Wednesday, March 03, 2010

Commission on the Future of Nursing and Midwifery calls for the development and use of new technologies.

The report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England sets out the way forward for the future of the professions which was published yesterday, calls for the establishment of a "high-level group to determine how to build nursing and midwifery capacity to understand and influence the development and use of new technologies. It must consider how pre- and post-registration education and development programmes could best deliver technological understanding and skills for information, communications and practice."

Amongst a range of other recommendations about the delivery of "high quality, compassionate care" emphasis is placed on the role of nurses and midwives in "making best use of technological advances as an increasingly important aspect of high quality care, including innovative ‘remote care’ approaches such as telenursing, as well as improving metrics", with the appointment of “innovation fellows" to lead some of the changes.

The has implications for all nurses and midwives and the educational processes which prepare and support them: “Starting in their initial education, nurses and midwives need a better understanding of and influence over the development of technologies and informatics, including information and communications technology and remote care.”

It will be interesting to see how some of the (vague) aspirations are turned into reality, particularly with current budget pressures in the NHS. The "high level group" has the potential to usher in some interesting developments and I wait with interest to see who might be selected to serve on this - and how its remit will be worded.

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Tuesday, March 03, 2009

Developing a culture of knowledge sharing across the NHS that stimulates the application of Heath Informatics research and best practice

Clinicians, from the Bristol Royal Hospital for Children, and Academics in the field of Health Informatics, from the University of the West of England, have joined together to evaluate knowledge sharing across the NHS. We aim to look at knowledge sharing both within the NHS and between the NHS and external organisations. We have developed an on-line survey which is aimed not only at NHS clinicians and health informatics professionals but also at representatives from external organisations which interact with the NHS.

Please take part in this on-line survey which can be found at:

Using this survey we hope to identify and explore examples of good practice, in terms of knowledge sharing, across the NHS. We also hope to document and understand the obstacles to knowledge sharing which currently exist.

Following analysis of the data, we aim to produce recommendations regarding how Heath Informatics research and best practice can help foster and support a culture of knowledge sharing across the NHS.

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Tuesday, January 27, 2009

PAC report on NPfIT

The House of Commons Public Accounts Committee has today published a damming report on the NHS's National Programme for IT (NPfIT) and Connecting for Health - the atgency "delivering" it. The report entitled "The National Programme for IT in the NHS: Progress since 2006" points out the delays and cost implications of current problems and highlights other issues concerning the the potential effects of the systems on the NHS and its patients.

The media this morning seems full of comment about the financial status of the programme and relationships with suppliers. (see links below) This is not surprising given the remit of the committee, however there is less comment on the lack of clinical functionality in the systems being deployed and the effect of this on the expectations of clinical staff. In addition some important points are made about data security and confidentiality of patient records and the concerns health professionals and the public have about this.

The report says "The Department considers that the current levels of support [from staff] reflect the fact that for many staff the benefits of the Programme are still theoretical," and comments on the requirements on staff to change how they work with little or no consultation.

The tension between the role of suppliers who are responsible for the security of the systems themselves, and NHS organisations and staff who are responsible for keeping secure any data they access are briefly explored. The report also points out "Access to the Care Records Service is controlled through Smartcards and passcodes, though these are not yet in use in all Trusts because early releases of the care records software in London and the South do not support them and the Trusts concerned therefore continue to rely on passwords." The change in the consent model adopted for the sharing of patient records to a "Consent to View" approach is also mentioned.

I hope to post some more thoughts when I've had time to read the report in full.

Further comment and analysis is available from:

BBC News - Warning over fresh NHS IT delays

Times Online - MPs point to 'further delays and turmoil' for £12.4 billion NHS computer upgrade

EHealth Insider - PAC gives NPfIT six months to deliver CRS

HSJ - NHS Confed calls for IT programme overhaul

Public - MPs' recommendations to improve NHS IT - in full

Public - Harsh MP committee report condemns NHS National Programme for IT

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Sunday, November 09, 2008

Socio-technical approach to technology projects in the NHS

At a masterclass event entitled: “10% Technology, 90% Business Change hosted by the UK Faculty of Health Informatics participants were asked "What should be done to make a socio-technical approach to the delivery of technology projects in health and social care in the NHS the norm?"

