Thought for the day: Don't throw out the baby

NHS could lose vital resources as it forces changes, says Jean Roberts

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The NHS could lose vital resources as it forces changes, warns health IT expert Jean Roberts. 




Reading last week's front page article "Angry IT staff say NHS denigrates their success", I too was angered to recall we have been here before.

Many of the issues faced by the current generation of health informaticians are mirrored back to the early 1970s, when I started in health IT. Effective communication between the strategic designers, developers and those active in care was well demonstrated by a 1984 BJHC report from the Department of Health-led Korner programme. Such transparency appears to be limited today.

Early activity was on a more locally-sensitive basis - suppliers providing customised applications directly to end-users and home-grown solutions coming through to market if they warranted it. Today there are concerns that paths for stimulating innovation, capitalising on emerging technologies and keeping pace with clinical developments and rising patient expectations are unclear, if they exist at all.

Achieving useful solutions needs sensitivity to local history, current context and close user liaison. Extensive additional investment is needed in people and procedures to ensure the proposed solutions deliver the goods.

That investment has been estimated as four to eight times the cost of the initial national programme for IT contribution - way above the ongoing budget for total cost of ownership of existing informatics in health.

Where will this funding come from, and will it be sustainable over the transition period to full implementation of these new systems?

If the national programme service providers will really "cut and run" after delivery and installation on-site, then who will keep the support to the care deliverers going? The IT professionals who have not been fully engaged to date.

I hope my concerns, and those of colleagues in the service are misplaced; health informatics could make a positive difference. Domino effects may occur if any piece of the complex contract plans fail to come in on time, presenting considerable risk to patient care, health planning and the wider development of e-government strategies. These risks need a firm hand.

The national programme delivers black box solutions and infrastructure. It does not, in its current contracts, ensure the solutions are fit for purpose nor that clinicians and managers can get the best out of them without jeopardising patient care.

Information handling training for an estimated 300,000 additional NHS people will have to be delivered alongside ongoing patient care and will, without question, call upon the domain knowledge and expertise of many of those health informatics professionals who have been slighted by recent statements by NHS management.

To succeed, informatics to support care and ultimately to sustain the health of the public needs true partnership. It needs designers, providers and implementors to make sure solutions do what they are supposed to do. Alienation of those with domain experience is a risky strategy, whether intended or incidental.

The health domain is moving at warp speed. It is not advisable to demotivate those streetwise to the environment. There is a real danger of throwing the very experienced, justifiably angry "baby" out with today's cloudy bathwater on the promise of bubbles in the bath tomorrow.

What do you think?

Are you an NHS IT worker disillusioned with the way changes are taking place?  Tell us in an e-mail >> reserves the right to edit and publish answers on the website. Please state if your answer is not for publication.

Jean Roberts is lead for the BCS Health Informatics Committee and a member of the UK Council for Health Informatics Professions.

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