Conservatives to ‘dismantle’ NPfIT

Tags: BT CfH Choice CSC Google Google Health Health Vault Labour Lansley NPfIT O'Brien Social care

10 Aug 2009

The Conservatives have promised to “dismantle Labour's central NHS IT infrastructure” and instead move to a choice of local accredited patient record and clinical systems.

Following the publication of the Independent Review of NHS and Social Care IT the Conservative party pledged to abolish the NHS national database of electronic patient records, but then say firms – including Google and Microsoft – be allowed to host patient controlled records accessed online.

As a first step they promise to “Halt and renegotiate the contracts Labour have signed for IT service providers to prevent further inefficiencies.”

The commitment raises the prospect of an incoming Tory government becoming embroiled in legal disputes with BT and CSC, the two main IT firms that hold local service provider (LSP) contracts. The government has been locked in legal dispute with Fujitsu since terminating its LSP contract in April 2008.

The Conservatives say the NHS National Programme for IT has proved bureaucratic and been plagued with delays and cost overruns and proved hugely disruptive to the NHS. They promise reform focused on local choice of systems, and pledge they will deliver cost savings from the £12.7 billion IT project.

The Conservatives say that in Government they would “stop imposing central IT systems on the NHS” and instead “allow healthcare providers to use and develop the IT they have already purchased and developed, within a rigorous framework of interoperability”. As part of a new approach use of open source across the public sector will be given a new priority.

Taken together the Conservatives say the measures “will deliver huge cost savings and ensure that NHS IT is geared towards the needs and wishes of patients”.

Dr Glyn Hayes, chair of the review, said: "The review makes clear that NHS IT will only succeed in improving patient care if information is held locally and centred on the patient.”

Speaking on Sunday Shadow Health Secretary Andrew Lansley outlined new proposals to allow NHS patients access to their records online would give people "greater control over their own health care".

Firms such as Google or Microsoft, both of which are developing personal health records, could host such patient controlled records, enabling users could update their medical records with information like blood pressure and cholesterol levels, he added.

Patient records should be stored locally rather than on a national database, with the capability of transferring the information when necessary.

The Tories say that buying such PHR systems "off the shelf" instead of developing them at taxpayers’ expense would mean that personalised records system could be delivered at "little or no cost to the taxpayer".

Link

Independent Review of NHS and Social Care IT (1.3Mb)

Conservative party response to the independent review

Jon Hoeksma

Reader's Comments

We seem to have been here before...

10 Aug 09 09:08

Ah well here we are and the NHS IT wheel has almost gone full circle again!...A frame work of open systems that talk to each other, now where have I heard that before?? I must have a document somewhere.

Non-Internet users

10 Aug 09 09:08

I'd like to know how using Microsoft or Google will assist those members of the public that have no access to the 'net and do not intend to?...strangley there are many.

They'd better have deep pockets

10 Aug 09 09:08

If they are going to re-negotiate the contracts. CSC and BT must be rubbing their hands together. Yet another bundle of dosh for doing nothing. Oh, to be a lawyer.

Let's wait to see the actual report

10 Aug 09 10:08

In a preview session of the review at the BCS Primary Health Care Specialist Group Conference last month (held by Glyn Hayes) there was no mention of either Google or 'dismantling' anything.

Have these have been bolted onto the report at the last moment or is newly minted Conservative policy (bearing litle or no relationship to the Hayes report recommendations) being conflated with it?

Either way it looks like NPfIT induced planning blight now has yet another loop of recursion wrapped around it.

Non delivery = Cancel the order

10 Aug 09 10:08

IMHO BT and CSC have obviously failed to deliver what was "ordered" with "reasonable promptness and to an acceptable quality", so what is the legal problem in cancelling the unfulfilled order?

Tories right to pull the rug

10 Aug 09 11:08

The Tories plans will add yet more delay to implementing Npfit in the South. I still think it's right to call time on what is a bureaucratic juggernaught which leaves NHS at the mercy of BT and CSC (BT have already extracted millions for taking over Fujitsu's sites in the South). Let's look forward to more choice of products and bottlenecks through reliance on one supplier.

now you're legal experts too?

dead.clanger@ntlworld.com

10 Aug 09 12:08

I love how previous comments give the impression that nothing's been delivered. How about PACS, PDS, EPR etc? Having been in A&E recently and seeing how two of these systems helped save a man's life, I'd say they were delivered good and proper!

In your calls to break or renogiate the contracts, have you stopped to read the contracts, penaly clauses and all? Look at how hard it was to try to prove Accenture and Fujitsu were failing to meet their obligations - and Accenture only went because they thought they were losing too much money!

Now for the big question - why have the decriers of the N3 network's security measures not picked up their torches and pitchforks and marched on Tory HQ for offering to publish everyone's medical records on the internet?

If secure networks, smartcards and biometrics aren't enough, how on earth can a username and password be adequate? This plan is pathetic. Should Microsoft or Google take up the hosting, how much will they charge to set up data centres in the EU, with the requisite system response and disaster recovery times? Will their staff be CRB checked? What else will they use this data for?

(Oh, before I forget, I had to visit a clinic this morning; the consultant left the room without locking the keyboard or removing her smartcard. Had I been inclined, I could have run rampant though everyone's notes. When I asked her about it, she threw a tantrum and now has a note going to the hospital Caldicott officer. There's little point in arguing about the delivery of secure systems when the clinicians still obviously don't care at all about security.)

Contracts?

10 Aug 09 12:08

Does anyone know how long the current contracts have to run or is that information covered by commercial confidentiality

Non delivery = Cancel the order

10 Aug 09 14:08

Both the NHS and LSPs have commitments under the LSP contracts and I think that you can be sure that both sides are in material breach (and I have a sneaking suspicion as to which side has this better documented)

The only winners from a legal fight will be the lawyers and both sides would be well advised to enter into some damaging limiting renegotiation which acknowledges the current mess.

We need to consider the longer term advantages

john.aird@uhl-tr.nhs.uk

10 Aug 09 15:08

There is little doubt that the wait for Lorenzo has been far longer than was acceptable or necessary, or that, along with earlier/other acute EPR product issues, this exercise has seriously undermined the original and laudable NPfIT objectives, possibly to the point where the current mission is salvage rather than progress. But having learned such a hard lesson, having spent so much money and having waited so long, we should be careful not to cancel a product just as it becomes usable.

Of course I may have misread the article or its implications, but I would argue against a call for scrapping the programme outright. Learn and build rather than slash and burn. Sharing data from local NHS IT systems doesn’t necessarily mean monolithic central IT systems, but it does require good local systems, at affordable costs, not just to feed the beast but to deliver the sort of local healthcare you want for your family.

Like many Trust’s we, with valuable support from our SHA/CfH, invested in Interim Solutions, so we are not is a desperate position, far from it. We, like others, now have several years of project and operational experience of working with CSC, so we know the value of planned, realistic development and that the pace of implementation is sometimes a slow learning exercise. Getting Lorenzo to a point where it replaces our PAS, Order/Comms and ER systems and is interfaced with the couple of dozen other clinical/business systems we run, will be more challenging than most realise. But the NHS has loads of quality experience to share with our LSP colleagues, many been here before, so it is an entirely doable joint project.

“Dismantling the infrastructure” (as the article says) needn’t necessarily mean a total demolition job. I like many, have only seen presentations of Lorenzo, but “if it does what it says on the can” it will be worth waiting for a little longer, before considering any terminal action. From the presentations of Lorenzo, it is not just a PAS Order/Comms replacement, it puts the patient and quality of patient service at the heart of Hospital patient care administration. Some would say long overdue (I couldn’t possibly), but this will entail procedural and cultural change on a scale not often seen in the NHS. If, in the world of politics, product functionality is compromised for contract expediency – what would have been the point of all the pain - just another PAS and lost opportunity.

I doubt Lorenzo’s future is entirely dependant on the NHS anyway. Regardless of what future political administrations decide to do, I would think that Lorenzo will continue to be developed and marketed world wide by the suppliers, probably quite successfully. It would be a shame for the NHS to miss out on such success, especially having contributed to and funded so much of its development. Also we need to ask ourselves; “what else is there”, “how would we afford to buy it” and “how long would it take”? Perhaps it is the contract and delivery mechanism that needs reviewing, adopting a more pragmatic and realistic approach to the flaws and pressures of the famous contracts”, find a win-win position.