To continue the work of the masterclass a Wetpaint Wiki has been set up at: where relevant contributions are welcomed, which will be incorporated into the report which is being prepared with the hope that it can be used to influence key developments in the NHS such as the implementation of the National Health Informatics Review in England.

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Saturday, May 31, 2008

Armchair involvement for using technology to engage people in health service improvement.

The NHS Institute for Innovation and Improvement has recently launched a new web site called "Armchair involvement" which aims to provide a practical guide to using technology to engage people in health service improvement.

The site will provide:

* descriptions of different types of technology
* interactive examples of where technology has been used to involve and engage people in health
* the benefits and potential pitfalls of using technology to engage people.

Comments on the various pages are invited with opportunities to share your own examples of where you have used technology to engage staff, patients, carers, service users and the public - although there seem to be very few comments yet, and I don't know what evel of moderation will be employed.

In developing this work some of the key thinkers and leading experts from health, information, television, multimedia, horizon-scanning, telecommunications and service design have come together to discuss what technologies are available today and what tomorrow’s world may look like. It is claimed that there is a great deal of enthusiasm across the NHS for using these tools to reach people, to better understand their opinions and to encourage involvement in service improvement.

It will be interesting to see the level of usage - and whether the ideas, examples and opinions expressed lead to changes in the ways the technologies are used by the NHS.

The research report on which it is based aims to offer key inputs into the role of technology in shaping of the NHS’ future relationship with staff, patients, carers and the public.

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Wednesday, May 21, 2008

Wetpaint wiki on social networking in the NHS

Following last weeks meeting on Social Networking in the NHS a wetpaint wiki entitled May Masterclass - social networking
has been set up to ensure that everyone can contribute to the final event report and discussion paper. All contributors need is a passion for utilising the full potential of Social Networking tools in the NHS.

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Thursday, May 15, 2008

Masterclass Event - Social Networking in the NHS

Today (Thurs 15th May) I'm attending a NHS Faculty of Health Informatics Masterclass Event - The Power and the Perils of Social Networking Tools in the NHS

The day is being held at the British Library was to be chaired by Bev Ellis (Vice Chair – NHS Faculty of Health Informatics and Head of Health Informatics – University of Central Lancashire) but she was on a train with delays at Bletchley. Therefore Bruce Elliot took over those duties, and started with an intro to the NHS Faculty of Health Informatics, and set out the aims for the day and dealt with practical issues.

The first presentation by Rowan Purdy ( ex Head of Knowledge Services – Care Service Improvement Partnership and now Senior consultant, Surepoint) covered "An overview of current Social Networking tools and predictions for the future". He started with hands up on a roller coaster for who had IT & used it to social networking (at work). He gave the definition of social networking from Wikipedia and talked about some of the ways in which people use the characteristic tools. He talked about the bottom up v top down approaches both online and off line. He looked at feeling oppressed by their email & advocated RSS readers as a way to manage this. He moved on to talk about blogs as personal and corporate voices, and then moved on to instant messaging for immediacy and emotion. He talked about Skype and video conferencing tools. He then gave an overview of wikis for collaborative editing for agenda, papers etc. and how house style and peer review emerges. He mentioned clear forest which tries to extract meaning from content and talked about how the various tools link together. Social tagging as a way of adding labels & keywords to create tag clouds and social bookmarking eg delicious was presented as another social networking tool. Social libraries eg librarious and Youtube and other media sharing eg flikr were discussed along with MySpace, Facebook & LinkedIn (I gave trying to link to them all live at this point).

