The NHS has a new IT strategy. Although it’s “not a strategy” and definitely “not a national plan” but a “framework for action.”
You can see why NHS England and the other bodies behind ‘Personalised Health and Social Care 2020’ are wary about claiming the ‘strategy’ tag. The NHS has had three major IT strategies since 1992 and none of them have panned out.
Indeed, the major aims of NHS IT have not changed much since the first strategy was launched in 1992. The identified requirements remain: a national network to join healthcare organisations together; IT systems to give clinicians access to information “at the point of care”; and new technology to give patients access to their records and other services.
The 1998 strategy, ‘Information for Health’ (fondly known as IfH) put a lot of the connectivity in train, by laying the foundations for the NHS’ own broadband and data network, N3. But it left buying big IT systems to trusts; and (broadly) they spent the money on other things.
The response was another strategy, published in 2000 (and therefore called ‘21st Century IT’), which laid the foundations for the National Programme for IT in the NHS (aka the “NHS super computer” c. David Cameron and all national newspapers). And nobody wants to mention that.
Meanwhile, the consumer bit has lagged; partly because the NHS itself has failed to make the move from websites to apps, and partly because hospitals and GPs seem deeply reluctant to overcome the (admittedly considerable) technical and financial barriers to building commercial personal health records, fitness trackers, and social networks into their workflows.
Against this background, ‘Personalised Health and Care 2020’ sets out a familiar set of targets; basically those laid down by IfH, with a new focus on building “trust” in NHS IT systems, in the wake of the care.data debacle (see posts below), and proving value for money (good luck with that).
However, as I argued in an EHI newsletter editorial, it’s a better strategy than many that have claimed the name, because it makes an attempt to align IT priorities with wider NHS policy developments.
It has a stab at identifying the work that needs to be done to create an effective healthcare IT market, and who needs to do it. And it starts to align IT with the NHS financial and regulatory regime.
The last bit feels like a particularly bold move; but one that might have a salutary effect on those trusts that continue to see IT as running email and fixing printers, rather than as something to drive more safer, more efficient ways of doing things.
For instance, EHI’s research arm, EHI Intelligence, records that around a fifth of the trusts that run maternity units say they do so without any kind of IT system.
Units will have paper notes. But paper notes can go missing. They can only be read by one person at a time. They can’t drive evidence-based pathways for care (or, to put it another way, encourage the kind of ‘fly by wire’ that, in general, make other safety critical industries safe).
So why aren’t the Care Quality Commission, Monitor, the National Patient Safety Agency, or the NHS’ insurer asking how paper can be good enough in this day and age, and when the negligence claims coming out of maternity are so high?
If it’s because they think that IT systems aren’t up to doing a better job, why aren’t they working with maternity system providers and trusts that have good safety records to improve them and make sure that everyone knows how to deploy them to get the most out of them?
There will be ‘roadmaps’ to put more detail on the document’s themes. So, as ever, the devil will be in the detail.
It will also be in the capacity and enthusiasm of the organisations tasked with running infrastructure, setting standards, keeping companies to them, making markets, asking failing trusts what they are up to, and looking out for disruptive innovations to actually do their jobs.
But ‘Personalised Health and Care 2020’ is a pretty good start. Probably a better one than most commentators were expecting.