This week the NHS Future Forum published its latest report spurring on headlines from the tabloids such as ‘NHS staff lacking compassion and ability to do their job’ and ‘doctors and nurses told to slim so patients listen.’

But for those IT and NHS professionals waiting for the long over due Information Strategy there were few headlines that could provide even a little direction on where their efforts should best be placed. In summary the report on information, needed…more information.

The report, much of what was leaked before Christmas, provided little that was new.

The key recommendations of the report around information were:

Patient ownership of data – a requirement for patients to be able to access their records online by 2015 and for the British Medical Association, Royal College of General Practitioners, NHS Commissioning Board and patient organisations to help to deliver a plan to roll this out, which includes an ethical and concrete consent process.

Data sharing - A move away from the National Programme for IT to interoperability and a call for the Information Strategy to clearly set out what is expected for providers of NHS services as well as a deadline.

• For contractual agreements to be put in place so ensure that the entire NHS has systems that allow full electronic data sharing against set standards.
• For hospital discharge summaries to be made available to the GP and patient at the point of discharge, and GP referral letters to be made available at the point of referral.
• For the universal adoption of the NHS number at the point of data capture across health and social care by 2013.

Information governance – The Government should commission a review of the current information governance rules and of their application, to report during 2012 to ensure appropriate balance between the protection of patient information and the use and sharing of information.

Using data to drive quality - A clinician who is responsible for organising data should be identified within every NHS and social care organisation.

Transparency - The need for a clear deadline for all information about clinical outcomes is put in the public domain and the need for the Information Strategy to emphasis the importance of patient‐generated comments through social media and for the NHS to use these to improve services.

Although there is little that is new, there are a couple of interesting points. Firstly, that the medical bodies will be asked to consult on the plan to allow patients to access their records online. However, there is no mention of suppliers/providers of the technology. The lack of communication between the technology world and the clinical world was one that led some of the major failures under NPfIT, could this be at risk of happening again?

A number of additional deadlines are set out, such as the adoption of the NHS number by 2013 (which was introduced 15 years ago) and for information about clinical outcomes to be placed in the public domain, but there is little information on the mechanisms that will drive these deadlines.

Perhaps more interestingly is the call for an emphasis on social media to improve services. While an innovative and forward thinking idea, this in itself needs an entire document and a huge amount of education aimed at the industry and NHS, considering only around half of NHS organisations actively use Twitter, for example.

The recommendations appear to provide a vague brief to build on and leave questions that it seems can only be answered by the Information Strategy, which will allegedly arrive in the spring.

Sarah Bruce, Marketing Manager One Health Alliance, Communications and Digital Media Consultant Highland Marketing

Last week, as Big Ben chimed out midnight and the fireworks erupted around the London Eye spectacularly, my mind went back to the chimes of Big Ben welcoming the Millennium.

We all waited with bated breath to see whether every computer in the land would come to a standstill as predicted. Intensive care units doubled their staff, emergency services were at the ready and many government departments and local authorities had contingency plans dusted off and ready to mobilise.

Due to a lot of planning and a huge investment in IT (an opportunity to replace elderly PCs) thankfully the Millennium had little impact. Twelve years on and dramatic changes in technology have occurred with the introduction of the ‘iPhone era’ where information, such as our friends’ relationship status to the latest headlines, is delivered to us in real-time through the internet, social media and mobile technology.

The ‘iPhone culture’ means that we can get instantaneous information about almost anything, like from Trip Advisor on how good a holiday destination might be and on trains, buses and planes, through to traffic congestion reports. But sadly we still can’t get information about which surgeon and or hospital has, for example, the best outcome for joint replacements.

The reality is that we behave as if the same technology we use within our everyday life is as equally pervasive within our healthcare. However, there is a silo infrastructure, which we have been unable to join up in any meaningful way despite the fact that it would release massive savings and enable real choice through patient involvement. Embracing such technology could not only support the ‘information revolution’ but create an ‘information evolution.’

