The general election
This week, all three of England’s main political parties staged big launches for their manifestos. Liberal Democrat health spokesman Norman Lamb was at his party’s launch at the Bloomberg financial information service in the City of London on Wednesday.
Yet, rather unusually, he had already published his own manifesto – “The NHS: a liberal blueprint” – which had its own launch at the King’s Fund think-tank in February.
“The publication was about making my contribution to the debate on how we transform the health service making it more responsive and sustainable as we move into a period of austerity,” says Lamb during a brief break in campaigning.
With no mention of NHS IT in the Liberal Democrats’ official manifesto – ‘Change that works for you: Building a fairer Britain’ – it’s perhaps not surprising that Lamb wanted to expand on his own ideas at more length.
Over the years, he has been a critic of the National Programme for IT in the NHS, and has also taken a close interest in other healthcare IT issues, such as confidentiality and how technology can drive modernisation.
“The NHS can work more efficiently. If it is going to do that, smart use of IT must be central to a modern health service. But it’s been clear for a while now that we are against NPfIT,” Lamb says.
Out of the NHS IT crisis
Lamb’s own publication lays out three points to address what he refers to as “The NHS IT crisis”. These are abolishing NHS Connecting for Health, making Choose and Book a simple online booking system and abandoning the National Care Records Service.
Lamb explains: “Not only is the national IT programme running years behind schedule and billions of pounds over budget, but it is failing to deliver the gains from IT seen elsewhere. The overall impression is one of strategic confusion.”
He maintains that there has never been a proper business case or a costs benefits analysis of the programme or its individual projects, and that on the ground there has been little involvement from GPs and other clinicians.
“I don’t have a difficulty with electronic patient records. They are an inevitable part of the health service and they make sense, instead of having reams and reams of paper being transferred between GPs and trusts and health and social care,” he says.
However, he adds: “There is no case for a national database – and that includes the SCR. The cost benefits have not been made for either.”
Lamb says he would instead provide local systems of choice across the care spectrum, with a focus on compatibility to allow for the transfer of data between them. He argues that this would make local managers and clinicians accountable for, and more engaged in the development of, IT.
Lamb adds: “The view that I have been given by numerous people, including those working on the project, is that we have bitten off far more than we can chew. The skills simply weren’t available when the project began – and in many cases they are still not available.
“We now need an approach that fosters creativity and set standards that need to be achieved by companies but allow other products to get into the market so that there is competition and innovation.”
Inspiration from the US
Lamb is a huge advocate of some of the joined up healthcare systems in the US, such as those developed by Kaiser Permanante and the Veteran’s Health Administration.
In California, Kaiser systems allow patients to email their GP for advice about their condition, as well as providing access to records. They also identify patients who need regular check-ups and screening visits. In March, Kaiser published evidence that email and telephone consultations cut GP visits by more than a quarter.
Lamb says: “We’ve seen success in systems like Kaiser and Veterans and countries like Sweden where they have started locally and built up to make records available and easy to exploit.
“Although the Kaiser system covers an entire organisation – and I recognise that that is huge – it’s still a vastly different scale to the UK. It’s horses for courses.”
NPfIT has recently been plunged into turmoil in the North, Midlands and East of England, following the failure of University Hospitals of Morecambe Bay NHS Trust to go live with the latest version of iSoft’s Lorenzo.
Despite this, Lamb recognises the difficulty of making a commitment to completely scrap the remaining local service provider contracts, when they are shrouded in commercial secrecy (and London’s deal has just been resigned).
“The problem with the LSP contracts is that we’ve got no idea what they commit to, how we can extract the government from the contract and / or get out of those contracts completely,” he says.
“If you could rewrite history you’d go down a different route now that we can see the mess we are in. But it looks like a future government will have to look at adopting some systems and achieving something sensible out of the contracts.”
The liberal approach
The Conservatives ran into a storm last year for managing to hint that commercial companies might be asked to deliver on their promise to give patients access to their records. In contrast, the Liberal Democrats have managed to stay relatively quiet on a similar pledge.
While recommending that that “at a minimum, patients should be given access to their records,” Lamb admits he is unclear on how that could be achieved safely.
“I have a very open mind about the mechanism for personal health records, but it is a principle that I feel very strongly about. There is a lot of concern about the Google approach that the Tories have – even on their side.”
Even so, Lamb refers to a more patient centred NHS as an example of his liberal approach to healthcare. “A liberal approach to healthcare means putting individuals centre stage,” he says.
“Both the patients, so that care is focused around their needs, but also the staff, so they have a greater say and greater engagement. That’s something that has been missing for a while, and not just in NHS IT.”