But it’s not all roses, a major flaw in the NPfIT programme is that local health communities have to fund the substantial project implementation costs, which in the current financial climate looks hard to do. Of course it would be handy not to have to find that money, dump NPfIT – dump those costs, but where would that leave us, where would that leave the joined up principles of Lord Dazi?

Dead Clanger

10 Aug 09 16:08

I'm just wondering where this hospital is that's had an EPR delivered under the NPfIT? The ones in the South seem to be buckling under the weight of a million unsuitable processes. The ones in the North have been given software that they could have bought off the shelf years ago and run locally for a fraction of the cost whilst integrating it into their local network of systems.

PACS - Off the shelf, could have bought for half the price AND be sharing images now which NPfIT are still arguing about.

PDS - Well yes but seriously is it that big a deal? Next you'll be saying they delivered N3, NHS Mail and a thousand PCs

Local System?

nichaywood@gmail.com

10 Aug 09 19:08

I really cant imagine the benefits of having local IT systems in place rather than a national one, surely one of the main benefits of having a national area that you could access Patient Details wherever you are in the country, e.g. Jo Bloggs falls off a roof, need to know blood type, allergic reactions, previous history, as poor old Jo is on his own, and no family there to give history. Can you imagine the implications of leaving it up to local Trusts to create/choose their own system providers that would be able to feed into the national spine!??!

Its taken this long to get one or two on board that would do that! Like another comment said, they are almost there! why scrap it and start all over again!? Talk about wasting money, do the Conservatives want to sign up for wasting another £12b???

Let alone, reporting data for statistical analysis, it takes 18 months for the DoH to issue guidance on what statutory reports are required, how long do you think it would take the local trusts to adjust their systems to fit into the reporting needs!? It would probably take a whole cycle of government to sort out, then the government would be criticised for not being able to produce accurate statistics, get voted out, then we would be back to square one again!!!

"Speaking at the launch"?

nhstechie@btinternet.com

11 Aug 09 07:08

Has Glyn Hayes' review actually been published? Can't find it anywhere online. Some of us in the BCS expressed concerns that the independent report would be hijacked by the Tories and spun in whatever direction they chose ... it looks like this has happened.

I cannot believe Glyn and Co would recommend the scrapping of the Spine - rather than the almost useless Summary Care Record (which is just one of many spine services). This really would be throwing the baby out with the bathwater as just one feature the death notification message has already saved countless families the trauma of receiving appointment letters for recently deceased relatives. This may seem trivial but the number of complaints letters received by my Trust has halved since we became spine compliant.

Post 11

11 Aug 09 09:08

I'm unconvinced thate, left to their own devices, the trusts would have implemented PACs nationwide not that is could have been done at half the price, GE has always been expensive and the poster may have not included implementation costs. As for sharing the images, this is surely an NHS issue, who seem to be all for declaring security is not tight enough when electronic but who would happily hand over notes to anyone looking remotely like a Dr and who have pt names written on a whiteboard for all to see.

Re: Local systems

11 Aug 09 11:08

Most health care is delivered locally and I'm unaware of any clear evidence that the enormous costs of implementing a national system (and we are still years away from that) are justified in terms of benefits to Jo Bloggs from Sunderland who breaks his leg in Southend.

Even if the database were available, it would need to be accurate, up-to-date, and - fundamentally - healthcare professionals would need to be confident in the integrity of the information they were viewing before making decisions based on it.

IMHO, the Tories' proposal to "think local" is long overdue and would enable real progress to be made in supporting healthcare delivery where it mainly happens. Let's hope this also includes a re-evaluation of UK home grown health IT systems, and well-established UK standards such as the Read Codes.

Conservative response shallow

draxmont_tjb@btinternet.com

11 Aug 09 12:08

Like ‘nhstechie’, I too have looked for Glyn’s report without success. It deserves study in its entirety before observations on it are offered.

I have read the brief Conservative Party response and quickly concluded that they are as confused on what to do next as are ‘Richmond House’. (Some senior guys there appear to know that the “biggest UK Government IT mess ever” has happened on their watch and they regret that the NAO were not sufficiently forthright in their reviews of NPfIT progress to cast more doubt on CfH credibility). In 60% of their short ‘response’ the Conservatives have followed the well worn path of discussing medical record confidentiality as the means of diverting attention from the main issues.

