- Smart Healthcare, Wednesday 12 August 2009 09.00 BST
Stop copying me: several Conservative ideas on NHS IT are already government policy. Photo: jiunlimited.com
Never have the Labour and the Conservative health modernisation agendas been so similar. Both understand and agree that the National Programme for IT (NPfIT) has achieved a lot and should not be scrapped, that decentralisation is required and that health services should become more patient-centric. They just use slightly different vocabulary.
The Conservative Party has just published a report entitled Independent Review of NHS and Social Care IT. This was commissioned by Stephen O'Brien MP and chaired by Dr Glyn Hayes, the former chair of the British Computer Society's Health Informatics Forum. Unfortunately, it fails to make any groundbreaking revelations or recommendations.
The review recommends that "the patient must be at the centre of all information systems; the provision of patient-level operational data should form the foundation of NHS IT." The Wanless Report – a document published by the UK government in 2002 – highlighted many years earlier that a "patient-centred service" was key to "high quality service".
Another section of the document suggests that NPfIT should offer "a wider choice of supplier to enable trusts to select cost effective systems that cater for local needs." Christine Connelly, the Department of Health's director general of informatics, stated three months ago that they "now want to open up the healthcare IT market to new suppliers and new technological developments, to inject more pace into this programme".
She added: "Working together we can help trusts configure systems to best meet their local needs as well as take advantage of market developments to make more use of the information held in the core systems."
Connelly has imposed a November 2009 deadline for the NPfIT local service providers, by which time they must make "significant progress" with the Care Record Service, otherwise the DH will look for alternative suppliers and solutions.
The Conservatives' document also asserts that "the centralised procurement and implementation structures of the Programme have created diseconomies of scale. These inefficiencies require a rigorous and robust reassessment on the part of the government." However, the government recognised the need to decentralise procurement more than three years ago.
The DH announced a review of the programme, called the NPfIT Local Ownership Programme, in April 2006, which signalled a major change of direction. The programme has since then taken a progressively decentralised approach. Most budgeting and procurement decisions have moved away from Connecting for Health (CfH) at national level towards the 10 Strategic Health Authorities (SHAs) at a regional level, as well as the local trusts.
It is important to distinguish substantial and effective recommendations and changes from empty political rhetoric and bravado. There have been some inaccurate claims and media reports. Some sources have quoted that Tories would "allow" trusts to choose their own system suppliers, when in fact health organisations have never been obliged to buy from the NPfIT suppliers. As a matter of fact, some have already opted out: Heatherwood and Wexham Hospitals NHS Trust signed a £2.4m deal with iSoft in April 2009 for a patient administration system, which is completely unrelated to NPfIT. It is likely that similar agreements will follow, especially in the South where many trusts remain without as LSP following Fujitsu's contract termination.
The DH's response to the Independent Review was very cold: "The report highlights nothing new - we already know that quality healthcare can be delivered through the effective use of IT.
"The report makes clear that there has been progress in modernising NHS IT. But we are constantly working to deliver and have already made clear to the local service providers involved in the programme that we fully expect further significant progress by the end of November."
Despite a large number of similarities, there are a few differences between the Labour and the Conservative plans for the NPfIT and the modernisation of the NHS in general.
The Tory-commissioned review claims that the government's development of a national database of health records "has caused extreme anxiety among individuals and organisations" and that the Spine should therefore be scrapped. This is in principle a bad idea. It would prevent clinicians from accessing a patient's medical history in an emergency scenario outside the patient's local area. For example, if a person from Liverpool is taken unconscious to an accident and emergency department in Bristol, clinicians will not be able access to vital health information such as allergies, major operations or blood type without the Spine.
Conservatives claim that they will consider alternative suppliers to the internally-run patient portal HealthSpace, which recently suffered a major setback as its expansion plans were scrapped. Products such as Microsoft HealthVault and Google Health are discussed and analysed in detail. This also represents a shift of direction from that of Labour, which has pledged to keep personal health records stored and managed within the UK. Using an external supplier would help government to reduce capital and operational costs and offer patients more advanced functionalities, but it could compromise data confidentiality and information ownership, as well as come into conflict with the Data Protection Act.
The Tories' Independent Review is unlikely to have any immediate impact on the NPfIT. Most of its recommendations do not represent a major change of direction and those which do are not substantiated enough and require further elaboration. Some of the proposals – such as the scrapping of the Spine and use of external web-based patient record service providers – raise more questions than answers. But they could also bring in fresh ideas and help to stir the health debate.
Victor Almeida is a senior analyst at Kable
