The new look central perspective

Thursday 30 September 1999

The Board Room, Moorfields Eye Hospital, City Road, London, EC1V 2CD


Peter Drury, Head of Information Policy, NHS Executive

This session was part of a joint meeting held by the LMSG and the Institute of Healthcare Management (IHM) covering many topics related to 'Making the Strategy Work', the year-long series of talks on the 'Information for Health' strategy. The session was chaired by Mike Rigby, Lecturer in Health planning and Management, Centre for Health Planning and Management, Keele University.

Peter opened with a review of the strategy and how its is being managed. He explained why it appeared that not much had been achieved since the launch, ie that much had been going on behind the scenes - the IMG had been disbanded, the Information Policy Unit and the NHS Information Authority had been created - and there were still many senior posts in these organisations to be filled. Hence almost all of the work programmes were on hold or operating on a care and maintenance basis.

Moving on to the here and now, he felt there were three questions about the information strategy that needed to be answered:

Who is it for, what is to be achieved and by them?
What needs to be done nationally?
What needs to be done locally?

The stakeholders for the strategy should be inclusive - patients and public so that they can see how to access the service and can learn about their diagnosis, treatment and outcomes; managers so that they can find out what works and what doesn't; and the professions so that there is good data on good systems and staff know how to access it.

The strategy has a seven year view - to put in place the resources, processes and culture required to ensure that NHS staff can provide and run the service, and to ensure that the public and patients have access to a range of quality services. As documented in the strategy there are a series of objectives, targets (national & local) and actions - 86 in total. The evaluation process has been criticised in the past and this is now explicitly addressed and the NHS Executive is willing to change in the light of experience. The plan is to introduce a dynamic evaluation feedback loop to support fast, convenient and dependable services. Peter cited the GPnet issue as an illustration of this new thinking. He then listed the current national work programme and how it is to be phased.

By 2005 the plan is to deliver in, primary care, the first generation of the Electronic Healthcare Record (EHR), level 3 Electronic Patient Record (EPR) in all acute trusts, and 24 hour access to records. These targets are set out in the relevant web sites.

The practical implementation was then discussed. Partnerships are the effective route to achieve the targets, both nationally & at a local level. These will involve the NHS Executive, Regional Offices, the NHS Information Authority, NHS organisations, local authorities, social care services, professional bodies, suppliers, academia & health management groups. Mechanisms to create these partnerships need to be developed, Peter recognised the concerns of suppliers, and was seeking ways to involve academics, for example in seeking funding for the evaluation of projects.

The infrastructure required to assist the work is largely in place - NSTS, NWCS, the Security & Confidentiality programme, NHSnet and other work is advancing, eg. NELH. Central funding for this work will assist in the their uptake. The Electronic Patient Record (EPR) & Electronic Health Record (EHR) will build on the infrastructure and support the clinical process.

A review of the procurement process is currently in process, with the participation of suppliers, to achieve a joint approach, with reduced administration, with local effort to realise benefits. A report on this is due at the end of 1999.

All draft local Local Implementation Strategies (LIS) have now been received. These will build on a blueprint for local action between 2000 and 2005. Local tasks will require a cohesive community-wide LIS linked to the local business plan. This is compounded by the number of potential stakeholders. The solution is clarity in the documentation - a costed, ordered plan for meeting targets in a local context. This then fits within policy guidelines. The requirements for a full LIS are set out in HSC 1999/200.

Peter concluded his presentation on the question of money. He said that he did not know how much money would be available from the modernisation fund, as the value of the fund will not be known until November 1999. The spending process must focus on the clinical case, relate to the HIMP, engage the stakeholders, and treat all work as a change agenda, not as a pure IT project. He alluded to some possible traps in the scheme - the recurrent demand for finance, the scope, the skills which are scarce within the NHS, the timescale due to the pressure and pace of change. Local ownership is required to manage these risks.

Mike Rigby thanked Peter Drury for his presentation and, in summing up, drew out three points about the strategy:

1. It is to support healthcare delivery, not to create an EPR
2. It will lead to process re-engineering
3. Facts, information and evaluation are required so that the work is seen to be real and the NHS learns of the best solutions

The session concluded with questions and answers annd some general discussion.