What is questionable is the unidentified cost for becoming ‘E-dependent’, particularly in a world where technology projects costs are 60-70% infrastructure and support costs.

Budgets are being cut as users, in both the public and private sectors, demand more for less. Periods of rapid change in the way both enterprises and consumers use technology create not only huge threats for those wedded to old models, but also huge opportunities for new ventures and existing businesses capable of capitalising on the new trends.

As we reorganise and restructure the NHS, we must look at new ways to reduce costs, such as moving to Software as a Service (similar to the Pay as you Go tariff on a mobile phone). In addition, the NHS is increasingly seeing more organisations embracing shared services, outsourcing and even cloud computing. Interestingly the NHS has more shared service contracts than any other government department covering finance, HR and clinical functions. Could this be just what the newly formed Clinical Commissioning Groups might need?

2011 brought a lot of uncertainty, predominantly due to changes to the National Programme for IT, the continuously disputed Health and Social Care Bill and the absence of an Information Strategy. Let’s hope that 2012 brings more clarity so that organisations can work to bring in today’s technology into tomorrow’s NHS.

Exciting times ahead I believe and of course we have both the Jubilee and the Olympics to look forward too.

Jeremy Nettle,
Chair of Intellect Healthcare Group

This week I had the pleasure to attend the eHealth 2011 conference in Malaga. Driving in the fog to Gatwick, I was feeling slightly boyish that soon I would be walking along the sunny pavements of Malaga and getting my dose of vitamin D. How wrong could I have been. I arrived in one of the worst rain storms that Andalucía had seen in some months. Perhaps Spain isn’t so different from the UK after all.

However, what I heard this week simply endorsed my understanding that healthcare globally is going through major reforms to improve performance, such as the measurement of clinical outcomes and encouraging patients to take more responsibility in decisions around their own care. A bit like finding the Holy Grail I have often thought. But what I discovered is that the route many countries are taking is not to dissimilar to our approach in the UK and more specifically in England with the Information Revolution.

One of the key messages at almost any conference in any country I attend is that there is unanimous agreement that by involving the population in their own healthcare, significant reductions in costs can be made. In fact some researchers estimate that costs could be reduced by almost 20%. If these estimations are true, ensuring people take ownership of their health would certainly make the £20 billion savings over next four years – often know as QIPP or more frequently ‘the Nicholson Challenge’ – more realistic and achievable whilst simultaneously improving patient care.

So, what is the driver to make this happen and what will push forward the QIPP agenda? History tells us that in austere times innovation will be key.

Research recently carried out by Professor Sir Brian Jarman, into hospital mortality rates in England, found that the number of deaths in hospitals are more closely related to the number of GPs in the area it serves, than to the number of doctors in the hospital itself. Surely this is proof that it is time to grasp innovative thinking and extend support for the case to develop the virtual hospital – sometimes known as a hospital without walls.

In addition, if we want to see better health outcomes, improved equity, patient involvement, access and lower costs, then we need to focus more resources on primary and social care as well as general practice. Health systems dominated by specialist secondary care ‘have higher total costs and reduced access’, a recent World Health Organisation report says. There is clearly room for innovation here.

Given that there is no extra cash in the system, I eagerly wait to see how innovative we can become in order to improve the quality and access to healthcare in this country. After recently witnessing and enthusiastically applauding the winners at the recent HSJ Awards and eHealth Insider Awards, it is clear that there are examples of great innovation scattered across the country. My plea is that we can develop a way in which this good practice is disseminated across a federated NHS.

Jeremy Nettle,
Chair of Intellect Healthcare Group

Return on investment (ROI) is a very hot topic within healthcare given the current efficiency saving challenge and the broader financial climate in the public sector. Nearly every NHS business case must now demonstrate a rapid ROI to executive teams and boards.

Whilst we must always consider financial factors and ultimately ensure that services and technology provide value for money, it’s imperative that we remember the purpose of an NHS: To provide high quality healthcare for all and improve the health and well-being of our citizens. However, it is clear that the current model and cost of service delivery is not sustainable and that there must be a focus on efficiency and good financial management.

