NHS information strategy: powerful plan or just a vision?

The power of information is a punchy title for the government's health and social care strategy. But while this long-awaited document is powerful on rhetoric, it's weak on implementation and reaction has been mixed. Jeremy Taylor, the chief executive of pressure groups Patient Voices, says the strategy is really a vision document: "The language is almost laughably seeking to avoid any impression of top down dictate; because this is the way this government does its business, but also because the previous government got badly bitten by the National Programme for IT." Localism is at the heart of the paper: although there is existing national infrastructure - such as Choose & Book and the Spine - and impetus to be provided by some central funding, future decisions about informatics spending will be down to local organisations. According to the Department of Health (DH) the strategy is about "a major culture change in which people take more control and ownership of their health and care, and partnerships are created with professionals treating them. "The government needs to set a clear strategic direction - we cannot tell people what to do - but we can help support people to make it happen." More detailed implementation planning will be led by organisations including the NHS Commissioning Board, the Health and Social Care Information Centre and Public Health England, the department promises. Some insiders believe that - unfortunate as this may be - financial incentives are necessary to drive change across the health service. For example, economic rewards have helped drive GP computing in a way that has not happened in hospitals. Dr Paul Altmann, the chief information officer at Oxford University Hospitals NHS trust, says: "In America one of the things that Obama has done very well is to develop a concept of meaningful use. So all healthcare organisations are told that they need to work towards electronic-centred information over three to four years. "If they do so much in year one, then they get a significant amount of money. In year two they get a little bit less, and in year three they get less. If they haven't achieved it in year four, then they start being penalised. Perhaps we need to develop similar incentive processes." The strategy promises a capital fund for informatics, initially covering 2013-14 and 2014-15, but it will be later this year before more details are released. At a time when the NHS is facing unprecedented budget cuts, this could be crucial in preventing the diversion of resources from frontline services. A small number of actions that will need to be led nationally, are set out in the strategy, however. One of these is the development of integrated health and social care networks, although the DH acknowledges that many health and social care IT systems have their own 'standards' and do not work together. According to Dr Charles Gutteridge, the DH's national clinical director for informatics, in 2013 the NHS Commissioning Board will publish standards for interoperability and have a process which "both rewards people who use the standards and applies sanctions to those who do not". Another action for 2013 is to provide a single portal, bringing together services currently provided by NHS Choices, NHS Direct online and Healthspace, plus a 111 "routine" phone number. For 111 this deadline could be over-ambitious because of issues with potential suppliers. Serco has decided not to bid and Capita has expressed concerns about the tendering process. By 2015 all general practices will be expected to enable patients to book and cancel appointments, order repeat prescriptions and access their records online. Issues about the confidentiality of electronic patient records remain unanswered by the strategy. Dr Laurence Buckman, the chair of the British Medical Association's GPs' committee, says: "We believe patients should have access to their health records, but we'd want to be satisfied that their records would remain secure before this was implemented. "For example, it would be important to be certain that it couldn't be an abusive partner or a parent trying to access their teenager's records." On the portal, Buckman says he would need to see the detail. He supports the sharing of relevant information between healthcare professionals, but maintains there are "challenges" with shared electronic systems. Victor Fraga points out that the information commissioner has found the NHS to be UK's the number one data breach perpetrator. The senior health analyst at Kable argues that: "Electronic record suppliers will need to provide NHS trusts with an online patient interface supported by robust end-user legitimisation and consent mechanisms, a recognised security token, as well as accepting some of the liability and penalties for any data losses and breaches." If the strategy does turn out to pack a punch, the benefits could be considerable. Andrew Lansley, the health secretary, says that digital and online services can simplify care. And there are financial benefits: Altmann points out it costs the NHS £5 each time a hospital doctor retrieves a paper patient record. London's King's College hospital has a target to be paperless by 2013. It has already rolled out e-prescribing and continuation notes are made electronically which, it says, has assured legibility and accessibility of medical records. Nurses use iPod Touch devices to record vital signs at the bedside, and the data is then sent via a wireless network and loaded into a web-based application, which clinicians will access via the core electronic patient record. The strategy uses King's College as an example of success; it indicates that even in secondary care it can be done. This article is published by Guardian Professional. For weekly updates on news, debate and best practice on public sector IT, join the Guardian Government Computing network here.