“The NHS has quite an expensive IT system that, frankly, is not essential for the front line” (pt 3)
The very structure of the CfH framework (the body which runs the NHS IT project) is flawed. I won’t go into detail here as much has been published on the topic already but suffice to say that the government has created a closed market which not only increases procurement costs but actively stifles competition and prevents innovation. It is, for example, impossible for a new company to provide new IT services to GPs as the provider must be on the GP Systems of Choice programme to be able to sell to GPs. This is a closed programme and will not be reopened for a number of years. This means that those on the programme are only incentivized to compete with each other (and even this is limited as PCTs can limit the choice still further by mandating use of certain systems).
Now, it is easy to argue that this is done to respect the sensitivity of patient data and to prevent the system being accessed inappropriately, which is a sound argument, however there are many well established ways of doing this without limiting the marketplace. International standards exist for the exchange of medical information for good reason. DICOM (in imaging), HL7 (for pretty much anything else) are two which spring to mind immediately. Every other kind of data can be processed securely over the internet (never mind N3, the private network for the NHS) so why is it such a problem here?
Scale could be an issue but linking 30,000 GPs to 300 hospitals (to quote numerous articles from the weekend) is not a daunting task. BACS processes billions of messages annually reliably and securely and has been running for years without problems.
So how do we go about fixing this?
The Tories are proposing a ‘shake up’ of the system – I don’t think anyone would have a problem with this – with the common message seeming to be a decentralization of the system and an opening up of the market.
This seems like a good idea, but extremely difficult to implement. Ignoring the issues of terminating billions of pounds of contracts with multinational suppliers and their subcontractors, none of whom have been fully paid for their work so far, the question is how to take the good from the system built so far and add to it, whilst integrating it into a coherent healthcare strategy that reduces costs and improves the quality of care for the patients (who are the ones that not only have to pay for it but also suffer by its mistakes)
If we build on the Tories suggestions and look at an open marketplace, then we have 2 fundamental issues:
- How to improve choice in healthcare
- How to lower costs in healthcare.
Technology seems to me to be the only solution to both of these.
Tomorrow we will conclude by looking at 3 specific measures which must be taken in order to make this happen.