The concept of ROI in healthcare does however need to be carefully considered. Consider the ROI related to a sky-scraper or office block. It would seem counter-intuitive to ask the question ‘What’s the ROI on the lifts’ or ‘What’s the ROI on the window frames?’. When it comes to buildings both lifts and window frames are integral parts of the infrastructure and essential for any ROI to be achieved – but we cannot realistically determine what the ROI for the individual components is.

Similarly within the healthcare context – the ROI on doctors, nurses or physiotherapists is seldom questioned. These are all ‘must have components’ in the delivery of healthcare today. Clearly – information and technology cannot be viewed in the same light as the ‘human resources’ we’ve outlined, but patients or healthcare consumers do now have an expectation that electronic resources will be utilised to deliver safe and effective care. We also see that high performance healthcare organisations have made heavy investments in information technology (VA, Kaiser etc). So to varying degrees, IT and broader technological solutions are and will undoubtedly become more embedded as essential components for the delivery of high quality care.

The word ‘evaluation’ is less widely used and definitely not associated with the same degree of importance and focus as ROI. And yet, effective evaluation is critical to determine and understand ROI.

The healthcare world has been sub-standard in terms of its approach and use of evaluation to understand the impact of interventions, technology and process change.

When we review the evidence of the impact IT has on healthcare, there is limited information available on the impact beyond processes being streamlined, paper being removed and time being saved. There are some obvious extrapolations linked to notes storage, legibility and potentially the reduction of errors related to lost notes etc. In terms of harder metrics however (e.g. length of stay, readmission rates, medication errors, clinical outcomes etc) we are still building up the evidence base.

So this is a call for commissioners and providers alike to have evaluation built into the project plans and not to shy away from doing some hard measurement. We have excellent research capability in the health system and we need to apply the same rigorous principles to the process of evaluation for IT initiatives.

Only then can we begin to understand the true ROI on these ‘essential’ components of our healthcare infrastructure.

Dr Lloyd McCann
Medical Director – EMEA
Carefx (A Subsidiary of Harris)

Over the past few weeks, there has been a lot of very familiar talk about the NHS IT market “opening up”. However, this time round and following renewed announcements by the Department of Health about the dismantling of the National Programme for IT, there appears to be a sense that companies, which have latterly been shut out of NHS IT, might finally get a chance to have the door re-opened to them.

But with all the optimism comes the question over whether there is really any place for SME’s in the market. Moreover, do the inroads exist to enable them to take advantage of opportunities that do come along?

A couple of weeks ago, one of our industry advisors, Jeremy Nettle, blogged about whether there is likely to be a procurement spate or blight. So far, it seems that trusts have used the DH announcement to move forward with procurements that had previously been put on ice. So, you would think that this is music to the ears of smaller NHS IT providers waiting to strike.

But instead, at several recent events I’ve noticed a common trend of frustration from the small and medium size companies. Companies appear exasperated that despite the big announcement from the DH, there are no mechanisms in place to allow them to even attempt to compete with enormous, multi-national corporations who have big balance sheets or big reputations behind them.

On a number of occasions I’ve heard how big players, whose primary focus is not healthcare, are winning trust procurements without even having the product that the trust initially tendered for.

Stories of how small companies, who have fantastic working and proven products that address all of the tender specifications and are being dismissed at the first hurdle, appear to be coming increasingly frequent. With the big players then subcontracting them to provide the service instead.

Whilst this method works in some ways, defining a company’s ability to provide for the NHS on their balance sheet as opposed to their product, could have some major implications.

Firstly, shutting smaller companies out has the potential to prevent the QIPP agenda from being pushed forward, stifling the innovation so often shown only by smaller more agile organisations.

Perhaps more scarily is the possibility that NHS IT could turn into another National Programme for IT in all but the name, with only a handful of big and ‘trusted’ companies winning the contracts.

