The Secretary of State for Health and Social Care has highlighted the lack of national interoperability standards after shadowing front-line staff during an overnight shift.
In a Facebook post on Friday, Matt Hancock said he was “a bit bleary-eyed” following his shift at the Chelsea and Westminster Hospital and the London Ambulance Service, but added he had been struck by three things.
One of these was technology, “or lack of it”.
Hancock said: “I was already motivated to improve the IT of the NHS – but boy! Chelsea and Westminster Hospital is one of the better trusts for IT, but even there is so far to go.
“And it was through no fault of their own – but rather the lack of national interoperability standards means systems just can’t talk to each other, so people are forced to revert to pen and paper.
“Staff were hindered by IT in a way that we simply wouldn’t accept in any other organisation in the 21st century.”
He added that his stint working at the hospital, which is part of Chelsea and Westminster Hospital NHS Foundation Trust, had motivated him “more than over” to sort technology out, adding “interoperable data standards are on their way”.
The full Facebook post can be read below.
Dedication and camaraderie within the NHS, and communication between health teams, also struck the health secretary.
In July, Hancock delivered his first speech since being appointed to the post, where he listed technology as one of his top three priorities along with workforce and prevention of illness.
The former secretary of state for digital, culture, media and sport also outlined how £412m will be made available to transform technology in hospitals, which Digital Health News recently revealed will be called the Health System Led Investment (HSLI) programme.
6 September 2018 @ 18:27
This could be a time of hope. Matt Hancock, unlike most Secs of State, knows his IT. He could get a grip. My advice to him is to read up the disasters of NHS IT so far, and learn not to make the same mistakes.
I would like to remind him that in 2005, Connecting for Health was launched, The purpose was to “move the National Health Service (NHS) in England towards a single, centrally-mandated electronic care record for patients and to connect 30,000 general practitioners to 300 hospitals, providing secure and audited access to these records by authorised health professionals.”
Thirteen years and several £billions later, hospitals and GPs are still largely unconnected.
What went wrong?
To start with, (2005-2009) they tried “top down”, and “one size fits all”. Very clumsily, against the massed resistance of the Hospital Trusts.
From 2010 or so, until now, they tried “bottom up”, “do your own thing” and share as little data as possible. That, unsurprisingly, hasn’t worked either. Few people implement what standards there are.
So we are still in a fragmented mess, and I, the patient, still feel hardly connected at all. Thirteen years have been wasted, and, so far, no one has shown the understanding or leadership skills to get NHS IT out of the mess.
Matt Hancock has to steer a clever course between top down and bottom up. I wish him luck.
6 September 2018 @ 18:49
Reality is the big initiative announced today is for the nhs to move forward and scrap their Fax machines, give us strength! Too many IT people employed in healthcare who know nothing about healthcare , too many managers with no experience of management, too many clinicians given up any hope of technology helping them manage what feels like daily chaos (sorry but it is), and only dedication of the individuals holds together the complexity of care; too many conferences and committees, too many initiatives that are only words. Get the information to the patient, let the patient manage their information at their next point of care😊😊😊
31 August 2018 @ 19:19
Sounds great but as many techies in the industry know we have one standard for basic api interop (HL7 FHIR called Care Connect API in UK) we have a good standard for basic hospital messaging (ITK HL7v2) plus intra trust messaging such as transfer of care and gp connect
We also have off the shelf standards for practitioner access (openid oauth2), that can be extended via other OAuth2 protocols to include patient consent and app consent eg smart on fhir).
Bertl, this can easily accommodate a patient not wanting to share (I’m not a fan of big single systems or data warehouses, the above doesn’t need them).
So for me the real question is why isn’t it being done? I’m open to other standards but let’s not get diverted until the core interop is in place.
31 August 2018 @ 14:48
Who briefed him to say that? The NHS has been fixated on standards local and international for 30 years! It is simple clinical logic that is missing?? Doctors tend to look at the last 3 clinical events , emergency doctors even less so, the idea of having the 100’s of key systems all talking to each other is a plan of the 90’s yet it hits the agenda for the NHS??? Again, use the systems we have to send a summary of the most recent care episode with results to the patient…then let the patient share with their next episode of care…you will quickly have a record owned by the patient and valuable to care staff….the NHS today works like a big digital letter box, supported by reports and some legacy, rather than spending £m’s Joining this up and taking 25 years to do it… to the joy of the overpaid providers of today’s systems, find a way to use what we have, send summary to patient, blockchain the information and get away from this world of fantasy in interoperability as the system providers will protect their systems and use patient data as the excuse. Providers have a key role but so does government , mandate that all letters and reports must be sent to the patient via an online portal – the patient can then control access
31 August 2018 @ 19:24
Yes patient control access but sending letters is a bit dated.
