The government's Connecting for Health agency has
launched a publicity campaign for IT modernisation of the NHS, but
major questions remain unanswered
Connecting for Health, an agency of the Department of Health,
last week launched an England-wide marketing campaign to spread the
word about some of the key benefits of the National Programme for
IT.
DVDs, videos, 1.3 million booklets and A3-sized posters will
market the benefits to health service staff of the NHS Care Records
Service, a scheme to give 50 million patients an electronic health
record that can be accessed by any authorised NHS employee across
the country.
The entire campaign will be branded and have a consistent visual
identity, but it cannot hide the patchy progress being made thus
far by the NPfIT.
A study released earlier this month by the British Computer
Society's Health Informatics Forum - and reported on in last
week's Computer Weekly - shows that support remains strong for the
aims of the NPfIT.
It also indicates that NHS IT specialists and IT-literate
clinicians still have a generally favourable view of the NPfIT.
In part, this is because work is being done by NHS staff across
England to improve the quality of information held on patients and
to replace outdated equipment. The programme is also regularly
discussed at meetings of trust boards of directors.
But the draft consultation paper issued by the BCS, although
setting out the benefits of the NPfIT, may also fuel concerns about
whether the programme will be a long-term success.
One of the big unanswered questions is whether patients will
benefit sufficiently from the new systems to justify the final
cost, which has been put at anywhere between £6.2bn and £31bn.
Mark Britnell, chief executive of University Hospital Birmingham
Foundation Trust, has asked, "Is the IT programme there to change
the NHS or just to provide an IT infrastructure for the health
service to use as it sees fit?"
The draft consultation paper issued by the British Computer
Society's Health Informatics Forum, on which comments are invited
from anyone before the final position paper is prepared, was
written in part to provide constructive criticism on the NPfIT. The
main points raised in the paper are as follows:
The importance of good communications
"It is recognised that communication is getting better, but its
effect is patchy and perceived as one-way, not a dialogue or
genuine debate. The requirement is for the talking to be catalytic
to engagement, not just empty consultation. The ethos encouraged by
government in general is much more open than that practised
currently by Connecting for Health."
The dangers of misinformation
"It is recognised that some material should remain confidential
and on a need to know basis, but the current climate of secrecy is
excessive. Subsequent misinformation and speculation fills the
vacuum and remains a serious risk to the success of the
programme."
The need for full information
"Even in the early adopters [NHS sites which are among the first
to go live] who are eager to move forward, they are constrained in
their organisational development and business change by not knowing
the detailed functionality being written now."
Constructive criticism
"There is still little evidence that Connecting for Health is
listening to constructive operational criticism."
Systems that reflect clinicial need
"Clinicians see that informatics will improve healthcare but
have yet to be convinced the products under development will
reflect their requirements and realise operational benefits.
Experiences to date with the emerging Patient Administration
Systems and Choose and Book support this concern."
Funding
"It is felt that there is a medium-term funding gap estimated at
over £10bn that needs to be covered locallyÉ Money could come from
efficiencies created by Connecting for Health, but this means that
trusts have to speculate to accumulate, and that may cause tension
in fundamental operating priorities."
Managing change, not just installing new IT
"Healthcare practitioners not directly involved in Connecting
for Health are not aware of how it will affect their ways of
working, and few plans are apparent of how they will be
engaged.
"All NHS staff will welcome being informed clearly about what is
being delivered and when, and what associated tasks are
planned.
"Health staff at local levels across the domain can become
ambassadors among the general public if they understand more about
the programme, its achievements and its objectives."
Innovation:
"Questions are being raised as to whether Connecting for Health
is looking outward to harness impending environmental change or
implementing yesterday's systems tomorrow. Local Service Providers
are known for focusing on rewrites to their existing software, so
the time available to participate in innovation will be severely
limited."
Connecting for Health has so far declined to comment on the BCS
paper.
A spokesman said: "We have still not formally been provided with
this paper. However, we will give this due consideration once we
have formally received it. We understand it makes some positive
comments about NHS Connecting for Health and also suggests ways in
which we could improve our engagement with stakeholders."
NHS National Programme for IT: the pain and the
gain
The gain
In July, Esssex Strategic Health Authority reported that its
areahad achieved "one of the largest National Programme for IT
deployments to date, encompassing 300,000 records and the
firstNPfIT Child Health implementation in the NHS."
It said a briefing has been supplied to ministers, noting the
names of Essex and Local ServiceProvider managers who have "worked
hard to bring this systemon line."
The pain
North East London Strategic Health Authority reported on 20
September that the supplier of a Child Health system, which records
information relating to child protection and inoculations, gave
notice that operational support was being withdrawn in March, later
extended to June. London's Local Service Provider, the BT-led
Capital Care Alliance consortium, agreed to provide an interim
system, but the authority says there have been problems: "This
application has been deployed across all the Primary Care Trusts
and a number of initial operational difficulties are being
resolved.
"The front-line child-health teams have found it difficult to
resource the increased workload of sustaining their operational
activity, supporting the development and assurance of the new
platform and managing the migration of records. Poor initial system
performance and printing difficulties have exacerbated this
challenge, but these are being addressed by CCA service teams."