One thing is clear- the Department of Health needs to address this matter now. Whether it is the encouragement of collaboration within the industry, a commitment around interoperability that ensures that all systems can integrate, thus not shutting certain players out of the market, or an easier route to procurement that allows smaller companies to participate without requiring huge amounts of their resources away, it is now time to make those changes.

Sarah Bruce,
Marketing Manager at One Health Alliance
Communications and Digital Media Consultant at Highland Marketing

According to the Institute for Innovation and Improvement ‘Innovation is about doing things differently or doing different things to achieve large gains in performance.’

Often, ‘innovation’ makes us think of technological developments. Whilst new technology makes an important contribution to innovation in the NHS, another critical component is service innovation. It involves designing the process our patients go through, the way we work and the way we redesign and develop our health services.

Following the approval of the Health and Social Care Bill this week, we know there is a utopian view that Lansley can achieve both innovation, service redesign and efficiency gains with his reforms, but can we really meet these objectives without the help of private money?

Radical changes in the way we commission services already mirror many aspects of the corporate sector, using fit for purpose models as opposed to the price is right mentality. Does this signify the privatisation of the NHS? Who knows and does anyone really mind as long as the standard of patient care improves?

Already the Department of Health (DH) has given approval for one NHS hospital, Hinchingbrooke in Cambridgeshire, to be acquired by a private company, Circle Health. In additon, the DH has identified more than 30 ‘underperforming’ NHS trusts increasing the prospect of private firms taking over.

The Guardian recently published an article detailing how a German company has been in talks to take over NHS hospitals, suggesting that there is already significant activity around the tendering of entire hospitals to foreign bidders. The key questions are what are the drivers here -, effective healthcare, patient choice, or off-loading the financial burden of the NHS to the highest bidder?

Advances in medicine coupled with increasing incidence of chronic disease and an ageing population have the potential to lead the NHS into catastrophe. In many respects the government has realised that single entity enterprises of such magnitude would be more of a hindrance than an effective national service.

So are we too stuck on tradition with the romantic notion that the NHS can just keep haemorrhaging money as we grow as a nation and be free at the point of access? I’m not sure.

The Guardian has written the article that suggests scandal. However, is it time to be more open minded on this and examine the potential benefits? As long as patients continue to receive the right care at the right time and in the right way, surely that’s all that matters.

Tom Humphries, UK Business Manager at Clinical Solutions

There is no getting away from the fact that what dominated the news headlines this week was the announcement of the death of Steve Jobs, chairman, co-founder and former CEO of Apple. For anyone unaware of this news, quite frankly you must be living in a dark cave.

In fact the online reactions – with many responses no doubt being tapped into iPhones or typed into MacBook Pros – attested to the far reaching accomplishments of a man many have likened to a modern Thomas Edison. From politicians to business and technology leaders, tributes flooded in:

“He changed the way each of us sees the world, we have lost a visionary,” said President Obama.

“Leadership doesn’t have a secret formula; all true leaders go about things in their own way. It’s this ability to think differently that sets them apart – and that enabled Steve Jobs to create perhaps the most respected brand in the world,” wrote Sir Richard Branson.

Microsoft’s Bill Gates tweeted: “For those of us lucky enough to get to work with Steve, it’s been an insanely great honour. I will miss him immensely.”

Even musicians paid homage:

“From my Mac to all Lovers … RIP Steve Jobs,” wrote Kylie Minogue.

“If you have yr health consider it the top of the GIFT pile. SteveJobs did a lot in 56yrs&wished he had wht many of yoU HAVE… I did the Grammy webcast in 1996 for Apple at MadisonSqGarden as payment they said $1000 or 2 POwerPCs, ..I took the 2 PowerMACs,” tweeted Chuck Dee. (It was my young nephew that reassured me that Chuck was a well respected rap star not an ill-educated individual lacking basic literacy skills – “get with it auntie”, was my nephews reply.)