He then talked to tools for social networking in the NHS eg NHS networks, Knowledge community, & CISP developments. He then talked about how some of these tools could be used within NHS organisations to produce a layer of loosely connected social tools. He highlighted the importance of the culture and passion rather than technology & mentioned the importance of leadership & behaviours. He got out his crystal ball to look at the future Web2.0 & Web3.0 providing more power to people to reuse content eg Yahoopies, QEDwiki, adding the personal touch & customisation eg BBC site. Second Life & its application to real work looked at potential applications for the future. The cabinet office was given as a potential example iterative policy documents. His final points were that technology is not key but that people being willing to take risks are the way to take small steps to help each other move forward. His gave the attribution for his photos etc and encouraged others to do the same otherwise people will stop sharing. The Q&A started with discussion of inclusion, IT literacy, access etc etc. Rowan suggested that some social tools eg Flikr are a way for getting those with less IT skills switched on to IT use, through the element of fun. The risk of the multiplicity of tools can reduce communication rather than improve it came up as a question & this raise issues of "smartness" & "interoperability" & building onto & connecting with others. The generational issues were also highlighted - and in came the words "control" by the organisation.

The power and the potential of the patient’s voice in transforming Health services – the experience of Patient Opinion – Paul Hodgkin (GP and Chief Executive – Patient Opinion) He started by highlighting the importance of recognising the things that are importance for individuals. He looked at what is driving social networking
*Economics of voice
*Economics of collaboration
*Economics of reputation

He used examples of photos from Flikr clearly describing patients experiences and rateMDs and similar sites. The freedom of speech issues and payment by advertising were seen as increasing the rankourous nature. He also talked about patient opinion & how they are checked & 5% edited & add tags. He also highlighted how the comments can be used to change practice. Collectivised wisdom as a social benefit and the importance in getting the tone right in web based responses - so it doesn't look like a whitewash. The issues of access and IT use in the elderly were addressed with phone and paper alternatives described. The profile of responders was discussed but not claimed to be representative but covers all almost all NHS services. He talk about how postings can be directed to the right managers and other key interested players via email alerts. The comments are rated so that you can filer the types of comments you want to see, and various reports are generated. It was funded by the DoH & is now funded by small subscriptions from Trusts etc & the benefits of this were highlighted. He moved on to talk about NHS choices - Your thoughts & the importance of independence and the value base and the similarities and differences between the different approaches. He talked about the advantages & disadvantages of surveys, user groups etc and the underlying business models. He described some of the lessons learned from the Patient Opinion experience and the advantages and highlighted some of the difficulties to achieve adaptation and use by public services - its about conversation not about data - not representative but useful. He took a Q&A session about Patient opinion which discussed identities, & how the data could inform reviews of the NHS & links to public health depts. Looking at the Return on Investment in terms of improvements compared to investment & whether this data was available + getting subscriptions out of hospitals and PCTs, SHAs, DoH etc.

A break was them negotiated, before Paul continued to talk about the cost of collaboration based on Clay Shirky's book. Examples given included pledgebank, and suggested how this can be used to recruit people for campaigns etc at low cost for people who feel isolated which can be benign or malign. He looked at the public policy on choice based on exit or voice & how exit has been the main way in which choice has been expressed - but how we are likely to move towards voice. He moved on to the economics of reputation and gift economies. value no longer resides in scarcity in the digital economy and non financial incentives. Work satisfaction is related to autonomy - linked to NHS culture. He suggested using the sort of things that ebay does to rank sellers could be used to rate GPs, outpatients depts & consultants, based on end user satisfaction not process. Q&A discussed issues around doctors being willing to rate each other, and the tensions between localness and general access. Also discussion were raised around private v public comments. Patientslikeme was discussed as a possible way forward.

The next presentation was about Experiences in the power and the perils of the use of Social Networking tools by Healthcare Staff and in Higher Education by me. The presentation will be added here later.

A summary of research on the power of Staff, Patient and other blogs et al in influencing change in Health and across the Public Sector was to have been given by – Steve Moore (Director and Co-founder of Policy Unplugged) but he was unable to attend.

