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Guest editorial Sunday 19 September 2010: Matthew Swindells on the future of the National Programme for IT

Professor Matthew Swindells, health chair of the British Computer Society, former DH chief information officer and soon to start work with Cerner, assesses the context and consequences of the latest news on NHS Connecting For Health

The Department of Health has announced that “The NHS is already using a number of effective solutions that are in addition to the scope of current national contracts. Recognising the likely timescales for the delivery the delivery of strategic solutions, NHS organisations should be able to consider the benefits of additional interim solutions where they offer the chance to deliver patient benefits sooner ...”

Well, sort of - actually, that was the DH Informatics Review, published in July 2008 (1).

Once more, with feeling
This time, they’ve announced, “A new approach to implementation will take a modular approach, allowing NHS organisation to introduce smaller, more manageable change, in line with business requirements and capacity.”

The 9 September 2010 press release from the DH (2) has been simultaneously heralded as a “decision to reorganise - and hence effectively scrap - the National Programme for IT (NPfIT) by Computer Weekly (3)”  and “IT shake-up leaves key components unaltered” by Health Service Journal (4).

So who is right?

This announcement, at face value, is a perfectly sensible announcement. It takes some money away from organisations who were taking far too long to do anything useful with it and says to the NHS, ‘you need to take responsibility’.

On the bright side
Viewed optimistically, it recognises two important truths about the implementation of major IT systems:
- Complex implementations can’t succeed in isolation from the operational transformation of the organisation into which they are going, and this need requires real local ownership and focus.
- The process of implementing invasive new information technology, by definition, changes the environment into which it is being implemented (5)

It may also recognise the NPfIT predates reforms such as plurality of providers, patient choice and the focus of managing long-term conditions at home.  NPfIT / CfH was an IT solution, not an information revolution.

On the less-bright side
On the other hand, the recent press release could be the Department’s way of saying that it has put informatics onto the “too hard” pile, and wants to take as much money back as it can get away with without ending up in court.

Only the Information Strategy, whose first publication is due any week now, will give us a real clue as to whether this a precursor to the information revolution, or simply a set of unfunded aspirations - or worse still, a cost-cutting exercise that points the NHS information industry back into the IT anarchy of the 1980s and 1990s?

If the NHS is going to simultaneously face the radical set of reforms laid out by the Secretary of State and the need to drive 20% cost reduction over the next four years, information and information technology will be crucial.

Five steps towards a future strategy
Having announced in its press release what the DH isn’t going to do, it needs to announce in the information strategy five things that it will do:
1) Put all clinical and operational performance data about the NHS into the public domain, using the Information Commissioner’s view of what would be released under an FOI request as a yardstick.
2) Use its power as the lead commissioner to mandate that any organisation providing services to the NHS but conform to a set of interoperability and data standards that will allow patient information to passed between IT systems and follow the patient along its care pathway.
3) Use its commissioning power to drive patient empowerment and self-service, incentivising GPs to allow patients to access their records from home and encouraging patients to re-register with a GP that offers this service if they want it. It should commission home-based services that use technology to allow patients to self-manage their condition, and require NHS providers to support patients in doing this.  
4) Work with professional bodies to introduce a mandatory professional qualification for Chief Information Officers and accreditation for informatics specialists.  The CIO role needs to be taken as seriously as that of the finance director.
5) Introduce basic numeracy and information competence for all NHS managers, in clinical and non-clinical managers. There is little point in us undertaking all these national surveys and generating a whole range of indicators on outcomes if senior managers don’t have a basic grasp of the concept of statistical variation and significance.

If the Department treats this as a moment to say to the NHS, “The implementation of IT Systems is a local priority and choice; the standardisation of information, integration and informatics capability is a national challenge,” we may be on our way to somewhere constructive.

But no-one should be under any illusion: information is not a free good.

1. DH Information Strategy, July 2008
2. DH press release on NHS Connecting For Health, September 2010
3. ComputerWeekly.com – 10 Sept 2010
4. Health Service Journal – 16 Sept 2010
5. Patel N V (2004), Deferred Systems: Deferring the Design Process and Systems. Journal of Applied Systems Studies. 5 (1)