Does this sounds like a Lib Dem healthcare manifesto to you? No, me neither – in fact, reading through the document by Norman Lamb, it strikes me that much of what he is advocating is eminently sensible and in fact very much in line with what the Tories are proposing.

The only difference is that only 5 times in the entire 48 page document, does he use the word Private. It seems to me that the core values of this document are the same, but it has been quite neatly ‘spun’ by the party to ensure that they aren’t seem to be endorsing the ‘privatisation of the NHS’.

Ideas such as co-ownership offer a fix to the issue that incentives in the NHS are not properly aligned and although he talks about not for profit organisations and co-owned trusts, he stops short of recommending the use of private companies to achieve the same thing.

The issue with this fundamentally is that although employee owned trusts will achieve better alignment of interests, it will be difficult for these enterprises to grow to the levels required to really achieve significant economies of scale. If we take this idea and combine it with the suggestion of GPs acting as commissioners, able to manage the patient pathway in a Kaiser-esque ‘managed care’ scenario, then surely it makes sense to allow the growth of organisations that specialise in specific types of care? Maternity services could be such an example where an expert company in the field is able to offer a managed service for the GP. Equally, this ties in nicely with the ‘direct payments’ or ‘individual budgets’ idea which would give patients the choice of where to spend their voucher for treatment. Competition at a national level between providers as well as at a local level will surely increase the quality of service provided and ensure providers remain as efficient as possible.

To manage this all effectively however, the Lib dems are correct in their assertion that the NHS IT system must change. It must become more oriented around pathways rather than episodes and must be intelligent enough to spot and prevent ‘failures’ in the system to stop patients falling through the gaps.

GPs cannot be expected to individually case manage every patient and if hundreds of further organisations are not to be created with the sole purpose of managing patient journeys, technology must be employed to ensure that proactive alerts and reminders are used where possible, combined with the effective delivery of this information into the hands of both the GP and the patient.

Furthermore, It must critically allow for the linking and joining up of services across providers and in particular those in social and primary care – not only because this is where the majority of care takes place, but also because it is here that the greatest savings can occur. Keeping patients out of hospitals with the intelligent use of technology ought to be the goal. This can be through the simple realignment of payments to GPs for measurements, to payments for improvements (ie, not pay GPs to ask people whether they smoke, pay them to get them to stop smoking!) and the efficient tracking and publishing of outcomes to measure performance of clinicians and providers.

This will ensure that excellence is rewarded by increased patient volumes (who will have access to this information in both the Tory and Lib Dem system) and that the overall health of the nation improves as a consequence.

I could go on for hours about this as this is a topic which is clearly of huge importance to me and those that I work with, but I will stop for the time being. Suffice it to say, nomatter the results of this next election, the challenges facing the next parliament will be huge and I look forward with interest to seeing what lies in wait for us.

Let’s cut to the core of the matter and lay out what is truly needed to sort out the mess that we’ve got ourselves into.

1. A redefinition of the ‘open’ market place

A single set of open standards must be defined and used for the exchange and storage of medical data. There are too many precedents to name for this but everything from the VA system in the US to the CALIOPE system in Europe. Data formats exist, they must just be used and adhered to.

To some extent, we do have this in the UK, but it is redefined every 6 months as it is in continual development (or so it seems) and the implementation and specification lag each other meaning it is often not possible to get ‘compliant’ with the latest specification. The compliance process also takes so long that you can easily find yourself building something on one standard only to find it out of date by the time it is deployed – by which time you have to begin compliance again as there is a change in ‘scope’ of the product.  In other words, we did not start this project with a fixed specification, but we are making it up as we go along…

All this costs money (in our case tens of thousands of pounds in internal costs annually and we are a small company working with consultants who do most of the work for us) and this prevents the small companies with the big ideas from delivering (assuming they can get an invite to the closed party in the first place)

2.  Don’t try to deliver everything for everyone.

Define the standards, make them fixed, and let the market do the rest. If there were one set of standard methods for data interchange then providers could make great tools, people could buy them and the market would sort the wheat from the chaff.

The best thing about this is that it could then enable healthcare providers to get on with delivering healthcare. This would allow them to innovate in their service delivery which would then improve the quality of their care.

