It's a family affair


It's a family affair

On the surface, Building the Information Core looks like the offspring of a marriage between last summer's NHS Plan and a 1998 IT strategy, Information for Health.


Justin Keen

On the surface, Building the Information Core looks like the offspring of a marriage between last summer's NHS Plan and a 1998 IT strategy, Information for Health. No daughter could escape this genetic inheritance, and parts of the new strategy are very prescriptive - like so much of NHS policy-making.

It sets very demanding targets for the implementation of new network infrastructure, electronic booking out-patient and other services, electronic patient records, and other technologies. Local implementation will be very closely monitored at national level.

Beneath the surface, though, there are signs that this particular daughter could be something of a rebel. The strategy proposes, for the first time, that patients should have access to their own electronic health records, and may even create and maintain records for themselves. The strategy also recognises that the NHS must be able to communicate securely with social services and other agencies.

If these two ideas take hold, the face of NHS computing will be transformed. The NHS will no longer be in sole charge of the structure and content of patient records - the backbone of NHS data management - or of the network infrastructure. Patients, local authorities and many others will all have stakes, and the NHS will have to negotiate with them. Fanciful solutions will not be possible, because the stakeholders will bring the NHS quickly down to earth.

As with so many families, these hopes may be dashed on the rocks of experience. Past attempts to persuade NHS staff to share data, whether in messages or in shared patient records, have simply highlighted the endemic lack of trust between people who work in the NHS.

The idea of sharing recorded information with patients will lead some doctors to run for the hills. This is a fundamental problem: there is not much point in linking people together on networks if they do not trust one another's data.

This chronic lack of trust leaves policy makers in a difficult position. After all, the trust problem extends to the policy makers, too. The NHS trusts nobody, and the IT people have the added handicap that they are still associated with embarrassing failures in the 1980s and 1990s. Yet the NHS executive has, somehow, to excite doctors and nurses so much that they begin to drive developments themselves.

Can it be done? The strategy proposes to give doctors, nurses and other staff a set of basic tools that people in many other walks of life find useful - e-mail, Web browsing and so on. If the tools are delivered and used, all well and good. If not, then there is simply no point in continuing with a nationally-driven strategy, because the NHS is not in a fit state to respond to one.

Whether this is the fault of the NHS executive, doctors or anyone else will be immaterial. Families that squabble all the time do not need new networks, they need therapy.

Justin Keen is a fellow in health systems at the King's Fund independent think tank

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This was first published in January 2001


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