The NHS was finally reorganised, health secretary Jeremy Hunt announced he wanted a paperless NHS – and found some money for it – the National Programme for IT came under fire yet again, and trusts had variable luck implementing their own IT systems.
The government found itself under fire for its care.data plans – even as Dame Fiona Caldicott’s second review of information governance imposed new restrictions on using data for commissioning – and the irrepressible Tim Kelsey came up with many creative ideas to give clinicians and patients data and get them coding. Whatever was happening in 2013, EHI’s newsletters told readers about it.
January:
The year opened with familiar NHS organisations getting ready to close down as a result of the ‘Liberating the NHS’ reforms, and new bodies getting ready to start work on 1 April. In the same spirit of ‘out with the old, in with the new’, NHS IT directors predicted that 2013 would be the year that the NHS really started to move on from the National Programme for IT in the NHS. But an EHI Primary Care survey revealed considerable concern about whether the shake-up of primary care IT structures would improve the service to GPs.
Then, in the middle of the month, health secretary Jeremy Hunt electrified healthcare IT by calling for a ‘paperless’ NHS by 2018. His call, in a speech to the Policy Exchange think-tank, was backed by a PriceWaterHouseCoopers report predicting that more use of IT could save the NHS £4.4 billion; but no central funding was promised.
February:
Reorganising the NHS does not, unfortunately, protect it from scandal, and February saw the publication of Robert Francis QC’s second report on Mid Staffordshire NHS Foundation Trust. The report’s impact was blunted by its length – 1,700 pages – and excessive number of recommendations – 290 – but it did identify a need for better NHS IT and information systems and much improved patient feedback mechanisms.
Leaving the National Programme for IT has not, unfortunately, protected some trusts from IT disasters, and February saw the first of a series of stories about the “significant operational and financial pressures” faced by Royal Berkshire NHS Foundation Trust, as a result of a disastrous implementation of Cerner Millennium. A week later, Monitor found The Rotherham NHS Foundation Trust in breach of its authorisation, in part because of a disastrous implementation of Meditech v6.0.
There were also signs that the government’s 3millionlives telehealth programme was going to struggle, with ‘pathfinder’ organisations admitting they were unlikely to recruit the 2013 target of 100,000 patients. And an EHI survey with doctors.net.uk found that most GPs were not ready to meet the government’s flagship IT pledge to give patients access to their records by 2015; never mind hold email consultations with them.
March:
If GPs were less than ready for the digital revolution in health, then Tim Kelsey, NHS England’s national director of patients and information, was ready to go much further. In a follow-up to his proposals for a Code4Health initiative to teach clinicians to write computer programs, he suggested that patients should also have a go at building apps. EHI readers were not convinced.
Back in the real world, three suppliers were shortlisted for a patient administration system and electronic patient record framework for London; ten Cerner sites in the South formed collaborations to prepare for the end of their NPfIT contracts in 2015; and a fifth trust in the North, Midlands and East announced that it would take CSC’s Lorenzo EPR under an interim deal between the company and the Department of Health signed the previous September.
April:
The much-contested re-organisation of the NHS finally took effect amid concerns about the cost and disruption of the reforms, the impact of the growing financial squeeze on the health service, and the reputational damage inflicted by the Mid Staffs scandal.
The task of the new NHS’ commissioning bodies was immediately complicated by Dame Fiona Caldicott’s second report on information governance in the NHS, which called for more information sharing in the interests of patients but tighter controls on the use of patient identifiable data for administration.
Ironically, the implications of this emerged just as clinicians and privacy campaigners became increasingly concerned about the care.data programme, which will expand the Hospital Episode Statistics, link them to new data sets, and make them far more widely available to researchers and others.
Worried that health secretary Jeremy Hunt’s January call for a ‘paperless’ NHS could lead the health service to abandon the idea of a single, connected health record that CfH had tried to take forward, EHI launched The Big EPR Debate to encourage readers to discuss the building blocks of EPR and the best routes forward for trusts. The idea caught fire and the debate soon attracted more than 150 comments.
May:
The Big EPR Debate became even more timely when the Department of Health announced that it had found some money for NHS IT after all, in the form of a £260m digital challenge fund that was initially pitched as being focused on e-prescribing and patient safety technologies. Meanwhile, the problems that Caldicott2 had caused commissioners and the analysis firms trying to work with them were a major focus of EHI’s first ‘Information for Commissioning’ event in London.
Otherwise, May was a month for company news. McKesson made a surprise announcement that it was to sell off McKesson UK, and with it the Liquidlogic and the System C business that it had recently acquired, while a Canadian pension fund bought Civica, and CSC apparently topped out on NME trusts interested in Lorenzo when South Warwickshire became the eight trust to say it wanted the system.
June:
The first signs that the NHS was in for a ‘winter crisis’ emerged when health secretary Jeremy Hunt lambasted GPs pulling out of out-of-hours care, which he claimed was behind pressure on A&E departments. Strangely, he had less to say about the ongoing balls-up that is NHS 111.
On the subject of balls-ups, June saw the Commons’ Public Accounts Committee hold a hearing on the latest National Audit Office report on the National Programme for IT. This concluded that 98% of the benefits that the Department of Health has identified are still to be achieved, and that many of them look decidedly optimistic. Also, that the DH is still throwing a surprising amount of money at a programme that is supposed to be dead. Not for the first time, the PAC branded the situation a disaster.
