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The Independent Review Group was set up in 2008 by the Conservative shadow health minister Stephen O'Brien MP and it was commissioned to be completed within a very tight time scale. Publication of the formal review report is still awaited but it is thought to be imminent.
The aim of the review was to inform the Conservative Party's policy for the use of IT in the NHS, health and social care in England and to advise the current and the future government to enable them to set the strategy for achieving that vision, including a workforce strategy.
The remit of the review included establishing how clinical, public and management needs can most effectively be met by information technology; establishing a vision for IT in the NHS, health and social care; setting a strategy for achieving that, including a workforce strategy; advice on action for the current government; and advice on the policy options open to an incoming Conservative government.
The mechanism of the review was to seek views on a standard set of questions, some more open and searching than others. At the more incisive end of the spectrum was the question: "Who has primary responsibility for the shared record?"
A BCS-Assist workshop was held on 24 September, made up of about 30 senior informaticians from varied backgrounds including suppliers, the NHS, NHS CFH, the NHS Information Centre and academics, with a total of around 500 years of total experience. Written contributions and comments were also submitted.
The full BCS-Assist submission which resulted can be found at www.assist.org.uk, but the recommendations are:
- Get the basics resolved before trying the ambitious
- Do not lose or threaten the hard won successes
- Focus on (person-centred) standards
- Achieve a balance between technology, systems, people, process and culture
- Ensure much earlier and more integrated policy planning at both national and local levels
- Invest in a systematic health informatics R&D programme
- Avoid structural change
- Avoid stand-alone data demands
- Avoid insular systems development
- Invest in developing informatics skills, leadership and the profession
IT imposed change has been common over the last few years. Often policy dictated that there had to be a change, but it was only after the change had been agreed that IT specialists were engaged. This could not only undermine the goal of "IT-enabled change" but had created the wholly undesirable alternative of "policy-disabled IT".
The vision for IT is still the same as it was in the early 1990s: detailed, person-centric, securely accessible electronic records across health and social care. IT has expanded to be the norm – not so long ago awards were given for new use of IT such as using SMS text messaging for patients' appointments, now this is commonplace.
Here be mythical supercomputers
Nonetheless, NHS IT remains an area of political disingenuousness. Alarmist references abound to a mythical "NHS supercomputer". One politician recently went as far as to say that he wouldn't rest until all computers have been removed from the NHS. This sort of informatics-illiterate scare-mongering, for short-term political expediency, does nothing to build public confidence in the proper use of IT to improve patient care or to improve public services more generally.
So pervasive is IT in the NHS that if a patient presented themselves in the A&E of a modern hospital and said that they did not want any of their information to be held electronically, then it would create serious clinical risk – they could not have an appointment booked, an X-ray taken, any tests done or be prescribed any medicine.
It is important to have standards rather than standardisation. Technology has moved very fast and some of the earlier technical constraints on strategic thinking have been overcome. Systems should be built around the patient encounter and not around organisations and professional groups. It is necessary to balance local needs against national ones, invest in a systematic health informatics research and development programme and avoid structural change.
The NHS has been likened to Asda – one large organisation that has the same structure and methods throughout – but in fact it is more like Spar, made up of lots of small franchises with a shared logo and supply chain. One system will not fit all.
In conclusion, there have been some wonderful successes and we need to build confidence and encourage in particular innovative smaller suppliers. It is important to build on success and learn from problems. Investing in IT is fundamentally about enabling change and change is never easy. But IT- imposed change rarely succeeds.
Based on a presentation by Brian Derry, Chair of ASSIST, and subsequent discussion at a joint meeting of the BCS West Yorkshire Branch and BCS Health Informatics (Northern) Specialist Group in Leeds in April 2009
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