We are where we are: A huge expenditure programme is underway in which few in the NHS have any confidence that it can be made to work and still there is no detailed business evaluation of its entirety available for scrutiny. Until the Public Accounts Committee DEMANDS a full unabridged business case for the entire NPfIT programme for it to look at, the costly drift to nowhere is likely to continue.

I found it!

11 Aug 09 15:08

I found it on the Conservatives webpage, via the Guardian website (of all places). It's available to download as a PDF.

Just working my way through it now. It is 187 pages long. Going through the recommendations, it seems their preferred model is local implementation with a central body overseeing and setting standards. Bring back the NHSIA?

Why ditch the Spine?

11 Aug 09 15:08

If they plan to ditch all of the NHS Spine - actually a series of services that make up the national IT infrastructure of which the personal spine information service (the so-called national patient record) is just one - does this mean the Conservatives are also planning on ditching GP2GP record transfers, the electronic prescription service, and Choose and Book - all of which depend on spine services?

So does this mean that a future Tory government would dismantle the mechanism for providing patients with choice of care provider?

Would certainly be an interesting starting point for a new 'post-bureaucratic' administration.

World of difference between report and politics

tonsmit@Qure.nl

11 Aug 09 21:08

I read the independent report quite extensively. But here seems to be a huge incongruence between the analysis and recommendations in the report and the political choices made by the Conservatives. I do not think that mr. Glyn Hayes will be happy with this interpretation and the resulting turmoil.

Ton Smit, editor-in-chief of Qure independent news service on healthcare IT, Amsterdam The Netherlands

Jo Bloggs

12 Aug 09 00:08

Love the Jo Bloggs example that is always trotted out. IMO if Jo has any life-threatening allergies, Jo should be given a MedicAlert bracelet. Jo's blood type can be included.

Jo's MedicAlert bracelet will also "work" in Scotland, and Australia. And at the scene of an accident, or in an aircraft.

For Jo - it's a much more powerful technology than an NPfIT.

It is good to throw away a dead baby out with the bath water

risk@cmseg.com

12 Aug 09 00:08

You write in your editorial: "The case for keeping detailed care records within local communities is well made...".

It was always well made. It was good then, and is still good now.

Many knew that large scale government IT projects fail.

I just hope that somebody or bodies will be held accountable for wasting billions of public money.

Oh, well.

Dave and the big NHS Mainframe.

12 Aug 09 09:08

Dave stated a few months ago that he wanted to scrap the big NHS Mainframe (now there is someone with a grip on the latest happenings in the NHS).

A lot of good thinking has gone into the NPfIT programme rather than throw the baby out with the bath water, get to grips with the situation and deliver what is promised.

Cerner is in hospitals throughout the world and Lorenzo has come a long way and has some minor deployments in the UK so its not all disaster.

This seems to be a situation of 'not invented by us, and get public support where ever they can'.

Jo Bloggs

12 Aug 09 10:08

Actually - there were nearly 30,000 adverse patient events in the NHS LAST YEAR alone - and as someone who has a pharmacy background as well as IT I can tell you that I spend alot of my Pharmacy time intervening on prescriptions where the patient is actually alergic to the likes of penicillin (not just a rash). These are potentially fatal - so actually - YES - I would be interested to know if the patient had allergies.

How short sighted some people can be?!

ESP/LSP

12 Aug 09 11:08

Can you imagine the implications of leaving it up to local Trusts to create/choose their own system providers that would be able to feed into the national spine!??!

I work for an ESP and we were one of the first to be compliant with Spine/Choose and Book. Many ESP's have continued to develop their solutions as compliant in order to retain existing business. It is a fallacy that the LSP's would be quicker doing this, although you would expect them to be given they are part of the same programme and the ESP's have been treated very poorly by NPfIT/CfH throughout the process by comparison.

"Let alone, reporting data for statistical analysis, it takes 18 months for the DoH to issue guidance on what statutory reports are required, how long do you think it would take the local trusts to adjust their systems to fit into the reporting needs!?"

