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There were no riots in the streets, but the NHS IT scene in England changed as tumultuously as any other area of public policy in 2010. A general election in which IT emerged as a campaign issue, followed by the announcement of the biggest organisational shake-up in the NHS's history, coincided with new concerns about the health service's management of information and eye-catching innovation.
The year opened with the Labour government's Department of Health battered by a continuing stream of damaging news reports about the National Programme for IT (NPfIT) in England. In March the department admitted that talks with Computer Sciences Corporation (CSC) about renegotiating contracts following implementation delays had reached an impasse.
Meanwhile, the deployment of the Summary Care Record (SCR) began in London - and was immediately embroiled in controversy as the national press reported allegations of primary care trusts "bullying" patients to agree to having their records loaded.
In April, the Conservative Party's election manifesto promised to put NHS patients in charge of making decisions about their care - "including control of their health records". In an earlier document, the Liberal Democrats had proposed that NPfIT be scrapped.
May's general election put the two parties in power in an unexpected coalition, and the fate of centralised health records (in England, at least) seemed sealed. However the incoming secretary of state for health, long-time shadow Andrew Lansley, resisted any temptation to grandstand on the topic.
In May, a long-awaited independent evaluation of the SCR and HealthSpace programmes concluded that there was little evidence of any benefits from the programmes - and that take-up of the HealthSpace personal health website had been negligible. The report found numerous examples of what the authors called "dissonance" between what policy makers and IT experts was expected of the summary care record, and the experience of clinicians and patients on the front line.
Simon Burns, who took over as the minister of state for health responsible for the IT programme, said the SCR programme would continue, but he signalled a change in the political wind. While the government "broadly" saw a need for patients and clinicians "to be able to access patient records in electronic form", that process "depends on patients and doctors feeling comfortable with those records rather than them being seen as something that (is) imposed as a central part of government".
The idea that the private sector might have a role to play in managing health records moved up the agenda when Microsoft announced that it would launch its HealthVault product in the UK. May also saw the UK launch of Apple's much talked-about iPad: one of the first users was a Cheshire GP who tested it with a document management system.
Torrid supplier summer
In general, however, it proved a torrid summer for the main IT suppliers to government, as they were hauled into the Cabinet Office to have their contracts renegotiated by the new government's Efficiency and Reform Group, under Cabinet Office minister Francis Maude.
For the NHS in England, the post election phoney war ended in July when the coalition government published its white paper 'Equity and excellence: Liberating the NHS'. It proposed a revolution in administration, with the abolition of primary care trusts and strategic health authorities, with consortia of GP practices taking on commissioning from 2013-14. The paper had little to say about IT, but the department gave a strong indication of the direction of travel by ending the NHS-wide agreement with Microsoft, saying that in future local organisations would be responsible for choosing and procuring software.
In August, the future of NHS Direct came under the spotlight, when Lansley indicated that the NHS Direct helpline - the big early win for the Labour government in NHS IT - would be replaced by the new NHS 111 non emergency number . A pilot of the new scheme began in County Durham.
It wasn't until September that the government finally sounded NPfIT's death knell. Burns announced that a review had concluded that "a more locally-led plural approach" should replace national procurements. The Department of Health said the move would save £700m, mainly by cutting back the scope of existing contracts. However the NHS Confederation warned that the change could lead to NHS trusts being forced to divert local resources to systems that had previously been centrally funded: "It is important to remember that removing some elements from the national programme is likely to shift cost to local providers."
A broader strategic picture emerged in October, with the publication of a consultation document 'The Information Revolution', which seems set to become the government's third NHS IT strategy in 20 years. While thin on specifics, the document sets out a vision of a mixed economy of health records, with individual patients in control. The deadline for responses is 14 January, and a final strategy is likely to emerge in late spring.
The direction of travel has clearly been set. In 2011, the political leaders of this revolution may come to appreciate the title of May's Summary Care Record evaluation, one of the most significant such exercises ever undertaken: The Devil is in the Detail.
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