- Smart Healthcare, Wednesday 5 August 2009 09.00 BST
The NHS IT programme has come to symbolise all that is wrong with the way that Labour has dealt with the NHS. Billions of pounds have been spent on building a shiny, high-tech and highly centralised system with little time devoted to thinking about what the aims of the project were. The result is a system which is over-budget, behind schedule and below specification.
The 2006 National Audit Office report into progress in the NHS National IT hit the nail on the head: the government seems to have failed on nearly every count when it comes to building the IT system the NHS needs. It failed to negotiate effectively with suppliers, engage with NHS organisations and win the support of staff and the public. This has helped create a system which not only doesn't work but isn't really wanted by anyone except a small group of mandarins in Whitehall.
Changing this state of affairs is going to require a radical rethink. I believe that one of the first things we need to do is banish the idea of huge national schemes. Successive governments have fallen for the charms of smooth talking management consultants and IT salesmen who have waxed lyrical about the potential savings and efficiencies of bespoke software packages and complex databases. Time and time again the British public have ended up paying for overly complex vanity projects which habitually under-deliver at greatly inflated prices. The great shame of the NHS IT programme is that instead of learning from past mistakes, the government seems to have set out to raise the bar when it comes to wasteful expenditure.
Instead of thinking about how national programmes can transform the NHS, we need to be much more realistic about what we are trying to achieve. IT has revolutionised how we work and when it works well in the NHS it has an excellent track record of improving patient care and workplace efficiency. All too often though the various sections of the National Programme for IT have failed to do this – either because the goals were not well thought out or because nobody really knew what they were being asked to do.
Confuse and Book
A great example of this is 'Choose and Book' – or 'Confuse and Book' as one of my colleagues christened it. What started out as an attempt to develop a simple booking tool has morphed into a system which regularly denies people the choices which it was meant to give them.
Instead of enhancing choice and making the referral process simpler, Choose and Book has often lead to less choice being offered, and has watered down the role of GPs in referring their patients to the most appropriate clinicians and facilities. Instead of helping to make patient care more personalised as the framers of the project had hoped, the national IT programme has often left people trapped by the whims of an unsuitable and unstable computer program.
We need to engage clinicians from the commissioning stage onwards rather than trying to engage them after the system has already been commissioned – doctors I know who are trying to implement the new NHS IT system have complained that they are now trying to tailor the system to their needs rather than having a system designed to service them. Given that clinicians are the ones who will work with these programs every day, we need to listen to what they have to say.
The proposals that the Conservatives have hinted at, about a localised system of IT commissioning, are a positive beginning and I welcome their belated conversion to the concept of localism. However, I believe that both Labour and the Conservatives are missing the point about what IT can do for the NHS and the role it should play.
As a Liberal I believe that one of the key criteria for measuring the success of a programme can be found in measuring how it improves interaction with the system. In its current monolithic form, the National Programme for IT is having a negative impact on patients and the NHS. It has led to restricted access to appointments, exposed confidential patient data to abuse and diverted resources away from frontline care into white elephant schemes. When we look at developing IT schemes in the future, we should not be looking at ways to build the NHS around an IT system, we should be looking at how IT can help improve patient care and improve the efficiency of the system.
A great example of this attitude can be found in the initiatives where IT has empowered patients to improve their health. These schemes don't have to be complex or wide ranging but the benefits they can bring are tangible and easy to understand. They reduce admissions which in turn reduces costs and pressure on resources.
Permanente improvements
For example, in America, Kaiser Permanente encourages patients to email their doctors to discuss health issues. This has proven very popular with patients and doctors and the benefits of improved doctor-patient relationships can be massive. In the UK, there are schemes which put patient records on smartcards so that the patient is in charge of their own records – bypassing the danger of an insecure and costly national database. If a patient chooses to do so, they can upload their records and take these with them to appointments at their GP and when they are referred to other services.
IT can also play a positive role in patient care. These schemes don't have to be complicated – often the best ideas are very simple. In the United States, the Veterans Administration embraced tele-health schemes with staggering results. Cooperation between doctors and patients enabled by the smart use of IT programmes and systems lead to a 25% reduction in bed days of care, a 20% reduction in numbers of admissions and 86% of those involved in the scheme expressed satisfaction with the improvements that had resulted from the scheme. If a drug came onto the market with these outcomes then the manufacturer would have a real blockbuster on its hands.
The examples I have highlighted sum up our NHS IT philosophy. I do not believe that an enormous organisation like the NHS is suited to the big bang approach which Labour has tried. Big projects generally require huge contractors which squeeze out smaller and more specialised organisations who are often best placed to innovate and transform our approaches to issues.
Our proposals, which put the patient-doctor relationship at the heart of IT use in the NHS, would enable the NHS to provide more personalised care without the need for the staggeringly complex IT systems currently under development.