We had letters with standard headings in the trenches (although that fell to bits when the army updated its processes and used information technology and sprang out of the trenches about 100 years ago to the day)
31 August 2018 @ 13:24
I believe Ewan is correct in his approach to the problem. One might simple look at the Atlas of Variation in Diagnostics as a starting point? As for Chelsea and Westminster with the £Billions Jarrold has had as RID for London on NPfIT and subsequently at RID for LPfIT and laterly CIO of Imperial and Chelsea and Westminster acutes where is the interoperability and where is the money? As for the London Ambulance Service one might ask where the SNOMED CT Ambulance subset is?? or the ePCR? In development of course? Delivery? What is the Architecture for the LCHRE London patient record integration? More of the same?
6 September 2018 @ 11:15
Oh dear, incomprehensible acronym soup. There are some readers here, who are ignorant human beings, some of us are even patients. We are not geeks. Just this week somebody from a Royal College has berated hospital doctors for writing obscure reports to GPs and patients. Mike, and other IT people, please note.
31 August 2018 @ 12:17
Perhaps Mr Hancock should conduct a root cause analysis of the interoperability issue? This isn’t a technology issue but a Political one.
David Cameron understandably decided to shut down NPfIT – it was extremely costly, increasingly out of touch with service requirements, overly-bureaucratic and ineffective at delivering joined up, detailed, local care records. What did Mr Hancock’s government replace it with … apart from a laissez fair approach to setting interoperability standards, promises of extra funding which never materialised (investment funds were used instead to shore up the results of the deliberate under-funding of operational services) and care.data with its disastrous approach to public engagement?
Like Joe, this is my umpteenth Health Secretary and he seems to be saying all the right things … but at least half of previous Health Secretaries of all parties from Frank Dobson to Jeremy Hunt have said similar things at the outset.
We need cross party support and consensus on a fully funded, long term strategy to turn the NHS around and introduce innovative, evidence-based, more efficient and more effective ways of delivering services, supported by relevant technology. The NHS is in a crisis whose roots are in demographic changes and increasing public expectations. No single party caused this but governments of all colours have been deferring action due to short term political expedience since 1979.
Unless this consensus is agreed, there is a real risk that the next change of government will simply result in the dismantling of the FYFV and STP/ACS plans, alongside yet another top-down restructuring of the NHS for ideological reasons.
So just two cheers from me 🙂
31 August 2018 @ 12:15
While the various interested parties and government departments continue to serve their self interest, may i suggest that in the first instance making the clinically relevant or social care relevant data available at the point of care should be the objective.
In the interim this will provide data for better decision making, eliminate the IG problems associated with secondary use, allow patients to see what the “professionals” see and be able to make changes or at least to request changes.
We have spent so many years trying to get the systems to talk to each other, let us now support professionals and patients talking to each other.
It CAN be done in a flexible, scale-able and affordable manner. We just need to look at the problem from the user’s perspectives.
31 August 2018 @ 09:38
I lead the IT function or a major UK care provider and am encouraged that the new minister has recognised early on one of the main reasons the NHS is far from the administrative efficiencies and effectiveness other industries have achieved. This stops hinders clinicians doing what they are best at – delivering great care.
There are many way to solve this, but all will require significant funding and political will.
31 August 2018 @ 08:21
Except that none of the companies in that agreement are actually healthcare IT suppliers.
2 September 2018 @ 08:40
Heaven forfend that the incumbent vendors have to deal with disruptive competition from developers coming in from other sectors!
With this madness, Tesco will be selling insurance and we’ll be getting our broadband from John Lewis!
Seriously, are we going to look to existing experts in BlockChain, AI and VR, or leave it to the existing supplier base, many of whom have been repackaging 90s technology as ‘new’ for decades?
30 August 2018 @ 22:34
Declaration of interest: I am a card -carrying champagne socialist and life-long labour voter but I did recently have the pleasure of spending half an hour with Matt Hancock in his first week in the job of health minister. He’s my 13th Health minister, but the first with a real grasp of the IT and seemed to understand how broken the market is. I’m not sure if any of the other 12 ever did a night shift or looked at the broken IT tools we have to use. Lets give the man a chance.
30 August 2018 @ 16:17
He should visit a care home, its nothing but paper based systems.
30 August 2018 @ 16:50
Mostly, but not quite 100% accurate…
https://www.icarehealth.co.uk/
30 August 2018 @ 14:37
If by interoperability he means semantic interoperability between the thousand of siloed system used in the health and care, each with their proprietary (often idiosyncratic) data formats, representing the same concepts in similar but incompatible ways then the SoS need to understand this is not an achievable objective.
