Health Service Focus

22.09.16

Realigning the delivery of hospital digitisation

Source: NHE Sep/Oct 16

On the first day of NHS Expo, Dr Robert Wachter released his report ‘Making IT work: harnessing the power of health information technology to improve care in England’. David Stevenson reports from the session.

The Making IT Work report, led by the ‘digital doctor’ Dr Robert Wachter, made for sober reading at its launch at NHS Expo, highlighting the variation in secondary care IT systems and the thinness of the clinician informatician workforce. 

However, the advisory group, which was appointed by the health secretary last year to run the review, concluded: “We believe that the NHS is poised to launch a successful national strategy to digitise the secondary care sector, and to create a digital and interoperable healthcare system.” 

So, how should this be done? 

The report noted that the £4.2bn the Treasury made available to promote digitisation, while welcome, is not enough to enable digital implementation and optimisation at all NHS trusts. 

“Our biggest worry was that £4.2bn might sound like a lot of money, but it isn’t to digitise the entire health system, particularly if you are trying to get it done in a few years,” said Dr Wachter. 

“While we understood ‘paperless’ by 2020 was an aspirational goal, the idea of trying to digitise the entire system in three years with £4.2bn, with many trusts in deficit, there was a reasonable chance that it would fail, like the ambitious National Programme for Information Technology (NPfIT). Too little money, not enough time.” 

Implementation plan 

Therefore, the group proposed a phased approach – something the Department of Health has agreed to with the development of global exemplar sites. 

The Wachter Review said during phase 1 (2016 to 2019), national funding should be combined with local resources to support implementation in trusts that are prepared to digitise, and to support those that are already digitised and ready to reach even higher levels of digital maturity. It suggested putting trusts into three groups A, B and C. Group A, now the global exemplars, would promote shared learning, with the aspiration that they become digitally superb by 2020, which Dr Wachter believes “is achievable”. 

In Group B, approximately a third of NHS trusts, funding would be provided to those that are “digitally immature”, but are able to demonstrate sufficient readiness to begin implementing clinical information systems. The report said: “This funding should not only support the purchasing of software licenses, hardware, and infrastructure improvements, but should also support workforce development, training, and participation in regional health IT learning networks.” 

For Group C, around half of NHS trusts, the report suggested smaller amounts of funding be made available to trusts that are not yet prepared to digitise. This funding should not, however, be for the implementation of robust clinical information systems in 2016 to 2019. Instead, it should be designed to help the trusts build capacity before they are mandated to implement clinical information systems in 2020-23. 

“The proposed Phase 2 national funding will be needed to support this group’s digitisation in 2020 to 2023,” the report noted. 

Workforce 

As well as focusing on the implementation plan, Dr Wachter’s review also looked at the workforce issue. 

“You need to have people who understand clinical practice and understand technology and can bridge these worlds. But they have to have training,” he said. “There is a problem in supply and demand. There are very few in the CCIO (chief clinical information officer) pipeline, no mature training programmes, it isn’t professionalised and there is no certification. This is different in the US.” 

Dr Wachter said there needs to be professionalism and training with regards to informatics, “and it is not unreasonable out of a £4.2bn budget to promote digitisation to allocate 1% to build this workforce”. Following the release of the report, Jeremy Hunt announced plans, for the first time, to form an NHS Digital Academy, to help train NHS professionals in the key skills to deliver digital healthcare. 

“Trusts will need to have a world-class clinical and informatics workforce,” said Dr Wachter. “But they should also demonstrate they either have that or are committed to having that as a condition to receive national funding.” 

The review also recommended having a national CCIO to oversee the process. Back in July, NHS England appointed Prof Keith McNeil, a former transplant specialist who has also held many senior roles in healthcare management around the world, including CEO at Addenbrooke’s Hospital, to the position. 

“I think he will do a great job in this role,” said Dr Wachter, adding that while there are many challenges to be overcome in the next few years “the NHS will simply not be able to provide high levels of service at an affordable cost without digitisation and appropriate use of digital data at every level”.

FOR MORE INFORMATION

To access the Making It Work report visit:

W: www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

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