Under a Conservative government the NHS Care Record Service would become the key tool enabling the introduction of the proposed Patient’s Passport initiative under which patients could choose between a range of health service providers taking their funding with them.

In an interview with E-Health Insider shadow health secretary Andrew Lansley, said that a future Conservative government would sustain the levels of investment committed by Labour into the NHS IT.  "Apart from anything else we need electronic records to apply the Patient’s Passport. It’s a necessary part of our structure."

Though he broadly backed the National Programme for IT he said that he did have concerns about holding back innovators. "The hospitals that are best at the moment at applying IT to their systems are feeling a bit of planning blight, though it does vary depending on who I talk to." 

His second area of concern was about the content of the data spine.  "There are concerns that the scope of spine seems to be reducing, and that begs questions about the extent to which the benefits of the introduction of the spine record will accrue at an early stage.

"…People felt the scope of what they were getting was changing and it wasn’t changing as a consequence of the discussions within the regional user groups, it was happening as a consequence of the procurement process."

He added that if the Conservatives were to form the next government after a 2005 election he would want to see electronic patient records introduced across the NHS by 2008.  Lansley said it was not currently clear to him whether the current government’s plans specified electronic records were to be in place by 2008 or 2010.

"We would be very keen by the middle of the subsequent parliament [following a 2005 general election] to have electronic patient records and a substantial measure of the Patient’s Passport in place, within about three years."

However, the Conservative shadow health spokesperson ruled out accelerating the NHS National Programme for IT or seeking to significantly alter existing contracts with providers.  "All past experience suggests that if you start to change the basis under which you have undertaken your procurement, you increase your costs and prejudice the achievement of the project overall."

He said the main thing that would be revisited would be the extent to which the Patient’s Passport could be introduced using the core ‘data spine’ within the NHS Care Records Service.  

In addition to providing an entitlement to care, "which carries with it a value", the Patient’s Passport would consist of standardised information to enable patient to make informed choices such as clinical outcomes data, hospital infection rates, patient satisfaction indicators and waiting times. 

“The second part of the passport is the standard of clinical care you can expect to receive,” said Lansley.  "And only providers willing to meet that standard should be able to offer you care." 

Lansley said that the first step towards the Patient’s Passport would be provided by the national electronic booking system now under development. "The Patient’s Passport does obviously depend upon an ability for patients to exercise choice across the NHS, so the introduction of the electronic booking service is necessary from the point of view of stage one, which is essentially choice in elective surgery at the point of referral."

From our point of view we don’t want to see the restrictions the government is building in, so hopefully the electronic booking service will not be artificially designed to constrain choice."

He said there were problems with the system as currently envisaged: "One the government have talked about a choice of four or five hospitals, so unfortunately the software may not be designed to allow you to go anywhere, so we want software that allows you to investigate possibilities more widely rather than be constrained."

Ideally the e-booking system should allow non-NHS providers who had contracted with the NHS to plug in, said Lansley.  "Though I suspect that the government themselves intend for that to be possible, because it really is no different from the continuation of the treatment centres."

"From my point of view I just want to make sure that the software being used for the patient choice programme will allow that to happen," said Lansley.

More significant “tweaks” to the national programme systems would be needed to enable the Patient’s Passport initiative, said Lansley: "A patient who has been accepted for NHS treatment, but who then chooses to go private [would] carry a subsidy with them equivalent to the marginal cost of the NHS tariff, so it would be necessary for the IT system to take that into account as well."  

The shadow health minister said it would be "burdensome for a separate system to be created."  Instead he argued that it would better for NHS systems to be designed to include transfers of patients and accompanying payments into the private sector, and any transfers in the other direction.

Lansley said the same principle should apply to the core spine record with NHS CRS.  "It would be efficient from the patient’s point of view if the spine record was capable of being transferred into the private sector as well, otherwise we’d simply create an IT obstacle to people exercising choice."  He added that he was shortly due to have conversations with private sector providers on this key point.

"Most of what we are saying in this regard does not destroy the work that is being done.  They might be adaptations, but they don’t go to the heart of what is being done…  There is a through train between Labour’s current situation and where we want to get to, which makes life easier for people in the NHS." 

Lansley said a more complex area was the Conservative’s intention to see the Patient’s Passport also applied to chronic disease management.  "That is a more complex and difficult issue than exercising patient choice for elective surgery."

The idea, he explained, was for patients with chronic conditions making a range of choices with their GPs, or going to what might, in time, be managed care providers "taking, as it were, their care budgets, and in some cases exercising direct payment within the NHS".  This approach will be developed for a range of chronic conditions like asthma and diabetes.

While the Patient’s Passport will not physically give patients cash, it will need to be developed as an individual account able to trigger financial transactions to different providers.  "From an IT point of view you need something that can accommodate this range of different approaches," said Lansley.  

Moving on to the wider potential benefits of the national programme, Lansley said there was great potential for IT to integrate services and speed up processes within the NHS.  "In theory it is perfectly possible to reduce the burdens on the NHS dramatically through the introduction of IT.  

"I’m sure people in the NHS only have to think about the number of times they clerk patients to realise that if you’ve got an electronic record and can just clerk a patient once that reduces the time spent dramatically.  So it’s bound to have benefits if it’s done properly."