Why the NHS needs an information revolution to get into gear

The government’s strategy on information use in the NHS was supposed to be a revolution - a step change in the way the NHS handled data. But the strategy has had a rocky road since it was first mooted in the consultation papers that came out alongside the white paper Equity and Excellence: Liberating the NHS back in October 2010.

The information revolution, said the consultation, was about “transforming the way information is accessed, collected, analysed, and used so that people are at the heart of health and adult social care services”.

The first draft, rumour had it, was rejected by the then chief information officer for informatics at the Department of Health, Christine Connelly. She decided to re-write it – and then in June 2011 announced her resignation and quick departure from the NHS.

The publication date was put back and promised in the autumn of 2011. Then it went to the Future Forum for consideration and the publication put back to “the winter”.

A DH spokesperson explained why. “The recent listening exercise and the work of the NHS Future Forum revealed the need for further engagement regarding the development of the Information Strategy. The NHS Future Forum will be undertaking this work, drawing on the published summary of the public consultation responses we have received. Their advice will be vital to shaping and improving the strategy so it best meets the government’s plans for patient-centred care and world-class outcomes.”

Meanwhile, the wheels of government keep turning. The National Programme for Health is being dismantled; the DH is reviewing data requirements; the Cabinet office is demanding greater transparency in all government-held data; and it has become clear that NHS will not be exempt from the “digital by default” philosophy now demanded of all public services.

The danger, says Matthew Swindells, chair of BCS Health (the Chartered Institute for IT), is that in the absence of a coherent strategy, NHS organisations will go their own way and risk making expensive mistakes.

“In the absence of clarity around the information strategy, the NHS is beginning to take decisions on its own,” he says. “Procurements are being launched, partnerships are being formed and leaders are saying that they must take action to protect the interests of their organisation.”

While this is welcome in some ways, he adds: “BCS believes that a coherent information strategy is still vital if local innovation is to be harnessed to provide a better integrated NHS.”

He explains: “There are key elements of the strategy that need to be explained urgently in order to avoid people making expensive mistakes and the NHS losing the gains of the previous investment.”

Among them are how will the spine be developed to provide a national infrastructure of identifiers, registers, security and scheduling? How will standards be set to allow the NHS to innovate within an interoperable framework? How will information transparency be promoted to drive quality improvement and patient empowerment? And, finally, how will technology be utilised to promote personal health records, self-care and long-term condition management, all of which are crucial to the quality, innovation, productivity and prevention agenda? 

A quick look at the range of tenders coming up in the Official Journal of the European Union would support Mr Swindells’ view that the NHS has not stopped developing IT in the strategy vacuum.

“We are seeing more tenders than we expected,” says Jon Lindberg, who manages the healthcare programme for Intellect, an umbrella organisation representing the UK technology industry. “But the longer we go without a strategy to help set direction for where they need to go, the more fragmented the NHS will become.”

Or, as Mr Swindells puts it: “The secretary of state may get the more devolved approach he wants by default.”

And this would run counter to the stated aims of the NHS reforms – better integrated care, more shared decision making and more patient choice all imply availability of shared data.

“If we transform the service to allow for information to flow freely from the patient to the GP to the acute hospital then the benefits will be huge,” says Mr Lindberg. “We need the vision for those kinds of benefits, not just for the IT people but for the clinicians and people in finance.”

So for all our sakes, vive la revolution.