for the department
of Work and Pensions and the Inland Revenue, is part of one large bidding
group, the Services Consortium, was recently blamed for poor delivery
of the child tax credit system and underperformance of the system being
used for the child support agency.
EDS has also just won the contract for a pensions credit system, and
looks well-placed to win a £4bn outsourcing contract at the Inland
Revenue.
The government says that it chose the strategic outsourcing route, where
companies like EDS and IBM will be asked to bid, because it didn’t
want the work done wholly in-house or to be completely privatised.
It also says that even though the government has a poor record of success
with big IT initiatives – though NHS Direct stands out as one of
the few real success stories - its risk management processes are now a
lot better, and there’s much less danger of anything going wrong.
Let’s hope they’re right, as an awful lot of patient information
is going to be passing through these companies’ hands. As well as
a lot – at least £2.3bn, more in the long run – into their
pockets.
Now is the time to find out what the National Programme is going to mean – and how your job might change. Because by the end of the year this new system of working is going to be part of your area’s health infrastructure – like it or not.
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UNISON calls for more information on NHS IT plansUNISON, the UK's largest health union representing
400,000 NHS staff, welcomes the objective of improved use of IT,
improved access to more accurate patient records, more co-operation,
and sharing of information. But as UNISON assistant national officer
Robert Baughan notes, "The option of 'strategic outsourcing'
obviously raises concerns, with the potential of the privatisation
of IT provision within the Health Service that this brings. "It is not entirely clear from the
government report what this strategic outsourcing will entail.
For example, would it involve private companies storing and having
access to confidential patient records? "The Data Protection Act says that
patients should know who and for what purpose has access to their
records. Would patients know who would have access to their data? "Whenever private companies outside
the NHS are involved in the storage and handling of information
there obviously must be concerns, whatever security measures are
in place. What other interests would these companies have? Would
they have links with the life and health insurance industries?" While these questions remain to be answered,
the last UNISON health conference has some questions it also wants
answered on a parallel IT development within the NHS - the new
Electronic Staff Records. Conference noted that "given the government's
track record on major IT developments," delegates were concerned
about the reliability of the system itself and the consequences
for members and all NHS staff should the system fail for any reason.
Members also said they need to know what
information the system will hold and need to know what safeguards
are in place to "guarantee accuracy, reliability, confidentiality,
and security". The Department of Health seems to need to start doing some work on better communicating how its new IT initiatives will affect staff, it seems. |
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