Shadow health secretary
Stephen O’Brien

Shadow health secretary Stephen O’Brien tells Jon Hoeksma that the centralised approach to NHS IT has failed, and interoperability must be the starting point for future NHS IT strategy.

Riding high in the polls, the Conservative Party is having to think about translating criticism of the government and its policies into a coherent alternative position and workable policies of its own.

In health terms, the past year has seen it move from simple criticism of IT failures and the late delivery of the National Programme for IT in the NHS, to something more sophisticated.

Shadow ministers no longer talk about the “NHS supercomputer” in the singular or refer to “open source” as if it was a get out of jail free card. Instead, a more coherant critique of the failings of the centralised NHS IT programme has been developed and an alternative strategy is being explored.

In January, Tory leader David Cameron attacked the national programme, but also called for local ownership and innovation and a shift to decentralised, open systems. “Instead of the national mainframe, we are entering the age of the local network,” he said. “This applies especially to health and healthcare.”

Shadow health minister Stephen O’Brien has been putting flesh on this emerging alternative strategy. In August, he commisisoned an independent review of NHS IT, led by Dr Glyn Hayes. He said the review will aim to establish a vision for IT in the NHS, health and social care and the policy needed to underpin it.

The review is due to report early in 2009, so O’Brien is unwilling to comment on it in detail. However, he makes it clear that it will be used to both provide ammunition for attacks on the government and to inform future policy.

“We start from the principle that, as the government is not prepared to come to the dispatch box or conduct a review of the programme, we will,” he says. “Hopefully our review will come up with a clear critique of the government’s programme to date and make some clear recommendations on what we could redirect and quite radically change.”

Like his party leader, O’Brien believes that the national programme has largely failed to deliver what was promised. “We start from the principle that if the government’s top down approach had worked, we wouldn’t be three to four years behind where we were meant to be by now,” he says.

He is also critical of the government for failing to “produce commensurate improvement in public services for the amount of money that has gone in.” And he says that delays to the national programme have been a huge “opportunity cost for improving patient care.”

Even so, the intention seems to be to review the national programme and carry out major surgery, rather than to scrap it. “As it involves £12 billion of taxpayers money, rather than have an audit and stop it, we will instead have a review that starts from the premise that improved exploitation of IT in health and care setting will contribute to improving patient outcomes,” he says.

O’Brien is also exploring how IT will support the Conservative’s wider healthcare plans, which focus on informed choice. These require portability of patient data and much more transparent quality and performance measures.

He indicates that to support these aims, some national systems, such as the spine personal demographic service, will still be needed. But others will be scrapped or replaced.

“The skill is in understanding the opportunity and procuring what can deliver the greatest benefit to the taxpayer,” he says. “And rather than develop specifications on the hoof, to have a solid specification that can be delivered.”

Within this context, O’Brien says the future focus must be local systems, based on standards and linked through interoperability. And he is confident that local organisations will rise to the challenge of finding, funding and deploying IT to meet their own needs.

He says that local approaches, and locally developed systems, are already the reality in many parts of the country. “In the absence of the systems the government has sought to impose from on high, many local healthcare providers have been commissioning and developing their own systems, many of which are doing well.”

The challenge is now to join up these local systems, and support many more like them across health communities. “That is where interoperability comes in,” says O’Brien. “How do you make the links between what is working well locally? Interoperability is the key to achieving those links. That is our first principle.”

Related articles:

Cameron says NHS IT must be local

Conservatives commission review of NHS IT


Stephen O’Brien will be the keynote speaker at the Healthcare Interoperability exhibition and event in Birmingham on 30 October. To see the programme and book a place, visit the event website: