The End of NPfIT Is Also a Beginning

Debbie Williams

Blog, Thursday 9th September 2010

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Today’s announcement by the Department of Health that NPfIT is to be replaced by a new, decentralised approach will be welcomed by many NHS IT managers. 

The move looks set to give control over their own systems back to them, whilst maintaining access to the NPfIT features that have found favour, like Choose and Book, PACS and electronic prescribing.

The new, modular approach announced by the DH will also help to encourage localised IT investment and approaches that will directly benefit individual NHS organisations – such as patient-level costing and improved business intelligence tools.  It’s hoped that some of the £700M NPfIT savings can be re-invested in these local initiatives.

Looking back to 2003, when NPfIT began, many of the IT developments we take for granted today were far from mainstream – such as widespread broadband access and interconnectivity.  It was the best idea at the time, and of course IT futures are hard to predict.  We now know that systems interoperability and access doesn’t require such a prescriptive, rigid approach.

As health minister Simon Burns put it in his statement:  “Localised decision making and responsibility will create fresh ways of ensuring that clinicians and patients are involved in planning and delivering front line care and driving change.”  Let’s hope that this is truly the case.

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Summary Care Records will Focus on Ownership of Information

Debbie Williams

Blog, Wednesday 16th June 2010

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Last week the Health IT Minister announced the continuation of the Summary Care Records. Smart Healthcare this week reported that Simon Burns told the British Medical Association (BMA) in a letter that SCR is under review with a ‘focus on ownership of the information’.

The Summary Care Records have come under intense criticism by many and the majority agree that the main problem of the records is in fact the way the programme was implemented rather than the online records themselves. Ultimately Mr Burns feels that the success of the Summary Care Records relies on the patients and the doctors and how they perceive the records, this can be acheived by making the process transparent for both parties.

The Summary Care Records are a central part of one of the most controversial elements of the NPfIT, the biggest healthcare IT programme in the world. To make the records a success all stakeholders must be informed of how the records will work, how patients can opt out of the records and the timeline of the roll out as these are the key issues many are concerned about. In order for the records to surpass expectations these key issues must be resolved, this should eventually result in the online records improving the quality and safety of treatment provided by hospital staff and out-of-hours doctors by giving them as much information to improve overall patient care.

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NHS E-Record System Goes Live at Morecambe Bay University Hospitals

Debbie Williams

Blog, Friday 4th June 2010

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E-Health Insider has reported that Lorenzo Release 1.9 went live at Morecambe Bay University Hospitals over the bank holiday weekend.

The trust is the first acute hospital to use the Lorenzo software with patient administration functionality. The software is being used by 3,500 staff across its five hospitals for all clinical activity and will change the way Morecambe Bay keeps patient records from being largely paper-based to a new electronic health record.

The software, which was designed by CSC’s sub-contractor iSoft, is a key part of the NHS’s £12bn National Programme for IT but has been plagued with delays.  It is still not certain exactly what the new coalition government’s plans are for NPfIT, but this is a significant step forward for the programme, so it will be interesting to see the results achieved by Morecambe Bay.

The push for electronic records, while often surrounded in controversy, does offer many considerable tome and cost savings to the NHS and so if implemented with the correct support and training, may offer great rewards to all those who use it.

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NHS Faces Job Cuts as £2bn Fund Set up to Cover Payouts

Debbie Williams

Blog, Friday 21st May 2010

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The Guardian has reported that the NHS has set aside a £2bn fund to cover the cost of payouts for redundancies as the NHS is facing a significant amount of job cuts, despite the government stating that NHS services will not be affected by budget cuts.

NHS trusts will be told to put aside two per cent of their funds for this year for one-off costs. This comes as last month, the Royal College of Nursing (RCN) warned that thousands of jobs would go in the health service as part of a drive to find between £15 and £20 billion of “efficiency savings” over three years.

The need to cut costs with such a huge economic deficit is of paramount importance but there are many ways to cuts costs that will not see the reduction of staffing and as a result not see the quality of patient care fall in the NHS. The scale of these cuts highlights the importance of efficiency savings wherever possible. Effective use of IT in healthcare, such as business intelligence, is a primary method to achieving this.