Such was the response of those paying their respects on Twitter, it struggled to keep up with the news feed. Thousands of users reported seeing the ‘Fail Whale’, a cartoon sperm whale that appears on the Twitter homepage when Twitter produces more messages than it can handle. May be this was a bizarre sign of reverence and a reflection of his impact on our global society.

However, as I personally reflect on his death, his elevation to near sainthood and comments such as “..the world is immeasurably better because of Steve,” – made by Jobs successor, Tim Cook – I think does he really deserve such veneration and credit? I certainly struggle to place him in the same visionary class as Edison, Einstein, Gutenburg, Arkwright and Brunel, for example – with whom many do – who really did revolutionise our world. He did not invent the computer, he merely speeded up what we were already doing – listening to music, communicating, sending messages and gathering information – and gave us smart looking gadgetry.

But not to take anything away from Jobs in terms of what he achieved as he was a brilliant, highly innovative technician, with great business flair and marketing ability. In fact I often quote Apple as a great example of how to build a ‘brand’. And I can’t deny that it is the increasing importance of technology that has kept me in a job for the past 25 years, and where would I be without my iPhone.

There is no doubt that Jobs has made a profound impact and has certainly helped to humanise technology in our computer-obsessed world. There are many instances where his innovations have enriched and improved our lives. If we take for example healthcare, the tools he created have supported patient empowerment and few have done as much to bring about the rise in use of mobile devices by medical professionals.

Many big-name electronic health records vendors have developed iPhone or iPad access capabilities and there’s also an increasing number of iPad-native EHRs, and these devices are proving their worth in telehealth and for remote diagnoses in time-sensitive emergencies. Plus the plethora of self-monitoring, smoking cessation, fitness and assorted other mHealth apps in Apple’s App Store have helped bring about a new era in personal health.

So, although not in the same league as Einstein, Jobs has made his mark in history. And to quote Neil Diamond, “iSad”.

Susan Venables
Client Services Director, Highland Marketing

With the advent of the demise of the National Programme for IT (NPfIT) will we see a procurement spate or blight?

Eight days ago we heard for the third time from the coalition government that NPfIT is dead and in last week’s blog, Sarah Bruce questioned once again whether this is finally it? Surely the cancellation of the contracts and a potentially enormous legal dispute could cripple the Department of Health, so is the intention just to let the LSP contracts ‘wither on the vine?’

Either way the announcement that Intellect will be working with the Department of Health’s Informatics Directorate is very welcome, especially after it has launched a campaign to engage with over 280 healthcare suppliers of different types and sizes.

Interestingly there are far more IT vendors now than at the start of the NPfIT, many who went away to other countries after being shut out from the programme have come back much stronger.

The view from Mike Sinclair, vice-chair BCS Health, is particularly interesting. He explains: “While we welcome this move, we are concerned however, that this is being done in the absence of an informatics strategy and without any guidance on the future of existing contracts or whether money will be devolved into the NHS alongside responsibility.”

Sinclair appears to be absolutely right. Will chief executives of NHS trusts now be applying for their part of the £12 billion? If this is the case then no procurements will take place as they wonder whether IT funding will be released from the centre. Or perhaps will we see the demise of the NPfIT as removing the ‘’handcuffs’ from NHS trusts keen to start their own procurements. Either way IT vendors should see some very interesting times.

As IT professionals we have a duty to support the government’s transformation agenda. But how will the systems and infrastructure be procured to support the transformation? It is key that procurement takes places within the appropriate timescales and if those timescales fall into many months or potentially years, then there will really be no transformation at all.

Jeremy Nettle,
Chair of Intellect Healthcare Group

Yesterday the Daily Mail ‘exclusively’ splashed the headline ‘£12 billion NHS computer system scrapped’ across its front page.

Having gasped at the check-out and nearly dropping my pint of milk after seeing the headline, the lady at the check-out in Sainsburys must have been concerned at my look of shock. Could the programme really have finally been completely abandoned? Have the contract negotiations with local service provider, CSC, really failed?

It turns out, probably not. Despite almost every national newspaper and health and IT business to business publication picking up on the lead, it turns out that there is really very little that is ‘new.’

