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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


NHS IT with Norman Lamb MP

Mar 09. till Mar 09.

2020health Expert Roundtable on NHS IT with Norman Lamb MP

Roundtable on Dual diagnosis: Mental Illness associated with Drug and Alcohol addiction

March 9, 20102010-03-09T08:30:00 - March 9, 2010 2010-03-09T10:00:00
8:30 AM 2010-03-09T08:30:00 - 10:00 AM 2010-03-09T10:00:00
Westminster, London


Norman Lamb MP, Shadow Health Secretary Liberal Democrats
Julia Manning, 2020health
Fiona Calnan, UKSH
Paul Altmann, Consultant Nephrologist Oxford Radcliffe
Tim Giles, Ascribe
Ian Denley, System C
Ailsa Williams, Portland Communications
Julian Wright, Independent IT Consultant
Kevin Dean, Cisco
Gail Beer, Independent Consultant
Mark Vincent, HP Enterprise Services
John Cruickshank, Consultant Director, 2020health
Patrick O’Connell, BT

Event Summary

Standards have been a moving target as CFH has been very active in its approach:

  • For vendors to participate and offer solutions, it has been suggested that we learn and lead by European example
  • There is a need to share IT services, collaborate using the intelligent part of the IT network and provide a better ladder for NHS staff to climb up

There are economic benefits but also social benefits as it allows for greater personalisation of care. However patience is required and we must understand that IT is not an end in itself; it is simply an enabler. It will still be 5 years before the care records vision is realised. However there have been a lot of successes along the way, in terms of building infrastructure, standards, and increased professionalism of NHS IT workers. Primary care, community care and mental health systems have all delivered; the biggest failure has been in acute hospitals. The reason for this was the "one size fits all" approach - Hospital Trusts did not like it.

Interoperability is key; it is essential to follow international standards and to have operating systems that can interact with each other. Otherwise you will not be able to share data across ambulance trusts, PCTs, children's services etc.

There are unexploited opportunities such as telemedicine, and collaboration. The problem is that the whole NHS IT programme has been tarred with the same brush. The next Government, of whatever political persuasion needs to:

  • avoid redundant variations
  • make best use of economies of scale where possible
  • recognise where there is a need for central co-ordination i.e. standards

Currently LSP contracts criteria considers:

  • Value for money
  • Joined up care
  • Removing exclusivity to give trusts choice

And now another way to introduce criteria and improve standards is to test solutions on offer to hospitals so that by using results providers can compete against other solutions – trusts and providers will be able to see this and trusts can assess which is best for them – ultimately targets choice

  • Is a need to aggregate and provide a range of solutions that meet a number of standards. Must work with trust to choose the most appropriate
  • Is a certain capacity in the market regarding the number of providers- if providers fall behind in performance they will lose market share
  • The concept of local health communities being able to make their own decisions is still important, but there is a need to operate within a shared framework for best practice and to achieve economies of scale. We cannot simply have a "free for all" where Trusts can use any supplier - the centre must mandate a short list of around 12 suppliers, and local trusts should then be free to choose the system that works best for them. The centre needs to better serve and enable the NHS, but we also have to strengthen the field - too many trusts are simply left on their own. The NHS could also have much better IT staff and could share services with other neighbouring trusts to be able to attract better people.
  • Data centres also need to be improved; at the moment many are very vulnerable to failure because data is simply kept in basements or insecure storage cupboards. There can also be huge savings by reducing the number of data centres.

We need to serve the NHS not the server (must be NHS facing) – issues such as staff exchange and career progression need to improve. Is the NHS a good workplace for someone to build a career in IT - are there ladders to climb and are IT career prospects good? Concern that too many trusts have no support with IT or systems: cloud concept – is a need to strengthen the field of technology in the NHS.

Implementing the vision:

  • Very large IT programs are difficult to implement regardless of the industry they are being use in.
  • Implementation is a practical exercise requiring people with practical experience – not theoretical.
  • We therefore need people who have implemented IT systems, not supported them – as they have the best lessons learned from other implementation exercises in various industries.

