NHS plan poses IT challenge

"The task should not be underestimated." These words from health secretary Alan Milburn summed up the challenge facing IT...

"The task should not be underestimated." These words from health secretary Alan Milburn summed up the challenge facing IT professionals in modernising health service systems.

Mike Simons

Following a last-minute makeover from Milburn, the new IT strategy for the health service emerged from the Department of Health last week. However, its half-cocked launch should not detract from the importance of the new document Building the Information Core - Implementing the NHS Plan.

Health service IT professionals have long been waiting for this document, an update of the 1998 Information for Health strategy.

And they are more interested in the strategy it outlines and the extra money on offer than Milburn's desire to give the package a pre-election spin.

Paul Cundy of the British Medical Association General Practitioners' IT Committee (GPC) welcomed the document, but added some crucial caveats.

"The GPC welcomes the continuing commitment to modernising the NHS," said Cundy. "This document represents a massive agenda for change in virtually all areas of NHS IT and we still need to apply the lessons of previous overly-ambitious NHS IT projects."

Building the Information Core is aimed at providing the infrastructure to deliver the Government's NHS Plan, which promises to redesign the delivery of care and services around the needs of patients. Achieving it, said Milburn, requires "a massive transformation".

A measure of the challenge this poses for IT is that while targets for the implementation of e-government in the rest of the public sector have been tightened progressively over the last 12 months, in the health service deadlines for key projects have slipped.

Turning this round depends, in the document's words, on creating "an infrastructure which is robust, flexible, secure and standardised".

That has to begin with the rapid implementation of the Government's Interoper-ability Framework - universal Internet technology, SMTP standard for e-mail and XML for messaging.

It means sorting out security and dealing with the appalling pay gap and skills crisis that is blighting health service IT.

All these issues are covered in the document, but in a way that raises as many questions as it answers.

The Interoperability Framework has been made mandatory for all future projects. Nigel Bell, National Health Service Information Authority CEO, told Computer Weekly he was particularly pleased to see "the introduction of a far more robust approach to standardisation in developing the essential infrastructure".

But the NHS has projects, including NHSNet and the pathology messaging service, using legacy technology which will be rolled out for years to come. It is, for example, moving to the internationally accepted Snomed system for clinical terminology but is advising IT departments they can continue to develop systems based on the NHS' own Read Codes until April 2003.

Security has long been a source of frustration among health service practitioners and IT professionals. Building the Information Core announces the NHS' formal adoption of the stringent BS 7799 code of practice and promises the development of a public key infrastructure for local health organisations by April 2002.

"Data security and confidentiality are critical hurdles that must be overcome," said Cundy. "But there does not seem to be any clear dependency between the document and security strategy timescales."

It is a recurring problem with the document, which sets new targets and deadlines based on pilot projects that have yet to be evaluated. Any hitches with a pilot project could knock the whole strategy off balance.

Above all, none of Milburn's plans will come to fruition without skilled, committed IT staff, and this issue only gets a cursory mention in the document.

"The Government cannot rely on an endless supply of goodwill from IT staff who can double their salaries by going to the private sector," said one teaching hospital IT manager.

"The common fear of IT managers of 'if I train them they will leave' must be banished from the NHS so that it can build and retain a highly skilled IT workforce."

NHSNet timeline

1992
The Tory Government proposes NHSNet, in part to ease administration of the internal market

1995
Contract signed with BT Syntegra to supply and manage NHSNet in a private finance deal

1997
Labour comes into power and promises to dismantle the internal market

1997
Labour announces it will connect all computerised GP surgeries to NHSNet by the end of 1999

1998
Labour announces its Information for Health NHS IT strategy with NHSNet as a central enabler

1999
April. The National Audit Office criticises the strategy for not having clear objectives or measurable outcomes

1999
July. The Department of Health says it will not connect all practices to NHSNet by the end of the year, but promises "doctor desktop" computers for every GP, and opens discussion to abandon the much-criticised X.400 messaging standard

2000
August. NHS Plan promises 95% of GPs access to NHSNet by 2001 and 100% access by 2002

2001
January. Building the Information Core promises desktop access to basic e-mail, browsing and directory services for 25% of NHS trust clinical and support staff by 2001 and 100% access for all NHS staff by 2003

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