Published: 13/12/2001, Volume III, No. 5785 Page 17
Star quality. Some names just have it. Some names just do not. The name 'Bill Gates' is one of the sparklers.
After all, IT is not a topic that sets many hearts beating faster - and the thought of NHS IT has been known to stop pulses altogether.
Yet the chance to see the great head of Microsoft was enough to persuade 300 NHS chief executives to spend a day in a London hotel discussing that very subject.
Nor was it just chief executives.
Most of the senior members of the NHS Executive found time to drop in, as did health secretary Alan Milburn.
Still, celebrity can be cruelly disappointing. Bill Gates would be described as 'nerdy' if he was not Bill Gates. That bowl haircut is not going to set trends, unless Microsoft can bury it in a new grooming product that puts independent hairdressers out of business (and who would put it past them).
The NHS recently became Microsoft's fifth-biggest customer by spending£17m on a licensing deal for its software. Though ministers claim this will save£50m, there are concerns it could leave the NHS dependent on Microsoft products.
Mr Milburn was careful to stress that similar deals are now being negotiated with Novel and Lotus - but there is more Microsoft involvement to come.
Microsoft joins eight major IT firms in a collaboration, known as Lightbulb, to 'develop a common integration architecture framework', based on governmentwide standards, to 'help achieve information-sharing by NHS organisations'.
Details of what Lightbulb will be doing have yet to be announced - but Mr Milburn has indicated that big projects in two NHS regions are being negotiated.
As such, the Microsoft deal can be seen as part of a trend to greater central control of NHS IT, started two or three years ago and still hotly debated.
Dr Richard Gibbs, chief executive of Kingston and Richmond health authority and chair of the NHS chief executive's IT forum, is happy with the approach.
He is sceptical about plans to start building a 'cradle-to-grave' electronic health record with emergency care, and would prefer to see one grow out of 'interim solutions' that help clinicians meet the standards set in the new national service frameworks.
He supports the Microsoft deal as a way of giving frontline staff the user-friendly tools they need to do this.
'We want a more corporate approach, ' he says. 'Imagine if Tesco or any other large corporation left it to 400 or 500 stores to do their own thing, ' he added.
Mr Gibbs also wants IT to have a higher profile, for it to be given more ring-fenced investment and for IT roll-out to be performance-managed as part of the modernisation agenda.
Last Thursday, he got the second part as Mr Milburn announced an additional£85m would be 'earmarked' for NHS IT - though three-quarters of this year's 'hypothecated' money went on other things.
What did Mr Gates think of the tension between 'letting things flower from below and the need for a mandate from above', as NHS director of research and development and conference chair Professor Sir John Pattison put it?
His answer was that some things, such as software standards, file formats, encryption and authorisation systems and directories, needed to be decided centrally, but staff should be encouraged to innovate as long as that fits in with the big picture.
The other big debates in NHS IT at the moment are not really about technology.
The stumbling blocks to further progress are widely seen as 'legacy' systems - old kit, often installed by smallish firms that have struggled to maintain it or left the market - and political and cultural issues.
Lightbulb may be a way to deal with the legacy issue. The debate about patient confidentiality and how to secure informed consent for data sharing between NHS and partner organisations is, as Mr Gates put it, 'a hot issue right now'.
He acknowledged that patient records were 'extremely confidential', and people might not want every 'medical functionary' they encountered to have access to all their notes. Password control was problematic because 'people write them down or they pick things that are easy to guess'.
Biometrics, such as finger-print recognition, might be a partial solution, but even then people might not want their whole record available in 'remote' locations.
What else did the NHS learn from the great man? Sadly, not a great deal.Mr Gates' speech was a business address with a few references to doctors and patients thrown in.
We gathered he was 'a great fan of digitalisation' (surprise), that the IT revolution has done great things for firms, which can now access information locked into paper records, keep in touch with their staff and devote time once spent on routine administration to customer care - and that there is more to come.
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