There has yet to be much mention of the plans for the National Programme for IT, but it is likely that there will be some announcement on this in the coming weeks, as the Liberal Democrats had wanted to scrap the programme altogether and with their position in the new coalition government it is not at all clear what the future is for NPfIT.

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Election Results

Debbie Williams

Blog, Friday 7th May 2010

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After us all enduring months of build up, the election results are in and a hung parliament is the outcome. What we are no doubt going to see from here is ongoing negotiations between the Conservatives and Lib Dems and the Labour party and Lib Dems to see which parties will now form coalitions for a majority government. However, no matter which parties form a coalition, we are likely to see changes in reform on a number of issues.

So how will this impact the NHS? If the Conservatives and the Lib Dems form a coalition this may see a mix of reform directly affecting the NHS. Conservatives want to cut the cost of NHS administration by a third, putting performances data online, as well as ensuring that every patient can access a GP in their area between 8am and 8pm, seven days a week. Meanwhile, the Liberal Democrats want to introduce “patient contracts” specifying what patients can expect from the NHS, scrap Strategic Health Authorities and create democratically elected local health boards with power to prevent hospital closures.

With the Liberal Democrats heavily opposing NPfIT, these could see the end of the summary care records, a central part of one of the most controversial elements of the NPfIT – the biggest healthcare IT programme in the world. However, if Labour forms a coalition government with the Liberal Democrats, there could be compromise on a number of issues including saving NPfIT.

At a time of uncertainty, we expect to see lots of changes to health reform, and in particular, IT in healthcare.

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Summary Care Records Halted

Debbie Williams

Blog, Tuesday 20th April 2010

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The Summary Care Records (SCR) system – the development of a medical records database for patients in England – has been halted according to the BBC. This comes after The British Medical Association warned the computer-based summary care records are being set up too fast and sometimes even without the patients’ knowledge.

The Department of Health said the roll-out would be delayed until there was better awareness of the scheme. The plans to computerise patients’ records in England have raised concerns about security and patient confidentiality.

More than 1.25 million patients’ records have already gone onto the database and in December, ministers announced that the process was being speeded up in some areas, which eventually could hold up to 50 million records.

The Summary Care Records are a central part of one of the most controversial elements of the NPfIT, which is the biggest healthcare IT programme in the world and while it is encouraging to see that the government is keen to progress this programme, there has been a worrying number of patients reporting that they had not given their permission or were completely unaware that their personal details would be stored in such a manner, both of which are factors that must be changed before the scheme can move forwards.

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NHS Will be Tailored to Patients, According to New Labour Manifesto

Debbie Williams

Blog, Wednesday 14th April 2010

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The NHS in England has improved significantly since 1997, according to the independent King’s Fund think-tank reported by the BBC. Access to drugs and treatments has become more consistent and rates of ‘superbug’ infections have fallen. There have also been sustained reductions in deaths from cancer and cardiovascular disease.

This comes as Labour launches its new manifesto for the upcoming general election. Because of the financial crisis, the manifesto will include no big new spending, but will instead feature new rights for patients to increase standards in the public sector.

The major changes to public services include underperforming hospitals being taken over by management teams from more successful organisations, as well as patients getting legally-binding guarantees on treatment they will receive. There will be a new focus on preventive care with routine check-ups being offered by GPs to the over-40s, along with a major expansion of diagnostic testing in GP practices.

The manifesto also promises to make all hospitals foundation trusts by giving those that already have the status new support and incentives to take over others that are underperforming. However, there was no mention of NPfIT or IT in healthcare within the manifesto.

And Mr Brown told The Guardian: “The days of take-it-or-leave-it public services are over. The days of just minimum standards are over. The days of the impersonal are finished.

“It has to be personal, accountable and tailored to your needs and with a mechanism to trigger change if the service does not meet your needs.”

At a time of change and ever-increasing healthcare budget restrictions, Trusts need to have a clear and accurate understanding of where costs are incurred for the new services that may be offered. This allows the opportunity for the NHS and PCTs in particular to ensure they have full control over their data and finances, so should there be an increase in the demand and a decrease in funding, they are able to see where money is being spent while still maintaining quality of care for the patient.

