Horses and Marx
(Karl, not Groucho)
This issue of the Journal, planned as long ago as last July, happily
coincides with the publication by NHS Connecting for Health of its first
annual report.1 Its publication is one that all will welcome and records
some very considerable measures of success.
In terms of positive achievement, the Programme has completed one of the
largest public procurements in rapid time; and even more welcome, the
central purchasing of core systems will over a period of 10 years save the
NHS some £3.8bn. An even greater achievement — though with perhaps
uncharacteristic modesty the report does not allude to it — is that,
whatever the initial reactions to the Programme, it has raised awareness of
IT within the Service. That awareness may in some quarters not necessarily
extend to what exactly it will do, but IT, and the system changes that will
ensue, are now very definitely high on the agenda.
Turning now to achievements on the ground, there are encouraging signs
for the future. The report describes initial successes in the installation
of the Quality Management and Assessment System; of pilot schemes for two
major planks of the central programme — Choose and Book and the new national
network, N3; and the work under way in moving towards the electronic
transmission of prescriptions. Much of this work, and that on other projects
covered in the report — theatre scheduling and PACS, for example — is still
restricted to a few sites, and does not particularly break new ground. The
encouraging difference is the obvious desire to spread country wide all
those benefits of IT that slowly, over the last three decades, the pioneers
of healthcare computing have shown to be possible. Equally heartening, the
annual report shows a willingness to think through problems in advance, and
to collaborate with potential users in developing solutions: the GP2GP
project is an example of this approach.
Our four articles cover four major elements of the Programme. In his
article, Len Chard, the N3 Programme Director describes progress in the
implementation of the National Network for the NHS — an absolutely crucial
element of the Programme, and one without which the integration vital to its
success would be impossible.
Tim Donohoe, the ETP Programme Director, sets out the vision for the
electronic transmission of prescriptions, some of the formidable obstacles
to be overcome in doing so (connecting and paying for 20,000 physical
locations is but one) and the work that is in hand to tackle them.
In their article, Jane Cummings and Clare Mitchell, respectively
Implementation Director and Programme Director of the Choose and Book
Programme, report on progress towards the demanding target that by the end
of 2005 requires 80% of patients needing a hospital referral to be able to
do so through the new system.
Our fourth article, by Graham King, Primary Care Programme Manager,
describes the work that has been done following the renegotiation of the
General Medical Services contract. Those changes called for radical changes
in payments for general practitioners. The resulting system, the Quality
Management and Assessment System, now covers more than 8,000 general
practices, 303 primary care organisations, and 28 strategic health
authorities, providing them with quality and performance data on 146
evidence-based indicators. And, significantly, it “reflects the commercial
reality that higher-quality care is most likely to be achieved through the
use of incentives”.
What then for the Programme in the year or so ahead? There have been
undoubted successes, but there will be problems.
The first is that of the horse — the horse, that is, that having been led
to water, still declines to drink. The Programme has yet to be extended into
the wider reaches of the NHS, and the great majority of future users of the
national systems have yet to be engaged. Perhaps one of the most positive
aspects of the annual report is the considerable section devoted to that
engagement. In it, Alan Burns, who brought to his brief role as Service
Implementation Director a long history of successful IT implementations,
states that to make the Programme “truly work, we have to deliver hearts,
minds and usage”. The report sends out good signals; the months ahead will
be crucial to their effect.
The second problem is history. Karl Marx, it is alleged, said that,
“those who do not observe the lessons of history are condemned to repeat
them, first as tragedy, then as farce”. It is absolutely clear that from as
long ago as Information for health, there would need to be funding from the
field, and not just the centre. Richard Granger is equally clear. The
Wanless Report’s solid-uptake scenario requires NHS IT expenditure to double
from 1.5% to 3%. In 2004–5, however, 15 of 28 strategic HAs were spending
less than 2% and only three spent more than 2.5%. The events of recent
years, including the hypothecation experiment, show that field authorities
will need far more than just encouragement if the potential gains of the
National Programme are to be realised. For the future we must hope that the
Service will heed the advice of Marx (Karl), and not emulate the work of
Marx (Groucho).
Michael Fairey
Reference
1. NHS Connecting for Health. NHS National Programme for IT annual report
2004–5: Better information, better health. Leeds: NHS Connecting for Health,
June 2005. |
