Last week Matt Hancock gave his most detailed speech yet on how he intends to help ensure health and care services become digitised.
No previous secretary of state has so closely aligned himself with sorting out the IT systems used across NHS and social care. While Hunt was an enthusiast, Hancock is a self-identified expert who says this is where he can make a big difference.
As has become customary for new health ministers – Simon Burns first did it way back in 2009 – the secretary of state for health and care sought to draw a line under past failures of NHS IT, both the National Programme for IT and the far more recent, and set out his blueprint for the future.
Having come from the Department of Digital, Culture, Media and Sport and worked for his family’s software business, this is territory that Hancock is clearly confident on and he seems convinced of his ability to make an impact while avoiding past mistakes.
The plan set out last week focuses on two poles: the need for board-level leadership and a relentless focus on interoperability and enforcing use of standards.
Hancock promises to have boards’ backs
While recent attention has been on beginning to build up and train a leadership cadre of expert clinical informatics leaders (CCIOs) and CIOs, Hancock stresses the importance of board-level leadership.
“I want every trust board and STP leadership team to drive this, and ensure this transformation happens. Driven only by an enthusiastic IT department reporting to the CFO, it will fail,” said Hancock.
“Owned by the whole organisation, the board, the chief executive and the clinical leadership, and the opportunities to improve our NHS are huge.”
Referring to the recent chequered past of NHS IT, he said it was understandable that many leaders had shied away from digitisation, but Hancock promised to support them.
“We must get back to driving this transformation,” he told delegates at the Health and Care Innovation Expo. “We must drive this agenda and you need to know that I’ve got your back.”
He encouraged leaders to experiment, take risks and recognise that mistakes will be made.
“The biggest risk is not doing digital transformation. So please hear this one message very clearly – I am not looking for people to blame; I am looking for people to lead. We will together drive this chance. We will make mistakes, and mis-steps. We will learn the right lessons from them and move on.”
Interoperability: immediate action pledged
Hancock also stressed that the patient record, and specifically the data it contains, is the focus of interoperability: “At the core of interoperability in the health and care system is the patient record. And by an electronic patient record I don’t mean an application or a particular company’s software. I mean the record – the data.”
Suppliers who don’t comply will not be allowed to do business with the NHS, he contends. Those with long memories may recall echoes of NPfIT here.
“We will publish robust standards in the coming weeks that IT systems must meet if they’re going to be bought by anyone in the NHS. No system will be allowed to be bought that does not meet these standards.”
That his prescription is very familiar is no bad thing: we don’t need new standards, just consistent use of current ones. What counts, though, is Hancock’s ability to hold the course and not be deflected by competing priorities or contingent expediencies.
Hancock promised definitive standards on interoperability in a matter of weeks. Given the painfully slow, perennially half-hearted and vague efforts on driving interoperability and enforcing standards’ use, this will require a sea-change in priorities.
NHS Digital and NHS England have proved themselves signally ineffectual, inconsistent and lukewarm on mandating and enforcing interoperability standards. If things are to change, the task needs to be given to an independent body of domain experts from customers and suppliers.
Properly funding INTEROPen and PRSB, the two existing bodies, and giving them a clear mandate as the lead organisations on standards development would be a good start. Yet at the moment, NHS Digital is actually watering down its support for INTEROPen.
Further steps could include high profile commitment to HL7, and to well-established movements like Integrating the Healthcare Exchange (IHE) – which holds regular connectathons; practical plugfests at which suppliers can demonstrate that they don’t just espouse commitment to standards, they actually walk the walk too.
These could be run nationally and should be made open to all interested, with the results openly published, to enable organisations to know who is serious about interoperability.
Carrying out a small number of interviews about impressions of suppliers’ interoperability – as a recent NHS Digital-supported study recently did – is better than nothing, but doesn’t offer much to guide local organisations.
The challenge to NHS CIOs, CCIOs and their supplier counterparts through bodies like techUK is to work out what this means in practice. How can commitment to open systems and standards be written into contracts, compliance monitored and enforced, and ‘bad suppliers’ publicly identified without involving Messrs Grabbit and Run?
Primary care suppliers named and shared
GP system suppliers were singled out by Hancock in his speech as particular offenders on the interoperability agenda.
The secretary of state said: “I’ve been appalled at some of the tales of blockages, especially in providers of systems for primary care. We are going to be extremely robust with any supplier who doesn’t live up to the new standards we are mandating.
“I want all our existing suppliers to come with us on this journey. But if you don’t want to come on this journey, you won’t be supplying IT to the NHS.”
Very welcome tough words, but we’ve unfortunately been here before. Again, it’s that all-important delivery that counts, or leadership risks becoming sloganeering.
Jeremy Hunt said very much the same and even personally went up to TPP’s offices in Leeds to eyeball Frank Hester, the company’s chief executive, and read him the riot act. Jeremy might as well have saved himself the journey. EMIS hardly has an unblemished record either.
So where to begin? Neither of the two main systems suppliers currently interoperate with GP Connect. Strongly encouraging them to do so would be a good start.
With the GP IT Futures framework looming, there is a rare opportunity to seriously disrupt the primary care supplier market.
20 September 2018 @ 18:04
What is needed is a robust scalable, decentralised governance structure that maintains and evolves a suite of standards and supporting scenarios, examples, reference implementations, and testing tools, supported by a conformance testing and issue resolution process. Maybe INTEROPen and PRSB can provide this – but don’t just commission them to create a one-off set of APIs… The key requirements are that there be no bottleneck, and that the process is ongoing and open to support innovation – the models of care are going to continue to evolve, and the types of data and the ways that it is used within and beyond healthcare will change.
18 September 2018 @ 12:53
Hancock seems to realise what needs to be done. I am not sure that hospital managers, clinicians, IT suppliers or rank-and-file IT people have got or will get the message.
I will know when my test results from ALL the hospitals which treat me appear seamlessly on my GP’s medical record. Currently, only one does. This means that my record is misleading. But, I am just an ignorant patient, so what do I know?
18 September 2018 @ 22:38
Talk is cheap. Let’s see whether Hancock’s rhetoric is matched by new hard cash (rather than the re-announcement of money preciously promised by Hunt) and real World delivery.
Hancock is not the first, nor the only, Secretary of State for Health to closely align themselves with sorting out Health and Social Care IT.
I seem to remember Alan Milburn took a personal interest in the subject and persuaded his government to invest billions in it.
Sadly, his alignment ended in 2003 – well before the wheels started to come off. Like so many in that post, his involvement was short-lived but disruptive and included a major top-down restructuring of the NHS as well as the well-intentioned but doomed NPfIT with its politically motivated, ridiculously short, time frame.
15 September 2018 @ 09:02
This area is a complete mess.
PRSB are currently decorative rather than functional.
Interopen does good work.
But PRSB/ Interopen work is irrelevant when the system suppliers refuse to connect.
What would I do?
Commission Interopen to define standard APIs for primary and secondary care.
Commission PRSB to standardise a framework for demonstrating IG compliance.
That way the power is put back into the hands of the data controller, where it should be.