Where will the money come from to connect the NHS?

Guest Blog by 2020health Consultant Director, John Cruickshank

Published in November 2014, ‘Personalised Health and Care 2020’ sets out a framework for action around the exploitation and adoption of digital healthcare.   The document has been prepared by the National Information Board, which now represents all the major national stakeholders in the English health and care system.
Over the course of my 30+ years in the sector, some half dozen of these national strategies for IT in the NHS have been published.  The better ones have been forward thinking on vision, short on platitudes, clear on expectations and what will be ‘done once’ nationally to enable progress, with evident funding policies and a structure that enables  – and measures – delivery.  How does this paper face up to these challenges?
The good news is that this document is above average and has much to commend it, not least the explicit focus on improving the care and experience of patients and citizens. It is well worth reading and in places inspiring.  Its three key themes of collaboration, transparency and participation all make good sense and are threaded through the document.
The document was originally due out much earlier in 2014, so was it worth the wait?  Rather like the ‘Pantomime Horse’, it suffers from design by committee (perhaps why it took so long to appear) with some recommendations rather convoluted and opaque.  But unlike our dear Horse, it is stronger and more appealing in its middle sections than its front and back.
Strangely for a major government report, the Executive Summary is so short as to give almost no clues to the depth of consideration and recommendations in the meat of the report.  And in then painting a picture in chapters 2-4 of the need and current status, it is sketchy.  It contrasts the uptake of digital in health with other industries in a way which is nothing new.  The paper apparently airbrushes out ten years’ of huge investment and some progress enabled by the National Programme for IT in the NHS (NPfIT).
And at the back end (chapter 12), while commendable in terms of commitments to specific dates, the action plan is long on promise about future roadmaps and the like, but short on clear deliverables, roles and responsibilities.   For example, it is widely known that one of the reasons for inaction has been the lack of clarity of roles between the Department of Health, NHS England and the Health & Social Care Information Centre (HSCIC) around digital, and where funding and accountability lies.  This paper hints at some progress but does not inspire one with much confidence.  And with many of the due dates lying after the next Election, one also wonders whether they are remotely deliverable given the likelihood of political change.
The meat of the report (chapters 5-11) has good analysis and many welcome recommendations.  The more eye catching ones include:
•    NHS Choices as a single point of access to common digital transactions, integrated with 111.
•    National accreditation and kitemarking of apps (one hopes this does not stifle innovation).
•    Piloting digital care accounts for patients with a personal budget.
•    National ‘experiment’ of a mobile care record under the control of patients.
•    Use of the Digital Maturity Index to track effective use of IT in the acute sector and beyond.
•    Dame Fiona Caldicott as National Data Guardian of health and care.
•     A new National Tariff that supports and rewards new models of care, enabled by technology.
•    Leadership support to exec and non-exec directors in the development of digital strategies.
So what are its limitations and gaps?  I would highlight the following:
•    How is the document expected to be used?  Would a Trust CEO or indeed an ICT Director know what to do next?
•    Throughout 2013, the promise was the NHS would be ‘paperless by 2018’.  Although laudable, this was a false promise in that the aim should be more streamlined care not the removal of paper. And it was not remotely deliverable. The ‘paperless’ term has been quietly dropped in this paper, with a new commitment ‘all patient and care records being digital by 2020’.  Why ‘all’ and how is this deliverable?
•    The commitment to greater standardisation is welcome but this is a familiar theme – ten years ago, the mantra of NPfIT was ‘ruthless standardisation’. What’s different this time?
•    What is the national technology architecture within which national infrastructure and systems will operate?  Who is responsible for developing it?
•    How will the hints on funding policy (e.g. around future Tech Funds) be developed to give longer term clarity about national investment policies? Nothing was mentioned in the Autumn Statement about funding this essential infrastructure.
•    In my opinion, some element of systems coordination around the common development of digital and health records are essential to corral health communities to deliver joined up care to their local population.  How will this report enable this to be achieved, particularly with NHS England rationalising its local informatics support?
Finally, many NHS organisations around the country (and particularly those in the north, midlands and east) face a cliff edge in July 2016 when their NPfIT patient record contracts will expire and national funding for their systems cease.  The paper is entirely silent on this. Can local commissioners and providers afford the new arrangements, do they have robust plans in place, and how will patients be assured that their care will not be put at risk?

Advertisements

About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
This entry was posted in Finance, Technology and tagged , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s