Using shared experiences: the future of social networking in the NHS Helen Nicol (Programme Manager – Capability & Capacity – NHS Connecting for Health and author of the "The Business of Knowing" blog). She described herself as interested in the way technology can enable learning and the interface between online and face to face. She talked about the conversational web and how the wisdom of the mases has a lot to offer in knowledge generation. She drew a parallel between the power of computer networks and networks of people. Her presentation was in two parts, one from the consumer perspective and the other from the organisational. She emphasised the points made earlier about people trusting user generated rather than professional advice and the useful "anonymity" of the web to investigate personal issues. The move to niche sites and applications for people with particular diseases or conditions was discussed, along with attitudes to institutions and conformity. The need for a recognition that there is more gray than black and white was highlighted. The expert patient approach and the qualitative components of interactions were seen as being key. Helen discussed espace and some of the issues which surround the "institution" and peoples willingness to "open up". The facebook group "Escape from NHS Connecting for Health" even got a mention, before moving on to look at appropriate business models. Helen then moved on from patients to the organisation and learning from experience. She raised questions about whether "communities of practice" can be engineered. Sermo was given as an example of the doctors lounge personified. Information arbitrage was then discussed as the model for pharmaceutical companies to gather data from communities of experts. The difficulties of creating communities either online or off line was explored with examples from espace. The demise of NHSnetworks was given as an example of the difficulties and OpenID and similar systems to integrate the disparate systems well suggested as the way of the future, and some suggestions for the NHS were put forward. Q&A touched on espace & whether it has a clear purpose.

The new report from Demos – "The Talking Cure: Why Conversation is the Future of Healthcare" was suggested as good reading.

The general discussion "What should be done in order to maximise the power and potential of Social Networking tools within the NHS and minimise risks?" was later than planned and occurred with final tea & coffee. The elephant in the room of "can you create a social network" was raised & the possible need for a "manager" was also raised. The importance of sharing between the different countries in the UK was highlighted.

Key messages were about trying things out and if its not working try something else. Support the mavericks & don't let them leave.

The place and ownership of social networking in the NHS raised problems & will be included in the final report which is being created as a wiki led by Rowan & the link to it will be placed here when available.

Delegates left for journeys home - with potential problems if they are getting trains up the west coast main line.

Members of eSpace and the NHS Faculty of Health Informatics can view copies of the presentations at:

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Wednesday, February 27, 2008

"National" NHS elearning system

The British Journal of Healthcare Computing and Information Management is currently carrying a news story "NHS to deploy national system for elearning" about the provision of a National Learning Management System (NLMS) as part of the NHS Electronic Staff Record (ESR).

This will provide both individual employees and their managers access to each persons record of learning. The new system is supposed to be piloted from June 2008 and is expected to be made available nationally by September 2008.

It will be interesting to see if this "national" system for England will be able to exchange data and resources with the system currently being purchased for NHS Scotland, and whether any testing has been done to see whether the system can exchange records with the systems used in universities and other educational organisations which deliver much of the learning (and elearning) for NHS staff.

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Friday, August 17, 2007

Health Informatics Community to restrict access

The latest bulletin from the Health Informatics Community says that:
"we plan to review our policy on access to the HIC and you will only be automatically granted access to the closed areas of the site if you have a, or domain name."

I am worried that this will limited the opportunities provided by this site for the exchange of news, views and ideas, and will mean that those from academia and others with a legitimate interest in the development of health informatics in the UK, including members of the Faculty of Health Informatics will be excluded from discussions.

I have sent an email requesting further explanation or discussion of this decision but not, as yet, received any reply.

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Thursday, July 19, 2007

Dr Foster & the Information Centre

Following the report in February from the National Audit Office about the deal between the NHS Information Centre and Dr Foster the public accounts committee of MPs has now weighed in with further criticism of the way the deal was done and the valuation placed upon it which put lots of money (£7.6 million) into the pockets of the shareholders of Dr Foster.

