Round table: Life after death?

Mention the letters ‘I’ and ‘T’ in the same sentence as ‘N’, ‘H’ and ‘S’ and the response in government circles is likely to be a sharp intake of breath. Add ‘National Programme’ to your verbal montage and the result could well be much more dramatic, not to say angry.

Put simply, computers are something of a tricky topic in the health service. Thanks to the perceived failure of the high-profile National Programme for IT (NPfIT), largely resulting from the difficulty of achieving interoperability between the vast array of organisations and bodies that exist under the healthcare umbrella, it’s a subject around which it pays to tread lightly.

That needn’t aver against an honest appraisal of the potential for IT to improve healthcare provision, however, as a recent CSW round table revealed. The event was sponsored by the technology company Dell, and offered NHS workers including GPs, hospital consultants, practice managers and CCG members a chance to assess the potential of digital and data in transforming, enhancing and reimagining healthcare.

 

Healing the wound

“Digital and information is clearly something of an open wound for the NHS,” opined Richard Vize, a consultant at CSW’s parent company Dods who chaired the debate. Even so, he said, the Five Year Forward View maps a new era, engendering a “much more permissive approach to health policy development, allowing [for] a wider range of care models, local care structures and financial flows.”

This reflects a sense of both the strengths and the failings of the NPfIT. After all, the case for greater connectivity between healthcare providers retains its force, despite the difficulty experienced in implementing it. But recognition that the Programme’s top-down method was unsatisfactory explains the sensitivity to local contexts seen in the Five Year Forward View.

“Essentially,” said Vize, “NHS England is making a clear demarcation in role between different areas [of healthcare]. There is a central spine and infrastructure that’s needed for digital records to work, and [allowance for] local solutions and innovations within a structured approach to enable connectivity.”

If the approach works, it will no doubt be greeted warmly by those within the health sector, and could change wider attitudes towards NHS IT. What’s more, and despite the bruising experiences of recent years, there’s a clear appetite for further innovation in Information Technology, as a recent survey conducted by Dell and Dods Research revealed.

The headline finding from the survey is easily expressed: namely, that 65 per cent of the senior healthcare managers who responded to the research believe IT within their organisation to be insufficient. This reflects a yearning for improvement in the sector, based upon experience of the efficiencies already garnered by technology (60 per cent of respondents recognised these) and the potential for improved patient care through innovations such as remote working and telehealth.

 

Joined-up thinking

While it’s easy to knock the NPfIT, Dell’s director of healthcare and life sciences, Gary Birks, was quick to identify the important contribution it has made to moving technology forward throughout the health service.

“The NPfIT found a significant difference just in the baseline technology used across General Practice from Primary Care Trust to Primary Care Trust,” he said. “One of the things it did was [to] bring that baseline up, [and make] software more readily available. It forced GPs that didn’t have a clinical system to take [one up], and at least got them on the road. Where it foundered, however, was that everyone was at a different point on that journey.”

If this explains why the connectivity that was a key part of the NPfIT’s approach didn’t succeed, it doesn’t obviate the need to join different healthcare providers together – as respondents to the Dell/Dods Research survey were quick to recognise.

For example, only two per cent of the nearly 2,000 respondents said that primary and secondary care is sufficiently joined up in their area.

Moreover, 65 per cent said they were unable to access relevant information from external organisations when trying to provide care to patients, and a staggering 96 per cent said healthcare and social care were not sufficiently linked for patient needs.

The benefits of a more joined-up approach to healthcare were highlighted by Shilpi Rahman, a practice manager from the West Midlands. “At the moment all the practices in our area use the same IT,” she reported. “This is immensely helpful, because it means [everything] is transferred electronically [between practices].” That enhances efficiency, Rahman said, by making record keeping less labour intensive. In a further benefit, it makes for a happier workforce, because they get to do more hands-on work and less paper pushing.

When joined-up healthcare works, then, it proves to be a big hit. And the converse is true: when healthcare providers don’t share information, it can be highly frustrating for patients.

Alan Kennedy, lay chair of the Clinical Commissioning Group (CCG) in Crawley, West Sussex, drew on personal experience to make this point. After a health scare, he was irritated by the lack of shared data among different parts of the NHS, meaning he had to repeat information and tests in a variety of places. “We’ve invested a lot of emotional time, resource and money in enabling new records,” he stated. “But they’re not portable, or connected at all. The NHS is driven by snail mail at the moment.”

Part of the problem is that healthcare providers are nervous about sharing patient data, as GP Dr Sunil Gupta noted. “There’s a great emphasis on patient confidentiality,” he reported, before suggesting that concern over patient safety discouraged healthcare workers from sharing information.

Perhaps unsurprisingly, another clinician endorsed these sentiments. Dr Ruth Law is a consultant geriatrician in North London, and said that she has “experienced a lot of defensiveness around data issues.”

“Clinicians have a fear of doing the wrong thing,” she noted. “[We’re] only meant to share information with people directly involved in [a patient’s] clinical care, and have to make judgments about this. [So while] we issue confidentiality guidance in favour of information sharing, it still reads as if we shouldn’t [do so]. This needs to be addressed at a national level, to give doctors more [guidance] on sharing information.”

