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It's no surprise that the government speaks of "an NHS information revolution" in its Liberating the NHS white paper on the future of the health service. New administrations like to blow the trumpet of radical change, and given the coalition parties' criticisms of Labour's initiatives in the field, they were not likely to portray their plans as an evolution of good work already done.
There are elements of the plans which suggest a continuity with the existing situation. These include maximising the use of the Choose and Book e-referral service, and making aggregated, anonymised data available to researchers, as already done by the Secondary Uses Service. But there are others alterations that, if they go ahead, would mark a genuine change in the way the NHS works.
One is making healthcare institutions more accountable through the provision of more online information. The white paper talks of enabling patients to rate services and clinical departments online, a capability available through the independent Patient Opinion website and promised, although apparently not delivered, for NHS Choices. It also advocates that patient reported outcome measures are extended, and that clinical teams see risk adjusted assessments of their performance against their peers.
The underlying theme is one of greater transparency that would keep patients better informed and make clinicians more accountable. This is a positive step, but it involves the collection of increasing quantities of data, and elsewhere in the document the government sets itself against such a trend. Later this year the Department of Health will review its data returns, and the white paper makes clear that the intention is a cull. It will be difficult to square this with the demands of making more available to patients.
Other elements of the paper involve increasing online services including consultations, giving patients control of their health records, and enabling them to share these with third parties. The latter ties in with the government's desire to see more social enterprises involved in the health service, and it will all require an accurate electronic patient record that is secure yet accessible to a widening range of professionals.
Yet this leaves the government in need of a solution. Both coalition parties have been hostile to the summary care record (SCR) developed under England's NHS National Programme for IT, and while the Conservatives have made approving noises about data repositories managed by the private sector, there is nothing that has been developed close to the point of meeting all the demands. Microsoft's HealthVault is on the market, but the company has no plans to share information with the NHS.
The government will have to clarify its priority for care records, whether it accepts the SCR with appropriate privacy safeguards, or asks the commercial providers to create products that can rise to the challenge. The first option will take time, the second will probably take longer and have to be underpinned by a commercial case that keeps the providers happy.
Whether or not the government knows how to deal with all this should become clear when it publishes an information strategy in the autumn. It's the kind of challenge that is easy to ignore while in opposition, but can cause a lot of headaches in government. If the coalition can pull it off it would justify that claim to be launching a revolution in these particular aspects of healthcare.
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