Again, DSCN's are released, we spec the changes and then they are delivered to Trusts. It is the suppliers to the Trusts that are responsible for enabling them to produce the correct reports. This has been a requirement long before NPfIT and will continue to be one long after. Incidentally, didn't a London Trust with an LSP system recently state they could not report on 18ww?

The existing providers were just that prior to NPfIT, existing. Driving change through compliance to data standards is the only way to ensure that a competitive marketplace is maintained from which Trusts have some choice while introducing commonality and therefore data sharing throughout the NHS. Getting rid of the Spine entirely is a ridiculous idea as a lot of good work has been done by suppliers in order to be compliant with it. Getting rid of the LSP's may be costly but surely no more costly that the mammoth cots BT have charged for their work taking over from Fujitsu's mess in the South.

As an afterthought. Even if NPfIT had gone entirely to plan what would we be left with? An NHS tied to three or four multinationals and no exit route from them and any costs they wished to impose for upgrades and maintenance and no option to go back to the market because it had been destroyed.

Re: ESP / LSP

12 Aug 09 12:08

Yes - I can imagine that fairly rapid progress driven by local needs would be made. IMHO, I'd forget the "national" elements - they are of secondary importance and should not continue to get in the way of local progess.

Re: Jo Bloggs

12 Aug 09 12:08

Interesting hypothesis, but where's the evidence that the national approach to shared records will actually prevent any or all of these adverse reactions occuring?

to my anonymous penpal

12 Aug 09 12:08

Yes, PACS might have been available seperately, but having enjoyed the half arsed way many local authorities obtained IT products and services, I doubt it would have been anywhere near as extensive.

PDS, not a big deal? Any comment I make to express my opinion of that would most likely be edited. Have you any idea of the work and effort that went into developing the systems involved to meet the response times and security leves demanded in the contract? While you might not think that having patients' (or customers in the case of GP businesses) details readily available for receptionists is much cop, but it speeds their work up, and has huge knock on benefits - e.g. an impovement in HA records? Think about the reduction in duplicate NHS numbers being given out, twins being misrecorded as a single child, deceased patients being given out to GP surgeries in those patient lists sent out on floppy disks? Five years at an ESP working on the data from the HAs gave me a very good idea of just how poor a state it was in before the project started; having an ongoing data cleansing process is invaluable.

Limiting your view of NPfIT to undelivered secondary care systems and conveniently ignoring the benefits it's bringing is rather childish. There are plenty of unsung successes which don't provide flashy headlines, but I guess those aren't as much fun to comment on. Oh, N3 and NHSMail, yup, work supported with NPfIT resources. Not sure about the thousand laptops, though I'm sure I could pick you up a few bargains from the ones still being left unsecured by NHS staff.

Mr Aird, that was a cracking reply to the article. Lorenzo, which has been described by a CSC bod I know as "bl**dy awful", was developed in what must have been the worst logistical environment I can think of. Developers outside the EU, having to use unrealistic data and without knowledge of or access to British hospital practices.

ESPs, left high and dry by NPfIT, a little harsh but there are good historical reasons why those relationships weren't always rosy. For example, EMIS, whose demands when the original tenders were put out resulted in a supplier with over 50% of their market being ignored by all the LSPs? EMIS's behaviour after that wasn't too constructive, with some of their public statements being downright atagonistic. The whole topic of systems of choice could have been discussed in a much more constructive manner.

(post edited by EHI)

Posters 14 and 27

12 Aug 09 14:08

Please don't wave your experience at me and confuse me with someone who doesn't have a clue (and don't bother with the obvious cheap shot replies to that one as it's just a waste of space).

You obviously have a very low opinion of all of the work that has happened in the NHS "despite" this procrastination that is NPfIT.

However, if you wish to use NPfIT as some kind of remedial school for those that can neither buy or implement technology then go ahead.

And the reason I have remained anonymous is the climate of fear that NPfIT'ers have introduced to the NHS over recent years.

Taking Academic Thinking Too Far

george.brown103@ntlworld.com

12 Aug 09 16:08

"Interesting hypothesis, but where's the evidence that the national approach to shared records will actually prevent any or all of these adverse reactions occuring?"

Isn't this a case of taking academic thinking to far?

Where is the risk managment? - we know the risk exists?

**I have intervened** on numerious prescriptions in the past where had I not - the patient would have been harmed. You ask for evidence - it's in the NHS's own adverse events logs.

