04.01.11
NPfIT – bless! A personal view by a GP
NpfIT is travelling in the right direction-it just needs to go about it a different way, says Dr Brian Fisher
NHS Connecting for Health tries, it really does. And in many ways it is succeeding. We need to applaud those. But in other ways, well…
The moto is, as explained in the website: “NHS Connecting for Health supports the NHS to deliver better, safer care to patients, via new computer systems and services, that link GPs and community services to hospitals.
NHS staff treating patients will be able to find information - such as notes, x-rays or scans - quickly, easily and securely. We would all agree with those aims, of course. And in some respects NpfIT and CfH are really delivering. PACS is working well, enabling good quality images where and when they are needed.
For my practice, Choose and Book is one of the more visible CfH products. CAB works most of the time, though it does seem to fall over towards the end of the day – it seems to get even more tired than I do. Patients appreciate CAB. It offers them more control and when they do want to choose between hospitals (which is unusual in my experience) they can be offered such a wealth of information immediately on which to base their decision that they are really impressed – and so am I.
The information available is extensive, including car park, disabled access, phone for patients, shops on site, Healthcare Commission ratings, waiting times, cancelled operations, MRSA infections and so on.This is high-quality relevant information, which can be printed out in seconds to help patients make informed choices. However, few clinicians have been willing to adapt their consultation style to accommodate making the booking themselves and rely on admin staff or the patients to make the booking.
Despite these successes, there remain some real difficulties that may still terminate development with extreme prejudice. My particular perspective is eccentric, but my experience with CfH/NpfIT is not unusual and offers a number of lessons.
I am a GP in SE London but I am also a director of a company that enables patients to see their full GP record both online and in kiosks in the GP surgery. The system (and others available in the NHS at the moment) offers the sort of functionality that CfH can only dream of at the moment – we offer full access linked to patient-centred information so that patients can better understand what they read. It offers patients high-quality personalised information, which can also be linked to the NHS Direct website as well as interactive sites that put people in touch with each other.
You would imagine that there would be interest in collaboration on this kind of facility. It offers comparable functionality to CfH systems plus a lot more.The system avoids using the Spine. It has been developed for a fraction of the price; it also has involved patients as designers throughout and continues to do so.
But it has been very difficult to get a dialogue until very recently. Objections did not cite any problems with the product, but boiled down to the fact that we came from outside the CfH stable. This seemed to make it very difficult for the organisation to link with us or, indeed, take us seriously, although they funded research into record access. It was only when we began to involve over 100 practices in the second phase of the work that CfH agreed to discuss concrete issues of collaboration.
This reaction demonstrates some of the problems of NpfIT/CfH in microcosm.
NPfIT has been conceived as if the UK is a planned economy. It has been a top-down approach with little engagement with grass-roots organisations and initiatives. The process has appeared blind to any good existing practice. It seemed to feel, arrogantly, that only designs with its own imprimateur would be acceptable.
This approach has proved counterproductive. Legacy systems were defended by current users and by the provider companies. CfH has finally had to allow them in as key players. Had they engaged them from the start, much time and money would have been saved, in my estimation.
Another example: Patient Opinion is a useful site that enables patients to record their reactions to treatment in the NHS online. It has been supported by the DH and CfH for 4 years. Its functions are now going to be taken over by a part of the NHS Choices website which is designing a similar functionality, apparently from scratch. Why? Build on what is there already, particularly if you had already supported it. Strange.
Large scale operations need to build in flexibility and need to work with existing energy on the ground. In systems such as Second Life, or Web2.0 generally, the more people get involved, the more useful the creative process becomes. The more data Tesco receives, the more responsive the reactions. Ditto with Patient Opinion.
The government may be coming to the same conclusion. In a recent document from the Cabinet Office , ‘Power of Information’ by Tom Steinberg, founder and Director of mySociety, and Ed Mayo, chief executive of the National Consumer Council, the government is urged to look at existing examples of excellence in IT. These are likely to be found outside the mainstream. This point is also made by Cross in the Guardian . Cabinet Office Minister Hilary Armstrong commissioned the report to ensure government acted as a leader in understanding changes in communication and information technology. Now with Richard Granger going, it may be that these ways of doing business may change radically.
CfH has tried to involve clinicians from its early stages, whatever the profession may now say. My experience of that, however, was a series of impenetrable documents and poorly timetabled meetings that made it impossible to usefully support the programme.
Decision-making within CfH is ponderous. It is hampered by a need to conform to a wide range of constraints, financial, legal and internal. I worked in CfH briefly and found change as slow as molasses in winter. The people are bright, keen and committed, but the system sucks out energy and inflates inertia.
The clinical leads are doing their best defending a very imperfect process. They have injected much needed reality into CfH and they are to be welcomed. The rank and file should be supporting them.
In summary, we should be supporting NPfIT/CfH. The Guardian hysteria about the Spine has been unhelpful and counterproductive. The organisation is travelling in a direction that is good for patients and good for the NHS. It just needs to go about it a different way. It needs to develop respect for other organisations and other ideas. It needs to listen to what is out there and harness existing expertise and enthusiasm. It needs to integrate existing work rather than create from scratch. It needs to get out more. Maybe necessity and a change of leadership will make it easier to do so.
Dr Brian Fisher is a GP and Public Involvement Lead at the NHS Alliance Patient. He is also co-director of PAERS, a company that enables patients to see their electronic health record.
THE 2006 INPATIENTS IMPORTANCE STUDY THE ACUTE CO-ORDINATION CENTRE FOR THE NHS ACUTE ATIENT SURVEY PROGRAMME Jason Boyd Research Associate Picker Institute Europe April 2007
http://www.headshift.com:80/archives/003248.cfm
http://www.cabinetoffice.gov.uk/newsroom/news_releases/2007/stories/070607_power_information.asp
http://technology.guardian.co.uk/weekly/story/0,,2101807,00
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