Inside Track on the NHS Constitution

Top politicians took time out of tackling the economic crisis to sign the first ever constitution for the NHS last week. Mark Treleaven looks at its rights and responsibilities and how information and IT is vital for delivering them.

An interesting signing ceremony took place last week at Number 10 Downing Street. Prime Minister Gordon Brown, health secretary Alan Johnson and NHS chief executive David Nicholson all sat down to put their names to the NHS Constitution for England.

This was promised at the end of Lord Darzi’s Next Stage Review of the NHS to “enshrine the values and principles of the NHS” and set out what patients and staff can expect from it.

The constitution brings together a number of rights that are already contained in British and European legislation. It also makes a wide range of pledges to users and employees – and sets out some of the responsibilities that users have to the health service return.

The NHS makes a pledge to keep people’s information safe and confidential, for example - and in return, users are given a responsibility to keep the information that the health service holds about them accurate and up to date.

Mr Johnson said the constitution would “form the basis of a new relationship between staff and patients”; one that is based on patient empowerment and engagement with the health service at all levels. Critically, the constitution identifies information and information technology as essential to delivering on that.

Informed choices

So, on page seven, the constitution says that people have the right to make informed choices about their GP, where they go for hospital treatment, and the details of the treatment they will be given. It also says they should have access to their medical records and to letters about them.

We see a big role for technology here, both in collecting information and in getting it to people in a way that they can understand it and act on it. Microsoft has developed technology platforms, such as Health Vault, that can support sophisticated interaction with patients.

Then, the constitution has whole section about more systematic engagement with populations; whether they are made up of people living in a particular geographical area or living with a particular disease.

We are talking to primary care trusts about how they can take industry best practice in customer relationship management and apply it to stakeholder engagement. The technology and techniques are already very well established in other sectors; and the NHS really needs to catch up.

Improved quality

Another big theme of the NHS Constitution is pushing forward with the quality agenda. For example, it says that care should be provided in safe, clean environments and that it should be based on best practice.

It pledges that the NHS will collect more information about quality in the future and use it to work out what good care really looks like. It also pledges to develop new, web-based services to get that information to planners, staff and users.

However, we see this as an area in which we can help the NHS to go further. We are doing a lot of work around helping commissioners to get the information they need for world class commissioning. And we have partners who are doing great work to get information to frontline staff.

For instance, The Learning Clinic has developed VitalPAC, which is an application, based on best practice, that collects data about a patient’s vital signs and delivers it to clinical staff via hand-held devices that can be used at the patient’s bedside.

Worldwide imperatives

The NHS Constitution has very high level backing and we would hope that it does help people to think about engagement and how it can be used to drive better outcomes. One of the encouraging signs is that it embodies a lot of ideas that have traction elsewhere.

Peter Neupert, Microsoft’s corporate vice-president for health strategy, recently gave evidence to the US Senate’s health, education, labor and pensions committee on how an increase in healthcare IT spending that is being planned to boost the economy can also be used to improve standards.

He told HELP that it was important to get IT systems working together; but that it was also vital to get the data out of them and to “turn it into useful information that will deliver value.” In particular, he said it was necessary to get that information to patients.

“We need to count on the patient to be fully informed - shared decision makers - or their advocates, their family. That’s the most important thing, and to give them access to information that can help them accomplish that.”

There is research from the National Academy of Sciences in the US that says the same thing. So we are seeing the same themes being picked up around the world. The question for health systems is how they take them forward.

Taking the work forward

We want to work with organisations that understand there is a technology requirement to delivering the rights and pledges in the NHS Constitution.

They already own a lot of the IT they need, as a result of the Enterprise Agreement that we have in place with the health service. So really, we are talking about helping them to get the most out of the IT they own, while taking forward the constitution’s agenda.