The EHI report DH blasted for 'back room deal' with Dr Foster carries further comment and criticism.

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Tuesday, February 13, 2007

NHS CfH Southern Cluster ETD day

Today I attended a study day organised by NHS Connecting for Health Southern Cluster Education, Training and Development (ETD) at Taunton Racecourse.

The day was chaired by Nick Jupp (ETD Lead, NHS Somerset Health Informatics)

The first speaker was different to the usual NHS "Men in Suits" when - Andrew Raynes (ETD Programme Manager, NHS CFH, Southern Cluster) appeared in his schoolboy outfit and used a high tech drum kit to illustrate points he wanted to make about working together, under the title of "NPfIT Skool of Rock". He achieved audience participation with the use of maracas and tambourines.
(I have video available for blackmail purposes)

The next (rather dry) presentation was on the Role and Benefits of Change Management within NPfIT by Steve Swift (Business Change Manager , Fujitsu NHS Services)

After coffee and some useful networking with colleagues from the NHS, Cerner and Fujitsu alliance, Phil Bolton (E-learning Development Manager, Royal United Hospital, Bath) gave a presentation about the issues they have experienced in training for their implementation of Cerner Millenium Release 0 which has been delayed for 14 months (so far) and demonstrated an elearning application they have developed rather than use the training domain provided by Fujitsu.

The final presentation of the morning was by Dr Roger Tackley (Chairman Southern Cluster Terminology Group SCCAG) who talked about the SNOMED CT terminology system as a concept. This seemed unfamilar to many of the trainers present and he emphasised the importance of this for clinical use of the Cerner Millenium system.

After a good lunch there were four parallel sessions:
• Table top challenge –Maria Scott (Clinical Benefits Advisors, NHS CFH)
• Professional Support and Development workshop - Di Wilson (ETD Networks Development Manager, NHS CFH) / Jackie Smith (Informatics Specialists Development Managers, NHS CFH)
• CIS Accredited Learning – Kamru Mohammed (ETD Systems & Platform Lead, NHS CFH)
• Implementing Training standards (What do you want out of the standards – A Case Study approach) – Jonathan Coe (ETD Standards Delivery Manager)

I attended the session on Professional Support and Development which involved teams using a variety of children's toys, sellotape, and modeling clay to represent what health informatics is and the knowledge and skills required - and the role of NPfIT (during which I got to do a bit of juggling!)

The day closed with a panel session answering (or trying to) some of the questions which had been put onto post it notes during the day by delegates.

An undercurrent to the day was provided by a report on the Radio 4 news this am which was carried by the Times as £6.2bn IT scheme for NHS ‘is not working and is not going to work’ with the comment that "A lack of vision and poor understanding of the sheer size of the task meant that the IT overhaul “isn’t working and isn’t going to work”, by Andrew Rollerson, an executive with Fujitsu. As I was sitting at a table with some of the staff from Fujitsu this caused some discussion!

Generally it was quite an interesting day - although obviously aimed at NHS ETD staff rather than me - and I did make some useful contacts and learn some bits I wasn't aware of.

I am assured that the power point presentations will be made available on the NHS Connecting for Health Southern Cluster Education, Training and Development (ETD) web site.

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Friday, February 09, 2007

NHSu report & Information Tribunal

Following the decision notice issued by the Information Commissioner in November about my request for the report by Sir William Wells into the NHS University, I have now received copies of the appeal by the Department of Health and the response to the appeal by the Information Commissioner.

The Department have argued that the Information Commissioner was wrong in his application of sections 33, 35(1)(a), 40(2) and 41 of the Freedom of Information Act 2000.

The appeal hearing is to be scheduled between 8th and 22nd March and the Information Tribunal and is aiming for a final determination by 22nd June 2007.

I am currently deciding whether I want to be "joined to the appeal" & will post further news wen I know the date of he appeal.

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Wednesday, January 03, 2007

NHSu report - DoH has appealed

Happy New year.

