Some of the older NHS IT hands may be planning a trip into the loft this weekend to dig out any local implementation strategies (LISs) that have survived from the days of the 1998 information strategy, Information for Health.

Because five years after the national programme tried to take control of NHS IT in general and care records services in particular, the focus of the latest Health Informatics Review is – possibly, nearly – back on local action.

The review, led initially by former Department of Health interim chief information officer Matthew Swindells, is careful to say that the “overall direction” of travel is towards the development and deployment of “strategic” information systems by local service providers.

But it also says there is a need for “interim” solutions “to make patient information available across different IT systems, care providers and care systems” while the wait for the strategic solutions grows ever longer.

Enter the clinical five

In particular, it says there is a need to get a “clinical 5” set of elements in place in secondary care. These are: a patient administration system with “integration with other systems and sophisticated reporting,” order communications and diagnostics reporting, letters with coding, scheduling for beds, tests and theatres, and e-prescribing.

Those older NHS IT hands might find the list eerily similar to some of the EPR “levels” that IfH hoped to achieve. Meanwhile, the Health Informatics Review launches a new implementation acronym. Local Informatics Plans (LIPs) will lay down the route to the “clinical 5.”

LSPs will develop their own “roadmaps” and then work with strategic health authorities on “appropriate strategies” for achieving them. Trust LIPs will cover both strategic and interim solutions and clinical governance issues, while local LIPs will focus on integration with community and primary care.

Welcoming the report

The similarities between the latest review and the IT strategies that have preceded it are not surprising. Every NHS IT strategy since 1992 has affirmed the need for the NHS to have a robust infrastructure to allow communication between different NHS organisations and for a system of electronic care records that can be used for different purposes, including management, patient care, and research.

What has differed is how the NHS is meant to get there. And as Swindells told E-Health-Insider, there is a need for pragmatism. “The reality is that the whole [national] programme is running years late and the NHS has moved on,” he said, adding that the health service could “not sit in pause mode” waiting for systems to arrive.

Speaking on behalf of the British Computer Society, the professional association Assist and the registration body UK CHIP, Glyn Hayes said the review’s report was has been “warmly welcomed because it moves in the right direction and deals with a lot of issues that we have raised over the years.”

The trade body Intellect also welcomed the review. However, it warned that it would depend on “early engagement” with suppliers “to ensure there is a proper understanding of the industry’s capability and capacity to deliver any given solution.”

Beyond NPfIT

The review is not just about the national programme, however and it is not all familiar. Admittedly, it opens, as similar documents have done, by pointing out that the NHS and its users have a pressing need for “high quality information.”

And it goes on to say, as similar documents have done, that while the NHS has “a great deal of data” it has “a lack of meaningful information and knowledge.” But it goes on to take a wide-ranging view of the action needed to change things that is closely tied to Lord Darzi of Denham’s ten year vision for the NHS, as set out in the final report of his Next Stage Review.

“This is a very comprehensive review,” said Lisa Franklin, director of health informatics consulting at Tribal, where Swindells now heads up health. “It points the direction across the board, from emphasising the need for high quality information to be available to support improving clinical care and wellness, to the critical need to develop the informatics skills of IT professionals and the wider NHS staff.”

Leadership and skills

The review argues that the NHS organisations that have made the most progress to date are those in which senior managers and clinicians have provided “leadership and ownership” and in which “the application of technology has been in support of NHS business and clinical priorities.

It says there is a need to strengthen leadership and that a National Leadership Council will be set up to do this. It notes that a new post of chief information officer is being created at the Department of Health and says SHAs, primary care trusts and trusts will be expected to appoint their own “credible, capable CIO able to contribute fully to strategic leadership and board decisions.”

Dr Hayes said this would be “a major step forward” if it happens. “One of the biggest hold-ups in the implementation of IT has been getting buy-in from management,” he said. “So we are very much in favour of this development.”

The review also identifies a need to recruit more programme and project managers with deployment and change management skills, to create better careers for informatics workers and to improve the IT skills of the general NHS workforce.

Policy, evidence and confidence

Elsewhere, the review says the Department of Health will establish a “policy and informatics support function” to address the persistent concern that its directorates can issue policy without considering the IT or informatics implications.

Dr Hayes identified this as one of the most important aspects of the review. “You only have to look at the 18 weeks fiasco to see what can happen now,” he said. “It was a major distraction. So this is a very important change in the DH’s way of working.”

The review says that new programmes will be developed to spread research into the benefits of new technology to boards and other investors and that there will be a stronger focus on information governance to convince both NHS staff and the public about the security of new systems.

There will also be a short-range focus on using existing data to support clinicians and improve the quality of NHS services. The review says new clinical metrics will be developed to measure safety and outcomes, enable “meaningful” comparisons between institutions and support patient choice.

These will include the “patient reported outcome measures” or PROMs that feature in the 2008/9 NHS Operating Framework and the Darzi report, High Quality Care for All. The new measures will be delivered to clinical staff through a “clinical dashboard” that may form part of the mystaffspace portal.

In the longer term, there will be a “strategic approach to reporting” to reduce the “burden” of data collection. In an example of what Swindells called “short paragraphs that contain a huge amount of work”, the review says this will require “a full review of the existing NHS data model.”

In another, it says there will be a “major programme of standards development” that was welcomed by Dr Hayes, although he notes that it is “a bit unclear” exactly what this will entail.

Finally, the report repeats the pledges in High Quality Care for All that vastly more information will be made available to the public through NHS Choices, the contract for which went to Capita this week, and its subsidiary, HealthSpace.

Moving forward

The review does its best to create a sense of momentum. It says the new CIO’s leadership team will create a framework to take its recommendations forward, in which the roles of NHS Connecting for Health and the national programme will be redefined.

It says NHS CfH will become “the source of technical, commercial, service and programme support expertise to the NHS” and not simply the implementer of the national programme, which will become “a platform for innovation within the NHS” and a “platform for service transformation.”

A review implementation report will also be published in the autumn, setting out progress to date and next steps. And at this point Dr Hayes sounds a note of caution. “This is a document that has been warmly welcomed, but the issue is going to be implementation,” he said.

“The review has involved a lot of consultation. It has not just [been put together] by the inner sanctum of NHS Connecting for Health. That receptiveness to other views is something we do not want to lose. This document seems to herald a new approach and there are a lot of good things in it. We want to see that carried forward into the autumn.”