Missing link

12 Aug 09 18:08

Isn't politics meant to be the art of the possible?

Having read the Hayes Review it seems fairly clear that the Conservatives have understandably taken the bits that suit them.

But IMHO we would be better served if they set out more clearly how we get from where we are to a situation in which core national infrastructure supports a range of accredited systems, able to interoperate and securely exchange data.

If the LSP contracts are to be re-negotiated - then what is the objective? If its for the LSPs to deliver say Clinical-5 functionality rather than a specific system; or to deliver e-prescribing and order comms rather than patient administration systems then the Conservatives are likely to find they are pushing at an open door.

CfH has even recently rejected proposals from CSC, in particular, to move in this direction.

Similarly on the NASP contract for the Spine, scaling right back on PSIS and the SCR to say a very specific limited use emergency, or unscheduled care record, makes a lot of sense.

What is missing and needed is a route map to get from where we are now to a more useful, if still imperfect, position that will see IT deliver improvements in patient care. Any suggestions....

Re: Taking academic thinking too far

12 Aug 09 18:08

With respect, my previous post (26) did not question the incidence of adverse events, nor did it intend to imply that this was a trivial problem.

However, it did question the notion that the national (rather than local) record would be a useful solution to this problem. There are numerous reasons for raising these doubts including: someone has to enter the data in the record; the record needs to be kept up-to-date; differentiating fact from opinion can be difficult in a summary record; and someone has to be able to access and read the record, and then have the confidence to act on the information it contains.

More of a common sense sanity check than abstract academic musing. But that said, don't we live in an age of evidence-based practice - or is the Health IT community exempt from this? And isn't NHS IT its present state in no small part due to the lack of answers to basic common-sense questions?

Please somebody make the Conservatives keep their feet on the ground

12 Aug 09 18:08

It seems that there has been a very good reaction to this report and supprisingly from reading the comments we have a lot of people sticking up for the programme.

All of us who have been around for a while know most of the problems that have occurred in the past four years but are also very aware of the achievements too. Things have taken time buerocracy has caused havoc with some of our lives but can somebody please do me a favour? Have a word in the ear of the Conservatives and tell them to keep their feet on the ground (I say this as unless the current government bucks a trend it will be bye bye Mr Brown sooner rather than later).

The world of Healthcare IT is very varied and very complicated as we have to deal with Patients lives 24/7. Having ideas of using Microsoft and Google who have hardly any expertise in this field would be madness. Come on everybody stand up and have a proper public debate in the open, instead of letting the few dissenters take charge once more.

Many of us have worked hard and implemented national solutions in challenging conditions during the past four years. Many staff at the likes of Bradford and Morecambe bay although they have had their ups and downs have been instrucmental in ensuring that the Lorenzo you will see in the end actually is good quality and robust.

Lets not scrap it now as we know the Politicians dont really understand IT never mind healthcare IT and of course it is their job to have "good ideas" but do they do the work in the end?

Nothing new under the sun

13 Aug 09 09:08

"They [the Tories] promise reform focused on local choice of systems"

See you all in Harrogate after the next election?

Must be a mistake - surely you mean E-Health Insider Live, 9-10 November, ICC Birmingham http://www.ehealthinsiderlive.com/ (editor)

rationale deja-vu not (just) media hype

13 Aug 09 10:08

Almost all the posters so far identify justifiable good things ('jewels in the mud') from developments to date. Lets not underestimate the ongoing discussion of what works / does not work / has provided valuable lessons on health informatics over the years. I confidently say 'many many years' as I can identify principles first put forward by the late Dame Edit Korner and her committees (of operational NHS practitioners) from the early 80s that are still valid (and in some cases not implemented) in the Hayes report.

Lets set the critical appraisal in a realistic situation - 'dismantle' is an agressive act unless and until we identify and recycle or refresh what is actually capable of delivering potential benefits to patients and professionals.

Is a patient focussed EPR really the right answer?

13 Aug 09 11:08

The essence of the Hayes report is that the NHS should refocus on allowing the decentralised purchase of interoperable systems that provide a patient focussed EPR. Unsurprisingly the Tories have used this to support their oft repeated soundbyte about the "NHS computer". The real question is what consultation are they engaged in with the stakeholders and how is this shaping their policies?