As regular readers of this blog will know I have been trying, for over 2 years, to get the Department of Health to disclose the report by Sir William Wells into the NHS University.

At the end of November I thought this had suceeded when the Information Commisioner issued his decision notice agreeing with me that it was in the public interest for the report to be published and ordering the department of health to disclose it within 35 days.

I have been watching for this over Christmas and New year and the 35 days expired a few days ago & I hadn't seen it.

I have found out today that the Department of Health appealed, on 21st December, to the Information Tribunal. Although I have not seen a copy of the appeal I understand it argues that the Information Commissioner was wrong in his application of sections 33, 35(1)(a), 40(2) and 41 of the Freedom of Information Act 2000.

The appeal has been sent to the information commissioner and then the chair of the information tribunal will rule on what is to be done next. I do not know how long this will take but will post it here when I find out anything further.

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Tuesday, December 05, 2006

NHSu - IC Decision Notice Now available

The Information Commissioners web site now has the Decision notice relating to the Wells report into the NHSuniversity see

You can search for Case ref number: FS50070878 or use the "Authority" drop down list to look at the Department of Health.

Now I'm just waiting for a sight of the actual report which I'm hoping will be posted on the Department of Health's New Publications page

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Thursday, November 30, 2006

Wells report on NHSU - IC Decision

The Information Commissioner has just released a "Decision notice" (Ref: FS50070878) relating to my request to the Department of Health to disclose the report by Sir William Wells into the NHS university (NHSU) which will appear on the Decision Notices section of their web site soon.

The creation of the NHSu was a 2001 Labour Manifesto commitment.

The Commissioner has ruled that under section 1(1) and 10 of the Freedom of Information Act:

1. The Department has not complied with its' obligations under section 1(1) of the Act in that it failed to communicate to the complainant information to which he was entitled on the basis that it is exempt from disclosure under sections 33, 35(1)(a), 40(2) and 41 of the Act.

In view of this he requires that:

The Department shall, within 35 calender days from the date of the notice (27th Nov 2006) disclose the information requested in accordance with its duty under section 1(1) of the Act.

I will not reproduce the full decision notice here - it runs to 15 pages of legal jargon and will appear on their web site soon, but I do want to give a few significant highlights.

I believe this is currently the longest running complaint.
I originally contacted my MP in Oct 2004
I sent my initial letter to the DoH on 1st Jan 2005 & they rejected my request
I appealed and they again refused (27th April 2005)

I first wrote to the Information Commissioner on 8th April 2005 and there have been various communications since.

I believe this is the first test of section 33(1) of the act which relates to audit functions of statutory bodies, and the commissioner has agreed with me that this should be disclosed to the public. It is not yet clear how much the NHSU cost but estimates of £50-£60 million pounds of taxpayers money do not seem fanciful. Maybe when we see the full report this will become clear.

During the course of the commissioners investigations the department claimed that in addition to section 33 of the act other sections applied eg 35(1) (formulation of government policy) for the entire report and sections 40(2) (personal information) and 41 (information provided in confidence) for parts of the report.

Although the commissioner accepted that some of the sections were relevant to the report in all cases he said that the public interest in disclosure was greater than the public interest in maintaining the exemption.

If the department disagrees with the Information Commissioners report they have 28 days to appeal - I hope they do not choose to exercise this right, as this has gone on long enough - however I am worried that some government lawyers will see this ruling as setting precedents which may be applied to other government departments and processes and will not be as open as I would like them to be.

I look forward to seeing the Wells report on the Department of Health Web Site as I hope there are many lessons we can learn for the future.

I still support the NHS and many of the declared aims of the NHSu although I have some doubts about the way in which it was implemented.

I will comment again here when I finally see details of the report.

I would like to say that although it has been a long wait I recognise that the Information Commissioner has received a massive number of complaints and I would like to compliment and thank the particular "Complaints Team Leader - Central Government" who has dealt with this complaint throughout in a professional and courteous way.

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