Matthew Swindells has said that the NHS Informatics Review sets an unprecedented information challenge and spells out the vital role that information has to play in NHS modernisation.
The Department of Health’s former interim chief information officer, and author of the initial draft of last week’s review, told E-Health Insider that Lord Darzi’s Next Stage Review of the NHS “is 50% about the use of information.”
He also said that one of the most important things about the Informatics Review is that it deals with the use of information to underpin modernisation, rather than with systems and technical standards. “You could argue that [until now] we’ve had an IT strategy without an information strategy,” Swindells told EHI.
Until May, Swindells was the DH’s interim chief information officer. He announced his departure to the private sector shortly before the final report of the review was published. He is now head of Tribal’s health practice.
Swindells told EHI the final review is in line with the draft he handed over, which contained a greater number of detailed recommendations. He also said the final report contains a lot of short paragraphs that contain huge amounts of work.
“The call for a complete review of the NHS data model is an absolutely huge piece of work. This alone potentially creates four to five pieces of work that could take a year each,” he said.
He added that one of the key aspects of the review – and one of the most eye-catching for IM&T specialists – was the need for “interim” systems; a move that has become necessary because of the four year delays to the two “strategic” patient record systems chosen by NHS Connecting for Health.
Swindells said: “It makes sense for the NHS to want to retain the benefits of a small number of core systems. But the reality is that the whole programme is running years late and the whole NHS has moved on, with new requirements like primary care trusts, payment by results, practice based commissioning and a growing plurality of providers.”
He added that “people need to be able to do things between now and the final solutions becoming available” and said that the Informatics Review acknowledges that “the NHS cannot just sit in pause mode” waiting for things to arrive. However, he said that the National Programme for IT in the NHS “is providing the core of a platform.”
He agreed that delays in the national programme “do create the opportunity for a market in informatics to grow.” But he said this was only partly about systems. The bigger opportunity, he suggested, is around the creation of an “information management” market.
Swindells also told EHI that London gives grounds for optimism about NPfIT. “In London it’s starting to look very positive. We’ve had implementations at Bart’s and the London and Royal Free. We could soon be in a position in London that with Cerner and BT we have a deployable model.”
However, he acknowledged that the “strategic” Lorenzo system has yet to arrive. “Lorenzo, of course, we are still waiting for. It could be absolutely brilliant or we could have a problem,” he said.
Swindells argued that: “If the national programme made a mistake, it was to not highlight just how difficult this was.” He also argued that one of the keys for the future was to make sure that when systems are deployed they offer more than basic patient administration functionality.
“[They need to] deliver something for nurses and junior doctors,” he said. “We’re getting a bit of that at the Royal Free. You need to show them the stuff you deliver after PAS.”
The Informatics Review covers far more than the national programme. It emphasises the importance of leadership, better careers for informatics specialists, IT training for other NHS staff, a new focus on information governance, and of providing new portals to deliver quality information to staff and transactional services to patients.
Among the recommendations on leadership, it says that strategic health authorities, primary care trusts and trusts should appoint chief information officers at board level.
Asked about this, about Swindells said it was a vital step that trusts had been urged to take previously, but it was not something the DH could mandate. “An instruction to appoint a CIO would not be appropriate when we are encouraging trusts to become more independent.”
However, he said he hopes the review’s clear message and the DH’s appointment of its first CIO will act as “a call to arms” for other NHS organisations.
Swindells pointed out that the NHS’ general management programmes attract some of the brightest graduates around and said the same was needed in Health Informatics. “It needs the equivalent of the NHS graduate training scheme.”
He said the national programme has already shown this can be done, successfully getting “some of the best people in the country working on NHS informatics.”