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Sunday, June 19, 2005

NHS Connecting for Health Annual Report 2004-05 - A brave new world ?

NHS Connecting for Health Annual Report 2004-05

NHS Conecting for Health has published "A review of the year 2004-05 highlighting achievements in delivery and engagement" and it seems to me more like a glossy brochure selectively trumpeting it's successes than a true annual report giving both positive and negative aspects. Let's hope that the reference number 1984 which has been allocated to the document is not prophetic!

Perhaps this is what Richard Granger meant when he insisted at the HC conference in Harrogate in March that the National Programme for IT (NPfIT) must be credited for it's achievement and not knocked for it's weaknesses.

His introduction gives an overview of some of the work undertaken in the 2 years so far on the "digitisation of the NHS". Terms such as the "NHS information illiquidity problem" will I'm sure enter everyone's lexicon, and perhaps provides a modern example of doublespeak. Other areas could be considered as glossing over some of the barriers which are emerging eg the number of NHS staff registering with "the spine" being over 5000 per week which sounds impressive - but even at that rate registering all staff in the NHS is likely to take 3-4 years.

There are several claims throughout the document, not just about the potential clinical and managerial benefits which NHS Connecting for Health (sometimes colloquially known as NHS Con), will bring but also about financial savings which will emerge. eGov Monitor have picked this up saying:

"Another development from the annual report, not thought to have been previously announced, is its claim that central purchasing of core systems and services will save the NHS in England an estimated £3.8 bn over 10 years."

It is not clear how this figure has been arrived at - presumably by central purchasing at a national level rather than local contracts - but if those contracts were not needed except to comply with the NPfIT standards, then it is a nebulous saving.

Another financial feature mentioned is about the mechanisms to collect data for the Quality Management and Analysis System (QMAS) for GPs, where the involvement of the NHS Bank is highlighted. I thought the remit of the NHS Bank was to be responsible for allocating the special assistance fund, which provides grants to SHAs with particular financial difficulties, but this seems now to include QMAS payments to GP surgeries.

Towards the end of the document there is a feature on the efforts to win the "hearts and minds" of NHS staff - which is rightly seen as one of the biggest challenges for the programme. It includes a quote from Alan Burns, service implementation director, who says "If you just computerise what you do, its not worth the effort", which I think could be read in several different ways!

Social care is mentioned in a column on the Care Record Development Board (CRDB), but hardly rates a mention in the rest of the document. The integration of health and social care records, and working practices, is potentially another major challenge for this work and seems to be being put off, to be dealt with later, rather than being addressed in the early procuremnet and implementation phases.

The involvement of patients and the public is also mentioned, although it appears this report may have gone to press before the publication of the 12 commitments in the Care Record Guarantee

Education and training is mentioned several times in connection with different projects eg Choose and Book & PACS systems, however it is not clear how pilot sites which are receiving "extensive support from the centre" are to achieve the necessary increase the knowledge and skills in their own staff, let alone other NHS organisations which do not have such extensive support. It is also not clear how the relationship between the NHS and Higher Education will be advanced, or whether online resources and demonstrations will also be available to those working and studying in the education sector.

Mention is made of the deal with Microsoft for desktop licences and a "consistent interface" across the NHS, which may reduce the training need and save staff time - but it doesn't say how tying the NHS to Microsoft for 9 years meets the recomendation of the government e-envoy on open source software., and certainly before the debate in the house of commons on the story of Helen Wilkinson a national health service practice manager, who found errors in her medical records and following a long period of correspondance wanted her records removed from the NHS and is very anxious about the implications of electronic patient records. This case raises important issues for privacy, confidentiaility and civil liberties which NPfIT needs to address.

The moving ahead section at the back of the annual report, suggests we are to receive a major information campaign related to electronic records and other NHS Connecting for Health work - it will be interesting to see how balanced this is, or whether we will get more glossy brochures, like this annual report.


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