If some of the concern over data sharing stems from a desire to reassure patients that information they divulge is stored safely, it’s ironic to note that many assume its free movement around the health service anyway. Shilpi Rahman made this point, arguing that “a lot of patients” assume primary and secondary care providers hold information in common – when in reality they don’t.

This misconception on the part of service users leads to the sort of frustration documented above. But it can be alleviated, said surgery business manager Paul Brown, by putting ownership of personal data, held digitally, in the hands of patients. “Get patients owning [their data digitally],” he proposed, “and [make them] responsible for sharing it with their clinicians.”

 

A brave new world

Brown’s suggestion is a bold one, and would need careful implementation to prove successful. But one thing is for certain: it reflects a changing view of technology in society, and greater awareness of its potential to transform lives.

The health service already has day-to-day examples of the use of technology to improve the patient experience, like self-check-in at GP surgeries and equipment such as home-use blood pressure monitors. But Alan Kennedy said it has a lot to learn from other sectors if real progress is to be made over the coming years.

“There is a tendency [in the health service] to think that we understand the NHS, and only we can invent technology answers to our problems,” he reflected. “But we should look at other sectors, and learn from them – especially when it comes to using multi-channel ways of working.”

Paul Houseman agreed, and argued that healthcare managers need to be educated about IT. “It’s down to senior leaders to push in new directions,” he said, “but CCGs are predominantly made up of GPs with clinical expertise.” The challenge, then, is to equip these skilled practitioners with sufficient knowledge about technology to “drive initiatives and connect the dots.”

Talking of connecting dots, some challenges are genuinely NHS-specific. These will only be met by a considered approach that takes account of the particularity and diversity of the healthcare sector – as the NPfIT revealed, and as the Five Year Forward View seeks to provide.

At a basic level, the key difference between the health service and other sectors was neatly summarised by Eliya Michael, a practice manager from the West Midlands. “We’re dealing with human beings,” he said, bringing considerations that don’t always apply to commercial organisations.

One benefit of this is that human beings can take at least some responsibility for their own wellbeing – thereby easing the pressure on resources. This happens through education about lifestyle, as practice manager Prabhavathi Venugopal was quick to point out. But there are other ways in which patients can be helped to ease the burden on healthcare providers, including the use of wearable devices.

In Suffolk, for example, a six-week programme has been adopted for obese patients, giving them a device that monitors their activity levels throughout the day. Local practice manager Paul Brown called it a “really important way of empowering patients”, which yielded improvements in their overall health and lifestyle.

Another example comes from Leicester, where Paul Houseman reported on a pilot involving diabetes patients. “The patients are given kits to measure blood pressure, weight, and other health indicators,” he said, before adding that data about their wellbeing is automatically fed back to their clinicians. The overall aim is to minimise complications arising from diabetes, thereby maintaining patient health and reducing hospital admissions.

This reflects an overarching aim of patient empowerment through the use of technology in their care: to reduce resource use across the health service and enhance efficiency. “At the moment, 70 per cent of NHS costs go to 30 per cent of patients with chronic disease,” stated Dr Sunil Gupta. “Patients who are given more information about their diseases [and responsibility for their own care] have better outcomes.”

 

Patient-centred care

There is no doubt that technology creates efficiencies and cost savings for the healthcare sector. As Eliya Michael observed, even simple steps like equipping doctors with tablet devices while they visit local nursing homes (as happens in the West Midlands practice where he works) can save time, by enabling them to write up case notes on the move.

More fundamental than this, though, is a desire to make the quality of care delivered to patients better, and to enhance wellbeing. A good example is the use of telehealth technology that enables clinicians to interact with patients remotely. Prabhavathi Venugopal described it as “really wonderful”, saying the technology avoided the risk of vulnerable patients picking up infections by visiting hospitals and surgeries in person.

What’s more, remote consultations give patients better access to expert opinion – something that was a key hope of the NPfIT. This is seen in the example of Cumbria, where Dell’s Gary Birks reported on the use of high-definition cameras in A&E departments. These enable specialist consultants to examine potential stroke victims remotely, thereby maximising the chances of early diagnosis and ensuring they receive appropriate care.

That’s a good indicator of the power of digital technology to transform healthcare. It works best when patients are “at the very centre of change”, as Dr Ruth Law stated. This argues against the pursuit of technology for technology’s sake, or centring reform on cost reduction alone.

Instead, it seeks to unlock the potential of IT to make citizens healthier, to treat them more effectively and to provide a better, more joined-up, health service in which different organisations in primary and secondary care talk to each other and share information. And when that’s finally achieved, it’s a fair bet that the letters ‘I’, ‘T’ and ‘NHS’ may not seem like such awkward bedfellows, after all.

 

Around the table

Gary Birks – UK director of healthcare and life sciences, Dell

Paul Brown – business manager for GP surgery, Suffolk

Dr Sunil Gupta – GP on governing body of Clinical Commissioning Group (CCG), Essex

Paul Houseman – practice manager, Leicester

Alan Kennedy – lay chair of Crawley Clinical Commission Group, Sussex

Dr Ruth Law – Consultant Geriatrician, North London

Eliya Michael – practice manager, West Midlands

Shilpi Rahman – practice manager, West Midlands (and CQC member)

Prabhavathi Venugopal – practice manager, Ascot

Chair: Richard Vize – consultant, Dods