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Department of Health Looks to Help Doctors Engage with Patients

Debbie Williams

Blog, Tuesday 13th April 2010

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EHealth Insider has reported on a new system launched by the Department of Health to encourage doctors to engage more with patients to find out more about what their views are on subjects such as treatment, experience and information available.

The new system, entitled the Invest in Engagement tool, analyses almost 300 research reviews and it is hoped that this will allow doctors to see what areas are working and where improvements need to be made.

This programme is an encouraging use of the online facilities available to the NHS, with it offering patients the opportunity to feedback to doctors their opinions on services. If the National Programme for IT is to succeed then such initiatives as this are required to help outline the importance of IT within healthcare.

Such a service highlights the importance of keeping patients at the centre of the NHS and not getting too distracted by efficiency savings and government targets, especially in the run up to the election.

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Election Battle Lines Are Drawn

Debbie Williams

Blog, Wednesday 7th April 2010

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Gordon Brown has confirmed that the next general election will take place on 6th May this year and with that date only a matter of weeks away, each party is busy campaigning to make sure their policies are the most talked about. Health has been very much at the centre of the political battle for some time, but with the election campaigns really building pace now, the Independent has outlined the major policies for each party when it comes to the NHS.

Interestingly, the Liberal Democrats are the ones to make most reference to NPfIT, claiming they would scrap the programme, as well as scaling back the “choose and book” appointment scheme. Their focus instead would be on introducing varied waiting times “for different conditions in place of the existing blanket 18-week target, and mental health services would be included”. While the proposal to target different conditions separately certainly has its merits, without a focus on healthcare IT, how are these targets to be met?

While NPfIT is not without its critics, it has achieved a significant amount since implementation and with the money that has been ploughed into this, a complete scrappage, especially with no supporting IT plans in place, risks causing more problems for the NHS.

Labour’s current focus on health seems to be steering clear of NPfIT, while instead opting to promote the flexibility they would look to offer the public through the introduction of “patient rights”. These would see people able to see doctors at weekends and in areas closer to where they work, with the removal of GP boundaries. They also claim they will reduce management costs by 30% over four years, if elected.

Finally, the Conservatives offer proposals that would see the NHS opened up to competition from private organisations, as well as introducing an independent board for the NHS. They also claim they would scrap “politically motivated” targets and place more emphasis on outcomes, “including survival rates for cancer, stroke and heart disease as well as patients’ satisfaction levels”.

The next few weeks will see endless campaigning by all three parties and the discussion on health is sure to be one of the hottest topics and while the Liberal Democrats may be the only party currently directly tackling NPfIT, such a large scale programme is guaranteed to be at the centre of several political debates, as no matter what the outcome of the election, the development of IT in healthcare is essential to ensuring high quality service for patients, making NPfIT a real talking point.

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GP Survey Reveals Support for Cuts to NPfIT

Debbie Williams

Blog, Wednesday 17th March 2010

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A recent survey of GPs has revealed that more than half believe the National Programme for IT in the NHS is an appropriate target for cuts in the current economic climate. In the survey by Pulse magazine, over 900 GPS were questioned, with 52% indicating they would be in favour of budget cuts to the National Programme for IT.

The survey results, which are reported on E-Health Insider, show NPfIT to be the third most popular target for budget cuts behind only Darzi-centre contracts and managerial headcount and salaries.

With the election build up really starting to gain pace, NPfIT and efficiency savings in the NHS are guaranteed to be at the heart of many political discussions. The support for budget cuts to NPfIT demonstrated by these survey results is hardly surprising, as there has always been much controversy surrounding the programme. However, it is important that we do not overlook the successes that it has achieved to date, with the systems that have been implemented so far offering benefits to both clinicians and patients.

The debate over NPfIT has always been ongoing, but the next few months are likely to see the spotlight thrust onto its short-comings to provide political leverage in the run up to the election. This is despite the government having already made the announcement at the end of last year on the £500m – £600m budget cuts to the programme.

It would be easy for certain political parties to jump on the ‘anti-NPfIT bandwaggon’ in the name of healthcare efficiency savings, but in spite of its short comings, NPfIT has begun to prove demonstrable benefits that should not be easily dismissed.

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