Moving forward, EHI held a round table as part of The Big EPR Debate at which Beverly Bryant, the director of strategic systems and technology at NHS England, said what had become the ‘Safer Hospitals, Safer Wards: Technology Fund’ would “catalyse” the adoption of IT in the NHS over ten years, while colleagues flirted with anglicising the US Veterans Health Administration’s open source system, VistA.
July:
Good news! NHS England hit – or to be very picky missed by only one day – it’s target of issuing guidance to trusts on how to apply to the tech fund. The guidance introduced the idea of integrated digital care records, which NHS England said it wanted to see in use across all care settings by 2018, and gave trusts until the end of the month to apply for the first tranche of money, which NHS England said it wanted to see spent on NHS Number, e-prescribing, scheduling, and information sharing.
Also good news! Liverpool Heart and Chest Hospital NHS Foundation Trust became the second in the country to go-live with its Allscripts electronic patient record system, in what may be a new model for trusts that want to retain their patient administration systems while making a leap-forward in clinical functionality.
Less good news! NHS England chief executive, David Nicholson, who announced his retirement after Francis2, made an emotional and doomy final speech to the NHS Confederation’s annual conference. He warned the gap between flat funding and growing demand could reach £30 billion by 2020, without fundamental change to NHS services, and called for a “big conversation” with the public on what change should look like.
August:
The first week of August marked the beginning of the end for one of the NHS’ first digital services, NHS Direct, which announced that it was pulling out of all of the contracts for NHS 111 that it had managed to win in a desperate bid to stay in business. Delays to the roll-out of the service and over-long calls made the contracts “unsustainable.”
As the BMA called for an investigation into the NHS 111 “omnishambles”, NHS England blithely announced that it would be launching an integrated customer service platform. This, it said, would do all that the NHS’ existing digital platforms do and more; and save the health service £1 billion into the bargain. EHI readers were not convinced. In Scotland, however, the Key Information Summary quietly rolled out, ahead of schedule.
September:
Could it be party conference season? Yes it could. Health secretary Jeremy Hunt announced what was billed as £1 billion for NHS IT over three years. On closer inspection, this turned out to be the £260m of the Safer Hospitals, Safer Wards: Technology Fund plus its matching funding from trusts, and another £240m of central money plus matching funding from trusts. It was still both welcome and brave, however, given that voters would generally spend money on nurses over computers.
The end of the month saw a landmark for EHI, which published its 600th newsletter. As the editorial remarked, it did so with a slight feeling of ‘déjà vu all over again’. Issue one reported that health secretary Alan Milburn had found an extra £85m for NHS IT ahead of a meeting attended by Microsoft head Bill Gates which, as it turned out, hatched the national programme.
Issue 600 focused on the PAC’s report on its latest hearing into the NPfIT “disaster” and the news that eight out of ten NHS desktops are still running the operating system Gates was in the UK to launch – Windows XP. In another echo of old rows over consent and confidentiality, the government was forced to find £1m for a national leaflet drop about care.data to placate furious GPs.
October:
In a month of US-flavoured news, NHS England decided that it would not, after all, spend millions of pounds anglicising VistA; although it would create a new network of trusts interested in open source projects. The Food and Drug Administration announced that it would regulate mobile health apps if they turned their host devices into medical devices; an approach that could be replicated in Europe.
A week later, the Mersey Burns App, which was the first UK healthcare app to get a CE mark from the Medicines and Healthcare Products Regulatory Authority, won the overall category of the EHI Awards 2013 in association with CGI. Rounding out the month, it was announced that Simon Stevens, a one-time Blairite health advisor and bigwig at US health group United Health, would be returning to the UK to become chief executive of NHS England.
November:
A series of items of “not happening” news suggested that some of NHS England’s more bubbly ideas might be deflating. These included the revelation that the government’s much-vaunted pledge to give patients access to their health records, which had already become access to their GP records, would, in the first instance, become access to the information in the Summary Care Record by 2015. Even HealthSpace got further. They also included the strong rumour that Code4Health has been scrapped. The 3millionlives pathfinder project was definitely put out of its misery.
NHS England’s revived interest in electronic patient records, however, was further demonstrated by its support for a Clinical Digital Maturity Index developed by EHI’s research arm, EHI Intelligence, and launched at a record-breakingly large and buzzy EHI Live 2013. The index models the presence of administrative and clinical systems at all 160 acute trusts in England, enables benchmarking, and will be used to track progress over time.
Just as the government confirmed that, as part of its response to Francis2 it would legislate to make it a crime to ‘fiddle’ NHS figures, Colchester University Hospital NHS Foundation Trust was put into special measures in response to an emerging scandal over the recording of cancer waiting times.
December:
Trusts and suppliers waiting to hear who had won what from the first round of the Safer Hospitals, Safer Wards: Technology Fund started to fret publicly that if an announcement was delayed for much longer it would be impossible to procure and implement projects effectively before the March 2014 deadline.
The delays were apparently caused by the Treasury, which was worried about the return on investment of the projects put forward. In the end, the winning bids were announced in the first week of the month. A formal announcement will follow in the New Year. EHI, will, of course, be covering it. Meantime, good luck in A&E, and try not to need NHS 111.