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Carter Review urges NHS to raise digital game



Report on operational productivity in English hospitals calls for 2018 implementation deadline for key digital systems

NHS hospitals in England need to improve their use of ICT urgently, adopting key digital information systems by October 2018, according to the Government's new report on their operational efficiency.

Lord Carter's (pictured) review of NHS acute hospitals, published today by the Department of Health (DoH), paints a broad picture of wide variations in the running costs around the service, and highlights serious problems such as 'bed blocking' and wasted money.

Among this is a focus on a disappointing use of digital technology by hospitals. More than a decade after the launch of the NHS National Programme IT, the review says that many trusts are still guilty of an “immaturity” in their use of basic information systems, such as those for e-rostering and e-prescribing.

Its recommendations include the 2018 deadline for trusts to have fully integrated systems for these functions, along with RFID, patient-level costing and accounting systems, e-catalogues and inventories for procurement, and where appropriate electronic health records.

Meaningful use

Carter says that NHS Improvement – the organisation set up in July to push frontline improvements in healthcare – should set standards for “meaningful use” of the systems and provide incentives for trusts to use them. Also, the DoH should make some of the money set aside in the Spending Review for healthcare technology available for trusts to meet the standards, but with meaningful use clauses in the contracts.

The review also identifies a failure by many trusts to make full use of the Electronic Staff Record (ESR). This leaves them without a clear picture of where staff are and what they are doing.

It says they have to get a grip of the coding for the ESR database and use the relevant data in the day-to-day management of staff.

A further, and highly familiar, problem is that much NHS data still resides in “independent pockets”, sometimes guarded by its owners, which makes it harder for doctors and hospital staff to use real time data in making decisions.

“It's long been said that the NHS, as a national system, has a huge opportunity to join up this data across boundaries but we continue to struggle to make this happen,” the review says.

New structure

Among the recommendations for clinical governance and best practice is that NHS Improvement pulls all existing clinical registries and data source feeds into its new structure by July of this year. This would help to establish national and local dashboards for each clinical speciality, enabling real time assessment of clinical performance.

There are more positive elements to the review's take on digital systems. Carter acknowledges that the Government has made £1 billion available to the NHS for investment in new technology over the next five years, and cites a number of cases where hospital teams have used digital apps and systems to improve performance.

But the overall view is one of a service which is still lagging in its take-up of digital and use of data.

Commenting on hospitals' performance as a whole, Carter said: “My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand in hand. To improve the quality of care hospitals must grasp resources more effectively, especially staff, which account for more than 60 pence of every pound hospitals spend.

“Giving hospitals the tools and support to better manage resources will make it easier for boards to follow the example of the best trusts and mean every patient can receive the same world class care, and taxpayers will also receive a fairer return on their significant investment in the NHS.”

Image from GOV.UK, Open Government Licence v3.0

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