04.01.11
Five minute interview
Matthew Swindells is a former chief information officer at the Department of Health and senior policy adviser to the secretary of state for health. He recently became chair of BCS Health
What do you hope to achieve in your new role as chair of BCS Health ?
I see BCS as having two priorities. The first is to help the government and the NHS make better policy decisions around information and IT, to enable to the NHS to maximise the benefit that informatics can bring. The second is to raise the information and IT expertise within the NHS, both amongst informatics professionals and the wider NHS staff, who should be using information to support their decision making. We will do this by engaging both at national level with the government and the department of health and by supporting NHS locally.
This is a crucial time for informatics and the NHS as a whole. The challenge is for the NHS to raise the quality of its services, whilst dramatically reducing costs. I find it hard to imagine that the NHS can succeed in doing this without the support of information technology. I will be working to the build skills and confidence of the informatics community to fully contribute to this strategic challenge.
How would you characterise the relationship between the NHS and IT projects?
One of the NHS’s failures has been that it has focussed too much on IT and not enough on information. Good, timely information allows clinicians and managers to make better decisions, allows the public to hold the NHS accountable and, ultimately, saves lives and improves care. I’d like us to spend more time talking about how we liberate the information that we have and less time talking about who supplies the boxes to hold the information.
However, you can’t ignore the National Programme for IT. It is one of the most complex informatics challenges anywhere in the world. It does the NHS no favours to claim either that it has been a disaster, when many real gains have been achieved, or that it is triumph, when so many of the objectives have palpably not been met yet.
I believe that the speed of change in the NHS is so fast and the need for local ownership is so great that a more flexible solution is necessary. The technology is available to support this in a way that it wasn’t when the programme was launched and the National Programme changed a great deal in the past two years to reflect this.
The National Programme must become ever more fleet of foot and position itself as a platform for innovation, rather than the only acceptable way. However, it should also be proud of its successes and continue to strive towards a system that joins up the information needed to support care. Throwing away the vision because it got difficult would be a monumental mistake.
How will informatics aid in shifting care from an acute setting into the community?
If the NHS is to be successful in joining up clinical pathways and allowing patients to be treated in the location that is most clinically appropriate rather than most administratively convenient, technology must up its game. Our failure to adequately track patients and deliver key clinical information in a timely manner has held up the redesign of clinical services.
The successful delivery of PACs has show the extent to which good technology, well delivered and eagerly adopted can improve care for patients, but the long term vision of a paperless electronic medical record is still some way away. This may be the gold standard, but the NHS can’t afford to stand still whilst it waits for informatics to catch up.
CIOs across the NHS will need to engage more closely with their organisational leaders to deliver the strategic systems that support the redesign of care pathways to drive quality and productivity. These will include systems such as electronic document management in medical records and remote order communications as well as the rigorous standardisation around the NHS number. They need to dig themselves out of the perennial problem of being bogged down dozens of routine system upgrades and implementations that are nice but not necessary.
To what extent has informatics changed the NHS over the last twenty years?
In the past twenty years, which pretty much covers my time in the NHS, information technology has transformed healthcare in the clinical setting with extraordinary equipment in theatres, intensive care, imaging and laboratories. However, the use of IT systems to transform the running of healthcare has been a disappointment. Indeed, some of the IT systems that were being used when I first came into the NHS are still in use!
However, green shoots are appearing. Some of the National Programme’s achievements mean that we are closer to a great leap forward than ever before and the recent row over Dr Fosters quality measures have shown that the next frontier may well be the use of information by the public to hold the NHS to account, which has the potential to be transformational.
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