From phoney war to white paper liberation?

Nearly 20 years ago, a Conservative government's health reform designed to put GPs in the driving seat left as its legacy the biggest success story in NHS computing. It was the near-universal move to computerised practice management - for many a first step to electronic patient records - made necessary by GP fundholding. It is far to early to tell whether the "Nothing about me without me" reform announced in health secretary Andrew Lansley's white paper on 12 July 2010 will have the same effect. What is clear is that the paper marks the end of the strange phoney war between the coalition government coming to power and it going on the offensive against what, in opposition, ministers had claimed was wasteful IT spending. That battle seems set to commence, in the run-up to an information strategy to be published in the autumn. The Liberating the NHS white paper admits that the government's vision of an NHS led by GPs and patients will depend on an information revolution. However, the white paper gives little clue how this will be achieved. For example, if local authorities are to replace primary care trusts (PCTs) in joining up the commissioning of local NHS services, social care and health improvement, they will need to take over many of the IT functions of PCTs, including full interconnection with NHS organisations. The goal of giving patients the ability "to download their record and pass it on, in a standard format, to any organisation of their choice" is highly optimistic in the near future, especially if electronic records contain social care data. As expected, the white paper says that control and choice in procurement will devolve to frontline organisations. "NHS services will increasingly be empowered to be the customers of a more plural system of IT and other suppliers." However in throwing out the PCT bathwater, the government may also be throwing out some bonny babies: some PCTs are showing leadership in local IT implementations. One example is the recently announced link between urgent care services at Aintree Hospital on Merseyside and 100 local GP practices. Merseyside's natural community The project, claimed to be the largest such scheme in England, is reminiscent of the electronic integration of "natural communities" envisaged in the NHS Information Management & Technology strategy of the 1990s. The scheme relies on the ability to view information from Aintree's Medway hospital information system, supplied by System C, on the GPs' Emis Web software. Opening GP-held information to hospital clinicians will give them a fuller picture of a patient's care, reducing the margin for error and speeding treatment and waiting times as well as reducing repeat testing and other duplications of effort. The hospital estimates that access to information will allow the medical assessment unit to handle an extra patient every hour. The white paper implies that patient and GP-led initiatives will achieve the same end result, with less bureaucracy. Although there is no mention of privately held health record systems, the presumption is that they will be part of this future. It is significant that Microsoft took the opportunity of the phoney war for the long-awaited launch of its HealthVault system in the UK ( article ). Meanwhile, we are still waiting for official news on the future of the Summary Care Record and Healthspace. The publication of the Greenhalgh evaluation of the project was the most significant step by NHS Connecting for Health during the phoney war. It produced an interesting government response: Simon Burns, the minister of state for health, told the BMA that the government "broadly" sees a need for patients and clinicians "to be able to access patient records in electronic form". The minister also showed sympathy with the BMA's concerns about confidentiality and consent, stressing that the effective use of summary care records "depends on patients and doctors feeling comfortable with those records rather than them being seen as... imposed as a central part of government." Where this leaves the organisations responsible for this supposed imposition remains to be seen. To the surprise of some, the white paper supports the strengthening of the Health and Social Care Information Centre, as part of the agenda to increase choice based on accurate information. The white paper also assumes the continuation of a centrally run electronic choose and book service. But it also promises the imminent publication of a review of arms' length bodies: "Subject to Parliamentary approval, we will abolish organisations that do not need to exist." At the launch of the white paper, NHS chief executive David Nicholson said that there would be news on the National Programme for IT "in the next four weeks or so". But the assumption must be that NHS Connecting for Health will not be part of Mr Lansley's information revolution.