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Analysis: health and care revolution races the calendar



Analysis: health and care revolution races the calendar

Health Secretary Jeremy Hunt last week formally launched MyNHS, a new feature of the NHS Choices website. It displays the performance of hospitals, GP surgeries and local authority care services in what the minister described as "an easy-to-understand table with regularly updated information". Most interestingly, it is designed for use by professionals and patients alike: an example of the "power of information" - a slogan coined by the Cabinet Office under the last Labour government and applied by the coalition to the NHS - in action.

MyNHS was only one in a rush of high-level announcements suggesting that the government's vision of the NHS in England transformed by information is beginning to come together after the botched introduction of the plan. Another example was the NHS medical director's unequivocal order that all clinicians will have to make public their outcome data. Meanwhile, as UKauthority revealed, the government said it would back a private member's bill enforcing the sharing of health and social care data.

All this - along with the appointment of Dame Fiona Caldecott as national data guardian for health and social care - will be welcomed by those who have been crying in the wilderness for years that healthcare can - and must - be transformed through information.

Yet the Conservative ministers' vision (the LibDems have never shown much interest) risks running out of political time. Many essential building blocks are not yet reality on the front line of the NHS or local authority-provided care, let alone in the informal sector. For a flavour of what remains to be done, it is worth reading last week's other major development, the publication by the National Information Board of an 'information framework' for the NHS in England, Personalised Health and Care 2020.

The National Information Board, chaired by healthcare transparency guru (and a former journalist colleague) Tim Kelsey, spans health and care across the NHS, clinical science and local government. The framework - the board stresses that it is not a 'strategy' - is designed to help take forward the ambitions in the 2013 Government Digital Strategy and the Department of Health's 2012 Power of Information report. The result is a blend of vision, self-evident hard truth - "many other industries, including safety-critical ones, have transformed their use of information" - and groundhog day.

The vision comes in such propositions as: "The ability for clinical decision support to be auto-populated with my existing healthcare information (my past), to take real-time feeds of my biometric data (my present), to consider my genome (my future) and to configure the questions that I need to be asked based on this information."

The groundhog day element is the section - obligatory in every NHS plan over the past 20 years - to try end encourage conformity on the NHS number and a single clinical terminology (SNOMED CT, adopted in the late 1990s after the embarrassments over the abortive Read codes). According to the strategy, the NIB "will work with commissioners and providers across the care system, including local authorities, to agree how the NHS number can be universally adopted". It will also "actively collaborate to ensure that all primary care systems adopt SNOMED CT by the end of December 2016".

It is extraordinary that, two years after the Power of Information strategy - let alone its predecessors since the 1990s - that this still needs to be said. The old problem, of course, is the extreme variability in IT sophistication in different parts of the NHS, now compounded by the integration with social care.

One attempt to iron out disparities is a new "digital maturity index" to track increases in the effective use of information technology, digital data and services, and the consequent reduction in clinical bureaucracy. "This will feature from April 2016 within the NHS England commissioning framework and relevant system specifications."

Meanwhile, the framework commits to opening the NHS network to outside providers while maintaining security. The Health and Social Care Information Centre will next month publish a plan "for the progressive opening up of connectivity with and use of the NHS infrastructure to all care providers and service users, subject to accreditation". Retail pharmacies will begin to have access to summary care records by June 2015 "with a view to a national rollout and then extension into social service providers and to nursing homes".

Unlike its predecessor strategies, the framework includes concrete measures aimed at "building and sustaining public trust". This includes the appointment of Dame Fiona Caldicott as national data guardian for health and care - and a promise to place the role of the guardian on a statutory footing "at the first suitable legislative opportunity".

Despite the obstacles, Personalised Health and Care 2020 is relentlessly upbeat in its approach, even finding reasons for optimism in the lack of progress so far. "The good news is that as a 'follower' or 'laggard' industry, the health and care system has enormous potential to benefit from the experience and learning of others."

The opportunity is now, it says in big letters. What it does not say is that in six months time a new government may want to put its own stamp on the NHS computing and put digital progress on hold while it comes up with its own blend of vision and groundhog day.


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