To get all trusts to move forward in IT at the same pace is difficult because IT is a differentiator not just an enabler. IT is a differentiator in the sense that each trust wants to be better than the other and will therefore compete via IT. There are differences of opinion on how to implement and these are due to differences in experience with IT systems.

  • A coalition between Users and builders of the system, and the centre, is necessary for each to voice their opinions. All have different motivations and needs, but the key is to get all three to join up and work together.

There is great disparity in the targets set across hospitals:

  • Is interface lagging
  • Need sufficient local choice surround the national framework standards
  • Need to familiarize people with the system eg press/media and other parties have weak information and make poor judgments because they make these based on a slice on information rather than analyzing the bigger picture. (SSR – System requirement review after 9/10 months of change over time)

An integrated healthcare and patient centric system was the original vision of the NHS but with the legal entities involved only sometimes work together in the best interests of the patient - often they do not. The key mistake at the start of the NHS IT project was not involving NHS IT experts in the contract awards process. For example the scoring systems used did not give any opportunity for differentiating between the varieties of quality between the systems - it was imply a "tick box" exercise.

Question arises whether all systems support clinical work when 1 IT system is lagging 10 years behind or pacing 10 years ahead of others. Conclusive that all do in a certain way but there is no way of differentiating which is problematic. Must question which functions would be centric and which would be locally supported.

There is disengagement of medical staff (especially boards) fitting trust goals, strategies and improving patient care with IT strategy. The system should be there to support the goals and patient care, not the other way around with trusts having to adjust care according to their IT systems.

IT implementation is a change management program requiring strong clinical leadership and positive attitudes:

  • Training for staff is a major issue – basic IT skills and data entry/analysis is poor
  • Need strong and enthusiastic leadership to push the IT programs forward and ensure it works efficiently
  • Behaviour and attitude is hard to change
  • The culture of NHS presents resistance to change which serves as a barrier towards implementing and using IT systems

Paper based pathway as an example:

  • Organisations often think clinicians require extra training but it is junior staff who often need it more
  • Is a large difference between senior and junior staff concerning technological knowledge and experience due to generation gap and the types of technology each is used to

In reality, this is a change management project rather than an IT project - yet the focus was on it being an IT system, into which you then had to fit patient care. This was then why staff became disengaged with it. The foundation has to be about where patient care is going, and then using NHS IT to supplement this. Another reason for ensuring collaboration on standards and system design is that it makes training much easier.

Clinical leadership is key to this - the south central area is now entirely clinically lead. Oxford Radcliffe is changing to be more clinically lead rather than management lead - clinicians are much better able to "sell" NHS IT to their colleagues than if it is a top down management decision and take risks.

Money has been wasted on increasingly complex IT programs because there is no organization when implementing the systems and these programs could have potentially been very successful e.g. Labour’s policy for health

  • There are many trusts that do not even have a foundation to build on and so failure in implementation occurs
  • Backtracking will occur in years to come because there is no organized integrated system, rather we have a mish mash collection of providers brought in from random areas for trusts

Spine needs to be more robust and central and disintegrated systems must simply become more integrated.

  • Simple messaging systems, thinking pragmatically is vital and this has been lost in the NHS
  • Integrating care pathways for patients across a number of organisations is very difficult (when patients are treated across a variety of settings)
  • There is a need for a central IT hub – expertise within each trust (use of PACS imaging transfer problem as example)
  • Culture is risk averse in the NHS and risk must be recognized and taken on – is a fear of doing and bringing in change to everyday working life (fear due to profession on the line)
  • Suggestions that if the government can take away clinical risk from suppliers, then numerous suppliers could build IT systems together

Examples of IT not being efficient – include smart cards for security which do not time

Concluding comments implementing IT systems require clinical directors and leads who are pragmatic and push visions forward (who having used it know more about the system than the supplier) there are mutual benefits can be gained if trusts invest in relationships with suppliers.

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Fixing NHS IT: A Plan of Action for a New Government

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