David Davies and Rhidian Hurle, the leaders of NHS Wales’ Informatics Service, tell Digital Health’s Laura Stevens, how NHS Wales remains committed to co-operation, particularly on IT, and what that means in practice.

While the English NHS continues to grapple with the pressures of delivering a public healthcare system, while incorporating market competition, NHS Wales remains committed to values based on collectivism and co-operation, including in IT and informatics.

David Davies and Rhidian Hurle, the leaders of NHS Wales’ Informatics Service, spoke to Digital Health’s Laura Stevens about what these values mean in practice.

Speaking in NHS Wales Informatics Services’ Cardiff offices, England is a different country, one with a very different healthcare system.  One that can look almost as alien to Welsh NHS leaders; as the full-blown US market system does to English NHS observers.

“What I’m most interested in is outcomes. I’m interested in us measuring ourselves in the world”, declares Rhidian Hurle medical director of NHS Wales Informatics Service and consultant urological surgeon.

With NHS England and NHS Wales taking such different paths for their respective IT strategies, it’s not surprising that Hurle looks further afield to judge his nation’s results.

2017 the year that Wales joins up the pieces

And 2017 is teeing up to be a watershed year for Welsh IT. David Davies, director of engagement at the Informatics Service, said that in 2017 all the components of years of work will be joined together.  Most notably a new national patient portal.

Using the analogy of a central heating system, Davies said all the pipes and radiators are now in place, and all will be connected this year. “In 2017 it will become entirely national in the way that it works.”

No competition in Wales on informatics

Despite the intense rivalry between the English and Welsh national rugby teams, Davies is clear that in Welsh health informatics things are different, “competition doesn’t feature in the language of NHS Wales”.

In part this is about size as much as political make-up.  With three million people, and seven large local health boards covering populations from 350,000 to 700,000, there are no competitive tariffs, and systems are rolled out nationally rather than locally.

Davies stressed, that there is the unified “once for Wales” approach to IT systems, so “wherever we can we deliver a single instance of a single component of national architecture used in common across the whole of Wales, without regard for organisational boundaries”.

A key part of this strategy is implementing a common Welsh patient administration system across the whole country, which will allow patients to be managed across different areas with a single system.

Welsh informatics strategy based on unified approach

In June 2015 the Welsh government invested £6.7 million to develop an IT system that linked health and social care services around the country, based on a unified approach.

Then in December 2015 came ‘Informed Health and Care: a digital health and social care strategy for Wales’, set out the nation’s five year ambitious digital goals.

The document detailed key foundations including: the launch of an online citizens’ portal; providing free wi-fi to patients; and a new My Health Online portal which allows NHS patients to book appointments and order prescriptions.

Time to deliver the Welsh “pizza” slices

When Hurle came into the job he says he used a “pizza diagram” to describe how all the informatics systems relate to one another. The Welsh radiology imaging archive service, Welsh care record service and Welsh results reports service each act as slices of the pizza, and all contain information that can be interchanged and seen elsewhere in Wales.

These slices create a disc of information that is then accessed through different interfaces but, critically for Hurle, this strategy means that for patients there’s “the ability to see what everyone has been doing to you”.

Whether you’re a GP accessing it through the Welsh general practice record, Welsh clinical portal in an acute setting, Welsh emergency department system or Welsh community care information system, the data can now be tracked and traced.

Having your pizza and eating it

There are multiple benefits to this, says Hurle: including the patient not having to repeat his or herself every time they contact the health system, and using health professionals’ time more wisely and giving patients more value from each consultation.

It also allows Hurle, as Caldicott Guardian for the Informatics Service, to reassure the public that their information is being used correctly.

He describes it as a carrot and stick model: “We trust you to do this, but we’ve got this open architecture which is being watched, off you go and behave.”

Crucially, the quality of the data also allows clinicians’ behaviour to be challenged, which allows “us to improve and that is the vision of reducing the variance of care across Wales”, said Hurle.

Changes for the patients

In 2017 this information will also start to be accessed by patients, through the patient portal, and Hurle said the team are currently building the common interface to enable this to happen.

Another change afoot is a move away from postcodes determining which care you receive. As Davies laughs, postcodes were decided during Norman times based on rivers, so “to use those boundaries as boundaries for an information system is madness”.

Cyber security and aging infrastructure

Hurle says that the NHS Wales is also investing in cyber security.

“There are legacy products within health boards that we are aware of, that are operational, that have a potential risk. There are Microsoft products that are unsupported, and that’s common across the whole of the UK NHS.”

The refresh is being assisted by a multi-million pound, government funding package, announced in October 2016. Some £11.3m will be used to replace aging equipment, boost systems’ resilience to cyber-attacks and improve infrastructure.

“We’re travelling far”

While there is the “inevitable problem” that it takes longer to and more effort to get a whole country to agree to something, said Davies, he also adds there’s a saying in Wales.

“If you want to travel quickly, travel alone, if you want to travel far, travel together”.

“And Wales’ philosophy is, we’re travelling far.”

 

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