Interoperable systems have been sought for decades. Systems designers are now focussing on web-hosted systems in the hope that they may provide an answer. I suspect this is bound up in the misleading, undefined notion of a patient focussed EPR, which in many respects, might be just as much a soundbyte, as the Tory one. Worse, there may be an implicit assumption of benefit, not born out by the evidence. What little there is shows that healthcare IT has been a success, only when used in small projects to improve processes (eg repeat prescriptions).

Most clinicians I talk to, say they work within unsafe and inefficient systems that are made more so by arbitrary cutbacks in resources, by poorly qualified and trained staff and by overly-simplistic guidelines. The NHS will be short of money for the next few years. It could cut the scope of services (IVF, plastic surgery etc) but this has been done already and is unlikely to provide more than marginal savings. It could cut resources further but they are already pared down to the minimum.

One solution might be for management and clinicians to work together to improve productivity by incrementally improving processes using feedback from patients and staff (ie not those over-used, banal patient satisfaction surveys).

Maybe healthcare IT systems designers should support this process by encouranging the development of software that supports gathering feedback about work done, from patients and staff. It turns out that there is published research that shows that an elegant, secure EPR drops out, when healthcare IT systems are designed from this perspective.

It is indeed time to refocus. There may be many other solutions out there but neither that of the Tories nor that of Hayes et al are the whole story.

(Anonymous due to the tedious spam, received after posting here.)

Integrated Care Pathways save patient days, save money.

john.aird@uhl-tr.nhs.uk

13 Aug 09 13:08

One of the “holy grail” solutions (agreed way back) was to improve the patient experience, reduce length of stay, minimise unnecessary investigations, free up bed days, reduce costs, etc, etc, through the use of integrated, intelligent computer systems to support Integrated Care Pathways.

The patient arrives, is assessed by a clinician and (where possible) allocated to a care pathway (set up by the clinicians to reflect their knowledge). The IT system automatically schedules investigations, porters, theatres, reviews, nursing, therapy, drugs, treatments, etc. At predefined times the patient’s progress is reviewed by doctors, nurses to assess progress and if the care pathway needs altering (rescheduling) in any way. Along with the treatments, these assessments are noted (Clinical Notation) in the EPR and form the basis for quality control and letters.

In such a way a significant proportion of patients are safely treated with the minimal of time or resources wasted by the hospital. We all know that reducing LOS to that of the best hospitals can save the average hospital millions£ annually, while ensuring that the Patient does not have excessive or longer treatment that the doctors see fit.

So, investing in the right IT can assist hospitals save money (pay for itself) and improve the patient experience. For what ever reason, the focus on reinventing PAS may have lost sight of the clinical and so financial advantages.

Still a holy grail!

Round & round

13 Aug 09 20:08

The wheel turns slowly but it still turns. There were many who stated at the start that NPFIT would all end in tears. Take a group of people who know nothing about Healthcate IT & let them convince you that they can sort it all out if you give them enough money & you have a disaster wating to happen.

Maybe someone will learn from the mistakes but I doubt it. We will set off on a long road again & reinvent a few wheels.

If we set some sensible standards for talking between systems but leave the systems to be selected to meet local needs we may have some hope. Few people other than those using & running the systems know what is needed locally unless they have been immersed in it for some time. There is a huge pool of knowledge out there but whatever Government party need to look & listen to the right people. Those people are generally NOT those trying to make money out of healthcare IT.

If Choose & Book is seen as a 'Good Thing' by some, they obviously haven't had to use it. A huge sum of money to satisfy Government spin

Not necessarily an inevitable cycle

23 Sep 09 11:09

For as long as the NHS (including NPfIT) continue to have a total absence of the calibre of staff who can actually articulate (and subsequently impose) effective solutions then this will continue. I'll throw in the insane Monty Python-esque Trust structure as well just for good measure..."I never voted for standard clinical codes".

This is not an attack on the capability of the people currently in the NHS it is just a statement of fact - this is the most difficult IT project ever attempted - where are the best IT requirements/deployments specialists?

Please don't say they should be in the LSPs - whilst I realise most NHS staff were never given formal access to the contracts, there are onerous requirements on the NHS they are totally incapable of delivering.