3. Make it easier for companies to get on board

This is really the key to solving this mess. With a dynamic marketplace built on standards and robust rules, we will see a rush of innovation coming from companies large and small, all of whom wish to get on board. We, as a society, are not short of ideas, but we are actively prevented from realizing them in this sector by infrastructure that simply cannot meet the demands of the industry, even 5 years after it was put into place.

By all means vet companies, by all means make hoops for people to jump through, but make them reasonable and make the standards fixed so that the effort that people spend on coming up with great ideas are not wasted.

What’s next?

There are a number of genuinely good ideas in both the political parties and in industry I genuinely hope the next government have the courage to implement some of the more radical proposals they are coming up with, but this continual separation of medicine and technology has got to stop. We long ago passed the point where we could justifiably say that IT was a niche. Technology is not a toy – it runs our stock markets, our power stations and our system of government.

Technology allows people to be great at what they do by making their lives easier. Technology doesn’t have to cost the earth and when it does, people don’t buy it so long as they have a choice.

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.

These are not complicated systems but have potentially huge benefits. Imagine being able to release patients out of hospital wings early and place them in ‘Hospital Hotels’ where skilled nurses and doctors can monitor patients proactively using sophisticated technology and provide them with a more comfortable environment to recover in. This not only costs less money to run but also frees up beds in hospitals for more intensive cases reducing waiting times and increasing the quality of patient care.

Or perhaps we look at the increasing problem of obesity in this country and the increasing incidence of diabetes. A remote monitoring system which monitors blood sugar levels and sends the data to a system which flags the GP is further intervention is required is simple, cheap and very effective in improving care. This device alone could act on acute episodes and remove the need for hospitalization.

Even a simple accelerometer integrated into a watch with a wireless chipset could phone an ambulance if an at-risk individual experienced a fall or an accident. By the age of 75+, the annual cost of servicing our healthcare needs are approximately 6x what they are in the 34-44 age bracket – much of this due to the disproportionate amount of time spent in hospital and on medication. If these can be reduced, then the overall cost of healthcare delivery can be dramatically cut whilst improving the quality of life for the patient.

None of these ideas are revolutionary. None of them are expensive to design or build and all of them use technologies which exist today, but so long as the NHS IT system remains closed, then they will remain within the domain of the private individual or private hospital group and out of the hands of those who would benefit most from it.

Tomorrow I will go into how this situation came into being and how we can go about fixing it

This quote really, genuinely intrigues me. I should explain that I am not a clinician of any kind, though I obviously come into contact with clinicians every day. Our company has been running for 5 years now designing healthcare technologies for clinicians so I would like to think that we are at least slightly informed on how IT and healthcare work together.
To suggest that this IT system is not essential for the front line of the delivery of medicine is to betray a complete lack of understanding of the objectives of the project. I don’t think anyone would disagree that the project has been badly run, badly managed and exceptionally poorly specified from the outset, but to attempt to write it off by suggesting that it is ‘not essential for the front line’ whilst completely failing to show any sense of awareness of the the root cause of the problems besieging this project absolutely astounds me.
First off, let me quote one small fact:

According to the NPDA report ‘Safety in doses’, the total cost of avoidable harms in medicine annually comes to £1.2bn including a £769 cost of avoidable hospital admissions due to ADR.

I am a firm believer that technology has its place in life and should never take the place of sound judgement, but it does seem to me that if £1.2bn is spent annually in correcting issues of medication, then there must be a reasonable case to be made that systems which can address these issues should be implemented wherever possible – be it in tracking interactions, medication history, correct dosages both at prescription and dispensing phases (particularly in hospitals with drip bags all full of clear liquid) or any of the other seemingly innocuous tasks performed, all of which carry potentially lethal consequences if done in error.
I don’t believe that any clinician will disagree that it is simply impossible to keep track of every single medication and interaction and that a significant majority of them will have been awoken in the middle of the night by worries about medication they may or may not have prescribed that day, particularly as a junior doctor. Even the BMA describe the project as ‘an essential tool for clinicians, doctors and other staff to be able to treat patients’.

Over the next few days, I will be posting 3 further short articles on technology and its uses in healthcare and why Mr Darling’s statement could not be more wrong.