Yes, the Major Projects Review of NPfIT has been completed and NHS chief executive, Sir David Nicholson, has written to the NHS regarding the ‘renewed steps’ that the DH is taking to move from a top down centralised system to greater local decision making. But the letter doesn’t actually tell us anything new about how it will be done.

In fact the letter gives little more information than we all knew back in September 2010, when virtually identical ‘Government scraps £12 billion NHS National Programme for IT’ titles hit the headlines of those same newspapers.

Even many of the statements that have been given by Francis Maude, who led the review and the DH, are the same with the exact key words popping up ‘scrapped’ ‘dismantle’ ‘local control’ ‘local decision making’ ‘move away from a top down approach’ and ‘greater choice’

Regardless of all this noise, the press release from the DH sums up the multi-billion dollar question: “We will continue to work with our existing suppliers to determine the best way to deliver the services upon which the NHS depends in a way which allows the local NHS to exercise choice while delivering best value for money.”

So is there anything new at all? Well, despite there clearly being a few rumbles of discontent from high up within the programme, it doesn’t look like the final nail has been put in the NPfIT coffin just yet. The LSP contract negotiations are clearly still ongoing and a subsequent informatics review is yet to follow in the autumn.

However, it does more than hint that there is the likelihood of much more business about to come around for many suppliers previously shut out of the NHS by NPfIT. Those suppliers should already be gearing up to get their message across to potential clients that they are ready and willing to take on the challenge.

Sarah Bruce,
Marketing Manager at One Health Alliance
Communications and Digital Media Consultant at Highland Marketing

Last month it was Smart Healthcare, before that it was HC2011 but this month it’s been the NHS Confederation’s time in the conference spotlight

Although I didn’t make it over to NHS Confed this year, I’ve heard many reports that health IT suppliers dominated what is traditionally an event focused on management, policy and politics.

But with the IT suppliers apparently trying to target a different audience, it begs the question of whether they see value in exhibiting at the increasing amount of national or international healthcare IT specific events. Especially as technology, including digital telecommunications is liberating the business processes in healthcare, expanding the possibilities for collaboration across the healthcare enterprise, and accelerating the pace of change in virtually every field.

The organisers of such events clearly think that there is a strong market and with changes to the NHS coupled with the government’s drive for greater use of IT and innovation within healthcare, it’s no wonder why the amount of such events have at least doubled.

But the race is on for at least two organisations to convince suppliers and NHS Delegates that theirs is better and well worth supporting than the other. However, I believe only one of them will be able to claim any Olympian success.
With 2012 fast approaching the healthcare conference organisations are starting to vie for your support. At least two of them intend to hold conferences within a matter of weeks of each other, with the BCS teaming up with Kable (Guardian Group), who formerly ran Smart Healthcare Live. Two weeks later in Birmingham, former BCS partner, Citadel Events are going it alone offering a free conference to NHS Delegates – In4matics.

So the questions must be asked in these austere times, is there a place for these large conferences, can the NHS afford to attend, can suppliers pay the costs of exhibition fees, the resources to man the stand let alone the hotels and other expenses associated with two or three day conferences?

Don’t get me wrong, the exchange of ideas, debate and networking that we see at good quality conferences is great BUT do we need three, four or even five in a year? My preference would be to have one good national/international conference in the UK for the NHS to show off its best and for the supplier industry to respond accordingly.

Many suppliers are moving to webinars with online Q&A where ‘delegates’ can watch either in real-time and participate or download at their convenience and from their own workplace. No travel costs, no hotel costs and certainly no exhibition cost. I recently chaired such an event, which had more than 1400 people registering with very powerful lead generation. So maybe there is a place for more of these types of digital interactions.

So in a time where the NHS is mandated to make massive savings, how then can these multiple events succeed without incurring huge losses and disappointment? Letting the market decide may be one way, or accept that actually low cost/budgeted events using multi-media will have their day.

Jeremy Nettle,
Chair of Intellect Healthcare Group