We have been trying in to do this for 40 years and have so far achieved interoperability with just a handful of (admittedly high value) items of the thousand of pieces of clinical content we want to share in a computable format.
We need to move to a shared representation of clinical content. We need to move to open platforms with a single source of truth for an individuals record (stored where they choose to store it and shared with who they choose to share it with) but in an open format and within an governance framework that ensure the rights and enforces the responsibilities of all parties.
30 August 2018 @ 17:26
That sounds fine in theory, but it cannot ever happen for two reasons:
1. The NHS will never let it happen because they have reasons for being absolutely determined to control where patients’ records are stored and who has access to them.
2. A significant proportion of patients will never let it happen because the NHS is violating their right to confidentiality, so they are forced to do everything they can to protect their privacy, which means a perpetual fight with what the NHS are trying to do.
The only way this conflict will ever end is if the patient decides they are better off without the NHS and they cease to generate an NHS record. If they are rich that means private healthcare or emigration to somehere without an NHS Staasi; if they are not rich it means taking their chances without healthcare. It may be the best option.
31 August 2018 @ 15:39
Totally agree Ewan. I am new to the UK Healthcare space but I am quickly realising that even the best intentioned, well-resourced and funded efforts to make existing NHS systems interoperable are a 20th-century solution to a 21st-century problem. Technology and expectations have moved on and it will be another costly mistake to make interoperability the silver bullet, rather than a tactical option amongst many. The NHS bureaucracy and its vendors may resist but freeing patient data seems the most powerful tool to quickly effect change improve efficiency and outcomes.
30 August 2018 @ 14:19
Should be a nice easy task now the US companies have all agreed to standardise on HL7/FHIR earlier in the month
31 August 2018 @ 08:42
What I’m proposing puts the patient in control, while respecting the rights of those who have relied on the information they have shared with those providing care to them.
Watch this space for a forthcoming publication from the Apperta Foundation which will lay this out in more detail.
Bertl – You seem to be at the extreme end of the spectrum on confidentiality – What is it that the NHS does with your record that cause you so much concern?You also seem to be deluded if you think that the NHS is anything like as good as the STASI at managing it’s data.
Have a look at “Fair Shares for All” a while ago now but still relevant 6 years on https://www.bcs.org/upload/pdf/fair-shares-for-all.pdf
31 August 2018 @ 09:44
Looking forward to your paper Ewan. Your goal of patient in control is absolutely the right one in my view – taking ownership of personal data away from any service producer / bureaucrat (of whatever political regime!). One of the best ways to galvanise current healthcare provision I’d suggest.
31 August 2018 @ 10:21
Ewan, I take your point that the Staasi/STASI were much more effective at what they were doing than the NHS. In everything I say I distinguish between the health professionals who work for the NHS, and the leadership and management of the institution, who are criminally insane and very bad at everything they do. What do I particularly object to? Where to begin? Perhaps with my reference to the Staasi. The comparison intended was not concerning effective management but concerning (1) the ideology of control and the idea that control of information gives you control over people, and (2) the trashing of values such as privacy, respect, honesty, trust and individual autonomy. The culture that emanates from the DHSC is one of ruthless determination to control, combined with all-pervasive duplicity and lying. This culture is seeping through the NHS – that is the real transformation we are seeing.
I will not entrust my personal confidential information to people who can be trusted in nothing, and whose words bear no relation to what they say. In theory (5YFV) they want all the data in order to adopt a completely new model of healthcare based on prevention, population health management, holistic medicine and empowering patients to control their own healthcare. First I don’t believe in that model; I think it will destroy any possibility of effective healthcare. Second, this is not what they are actually doing. What they are doing is even worse because it is based on coercion and consistent deception. Third, there is another agenda behind the Sustainability and Transformation Plan (which itself is commercially driven). This is all about coupling healthcare development to stimulation of economic growth in the digital and biotechnology industries, supposedly to the advantage of both. I don’t believe in that either. We already have the pharmaceutical industry driving healthcare in the wrong direction. We don’t need other commercial interests shaping how healthcare is delivered.
If the majority of the population understand where we are going and want to go there, I can’t stop them, but I do wonder how many people do understand where we are going. In any event, I just want to opt-out, but despite all the talk of empowering patients to take control of their own healthcare, and despite repeated personal assurances (from the Secretary of State, via my MP) that I will retain the right to opt-out and that any reasonable objection will be respected and upheld, the reality is that one can opt-out of nothing when it comes to data sharing and use of personal data. Objections are ignored, circumvented or overruled (in contravention of the GDPR). I don’t want my information in the hands of people like this. I am perfectly capable of managing my own data flow in my best interests, and I insist on doing that.