The NHS Confederation annual conference opens in Glasgow next week so E-Health Insider fixed an interview with its chief executive, Dr Gill Morgan, to find out what the nation’s trusts and health authorities think about recent IT developments. We found her upbeat about the possibilities opened up by IT investment, but concerned about the NHS’s lack of progress in embracing IT as an integral part of modernisation.
Gill Morgan is a believer – in healthcare IT, that is. “I think the NHS has not even yet dreamed if the things that IT can do. We’re still looking at information systems supporting the current ways we do things and the big challenge is how on earth we use IT to leapfrog from the past into a brave new world.
“We have been very conservative in the benefits we are looking for out of technology. There was research done at Harvard suggesting that the companies making the best use of technology aren’t looking for two or three fold improvements, they are looking for 100 fold improvements. We aren’t even having that debate yet.”
Why are NHS organisations apparently so reticent about demanding high cost and productivity improvements for their IT bucks? Dr Morgan thinks the problems stems from historic underinvestment.
“In the NHS, IT has been seen as some thing specialist ‘to do a few tasks over there’. But the way you get the gains from IT is clear: it’s when you see it as a clear way to deliver business functionality and that is the big leap we have to make.”
Local technology budgets have been raided in the past, she says, because of a “fundamental profound error” in the system which means that the service and the public only value things they can see put into, onto or around the patient.
”Stuff that provides infrastructure is not valued. It’s not the prescription of a drug. And therefore you have this cohort of people in the service who see investment in infrastructure – administration, management, a whole set of things like that – as wasted.”
Her argument is that infrastructure, including IT, is part of direct patient care and a critical element of a high quality service. “If we can change that cultural belief system, so that people really do understand how this improves the quality of the care they offer…then you might begin to overcome some of the prejudice.
”But as long as that prejudice is there, every time you come to a financial round everyone who comes from a clinical background will start talking about ‘direct patient care’ and it’s very difficult for managers – who really often themselves don’t have a full grasp of how this [IT] could leapfrog their capacity and capability – find themselves unable to invest in infrastructure.”
For Dr Morgan, a future that embraced technology properly would bring much slicker services for patients and ready access to information for clinicians.
”I saw some figures for a clinic where up to 40% of consultant time was spent looking for lost results and lost notes. That is down time in terms of productivity. 40% of lost time is an awful lot patients who can’t get treatment.
”If we can get those things right there are lots of resources to be innovative and imaginative with – if we could just get our internal systems and processes as slick as they possibly could be. And we are miles away from doing that. That’s not a criticism – it’s a very real reflection that infrastructure, in the minds of the press and everybody, equals bureaucracy, equals bad,” she says.
Dr Morgan see trusts where clinical staff and managers work well together on infrastructure issues and where clinicians become advocates for IT investment. But what percentage of the service do they cover? “The question would be: ‘Is it yet at the tipping point? And the answer is no.”
So where does this leave the National Programme for IT in the NHS which is working furiously to pull together the main elements 21st century IT for the service? Are the trusts ready for the advances being planned for them?
”That’s the exact question we need to be asking,” says Dr Morgan. “Part of my anxiety is that this is not about technology. This is about changing how we fundamentally run our organisations, deliver care, manage things internally.
“That needs a tremendous effort in terms of change. It needs to be built in at the time we are doing service redesign – you should be thinking about technology as part of the service redesign, not as a programme sitting somewhere else.”
Dr Morgan says that her greatest anxiety is that so many large scale technological programmes fail – in both the public and private sectors – because those implementing them do not change the way people think and work. They become an add-on and the equation “poor system plus technology equals expensive poor system” kicks in.
”The figures I’ve seen in very successful programmes [show that] people are investing about £8 in change for every £1 they invest in technology,” she says.
Eight times the £2.3 billion planned investment in NHS technology sounds guaranteed make the new health secretary’s eyes water, but Dr Morgan believes that a lot of the capacity for change exists in the system already. The service must, however, make space for people conducting the change management and give recognition to the importance of the work – and this is not happening at the moment.
”We’ve got a whole modernisation programme where the technology side is not part of how you modernise. The Modernisation Agency is trying increasingly to build this in. But fundamentally we are not yet at a stage where IT is seen entirely as a tool to achieve what you really want to achieve in your aspirations for your mainstream business. And it’s that cultural change we’re not investing in yet.”
More optimistically, Dr Morgan sees an IT-enabled future where services are “slicker and quicker with fewer mistakes” and patients use information to make choices and tailor services to suit their needs.
On her visits around the country she has been impressed by remote telemetry services that are enabling people with a range of conditions to avoid hospital admission and receive expert support in their own homes.
"For me that’s one of the really exciting things. That’s a fundamental change in how we provide services."