There may be troubles ahead...

2011 was billed as a year of transition for the NHS, but in the end a lot of the issues that had to be resolved at the start of it remained unresolved at the end.

The government was forced to delay the passage of its Health and Social Care Bill, which will make major changes to the structure of the NHS. It failed to publish the promised NHS information strategy, and has yet to issue guidance on how NHS informatics will be supported in the future.

The participants in a round table set up by eHealth Insider to look ahead to 2012 felt this uncertainty about the role of the “centre” and the responsibilities of local organisations had been a major stumbling block to IT developments.

Until these roles were sorted out, they argued, there is a risk that good systems and talented people will be lost in the “chaos”; and organisations will be too “paralysed” to embark on big procurements and IT implementations.

Mind the funding gap

One trust that is not standing still is Pennine Acute Hospitals NHS Trust, which is working in a consortium of ten trusts across Greater Manchester to procure picture archiving and communications systems and radiology information systems; the national contracts for which come to an end in 2013.

Pennine Acute’s associate director of IM&T, Christine Walters, said its hospitals remained “very paper based” and there was a “big opportunity to use technology to improve not just how the clinical side is delivered, but the non-clinical side.”

However, she pointed out that her trust is operating under significant financial constraints because of the imperative for the NHS as a whole to deliver £20 billion of efficiency savings over the next four years, with much of that coming straight off the NHS tariff.

“My trust has significant financial challenges, but I’m able to tap in for funding because it recognises that technology can transform patient care - but we have to be able to justify it,” she said.

Walters feels optimistic for her organisation in 2012, and told the round table it had both a clear strategy and the clinical engagement needed to make things happen. But while the more able trusts would be OK, she said, she was not confident about others.

Scrubbing the slate clean

A managing director of The Advisory Board Company, Jonathan Edwards, was cautiously optimistic about the use of health IT in 2012, arguing that transformation could not happen without technology. But he too was worried that trusts have taken their eye off the ball in terms of procuring essential IT systems.

Edwards said the demise of the National Programme for IT in the NHS had led many trusts to “pull back from the HISs (health informatics services), due to perceived issues with some of the service levels they have been getting.”

“Trusts are saying ‘we need to start from scratch’,” he said, and while this clean slate approach created a lot of opportunity, it also faced massive challenges because of the funding squeeze and the need for trusts to have strong business cases for any investment.

“[IT] remains something that trusts understand as being critical to quality improvement, but it seems to have become more of a long-term focus than a short-term focus, given the cost focus and disappointment of the national programme,” he argued.

Nick Harte, solutions director Northern Europe, Middle East and Africa at iSoft, a CSC company, said there was enormous pent up demand in the health service for a number of services offered by his company; so there was reason to be optimistic for 2012.

His concern was how quickly the NHS could get over the paralysis caused by the latest reforms. He also wanted to see trusts thinking more creatively about funding.

For example, he argued that trusts could work with big-pharma companies on IT developments that would both benefit them and generate data for clinical trials and other research projects.

Getting patients involved

Again and again, though, participants at the iSoft-sponsored event returned to the issue of “clarity” and how the ongoing lack of clarity about policy, organisation, and future demands were a major barrier to innovation in the market.

Justin Whatling, BT chief clinical officer, said it was important for the role of the centre to be clearly defined, so everybody else could understand their position in the new system.

“We need to find a middle ground. We need the centre to tell us what it does - not telling how us how to do things - but allowing things to flourish locally,” he said.

Participants also agreed that if the NHS was to continue to provide the expected levels of care, patients would have to take more responsibility for their own health.

Joanne Shaw, chair of NHS Direct, argued that it was imperative for technology be used to enable people to make better decisions and manage their health more effectively. However, she was not optimistic for developments in this area next year.

“When you look about the NHS, there’s real reason to be concerned. You can see technology being implemented that actually cuts the patient off from the system rather than integrating the two,” she said.

“I expect to see increasing divergence between what patients do themselves for their health [through the] use of technology and what the NHS is offering.”

Shaw argued that primary care desperately needs clinical engagement in the benefits that technology can bring to patients.

“The scale of change in primary care and clinical commissioning groups makes that a real challenge over the next 12 months, and it’s hard to see in many places how that will move forward,” she added.

“Some [CCGs] probably have some idea of how IT will support them, but for many it will be very, very low on their agenda. That’s one area where we may not see much progress in 2012.”

Clarity – perhaps in 2013

Health ICT Consulting director John Cruikshank, who wrote a major report on the future of the national programme for the 2020Health think-tank before the general election, feared the loss of some of the good things that had come out of national approaches.

His report argued that while there were many problems with the programme, it needed “fixing” rather than scrapping; but there was a danger that a new government would lead to a “hiatus” in NHS IT.

The best part of two years on, he told the round-table that the move to devolve IT decisions that had taken place was good, but “the pendulum seems to be flying very quickly.”

“Some NHS organisations may be well capable of responding to the IT agenda, but some may not be. As strategic health authorities disappear we may see a return to the days of the 1990s, where we had clear leaders and clear laggards in terms of application and use of IT,” he said.

And he added: “I’m much more optimistic for 2013 onwards than I am for 2012.”

The round-table was held on 14 December. It was chaired by Jon Hoeksma, editor of eHealth Insider, and the participants were: Paul Smith from EHI Intelligence; Joanne Shaw from NHS Direct; Nick Harte from iSoft, a CSC company; John Cruickshank from Health ICT Consulting; Justin Whatling from BT; Jonathan Edwards from The Advisory Board Company; and Christine Walters from Pennine Acute Hospitals NHS Foundation Trust. A full report will be published in January 2012.