Life on Marsland is quiet; too quiet

This may feel like a quiet time for NHS IT directors. New health service structures, IT arrangements and innovations are bedding down. No big announcements are expected until the summer.

The NHS is rarely quiet for long, however. And, Iain Marsland suggests, the next big IT challenge heading its way is likely to be posed by community provider services.

So who thinks things have quietened down? The ten strategic health authorities (SHAs) and 149 primary care trusts (PCTs) are in their second year. The National Programme for IT in the NHS (NPfIT) Local Ownership Programme appears to be operational.

Digital imaging systems (PACS), the electronic booking system Choose and Book, and the GP Systems of Choice scheme are becoming part of the NHS IT landscape. The main secondary care systems are still imminent.

The annual Healthcare Computing conference came a month later than usual and then went away again without any seismic announcements. Apart from repairing a few Information Governance fences and making sure that your IT assets are where you last left them, I would say that this is a quiet period for IT directors.

But not for long!

Community provider services, the Sleeping Beauty of the NHS, have woken up with a sore finger and developed a passion for IT. “Many aspects of community provider services’ IT will be at the difficult end of the health IT spectrum.”

Primary care trusts (PCTs) need to commission on a level playing field, and are therefore placing their internal provider services at arm’s-length. These organisations will fully separate from PCTs within the next 12 months.

The options are divestment to the independent sector, absorption into an acute or mental health trust or full independence as a new NHS trust or foundation trust. The latter option could theoretically result in 149 new NHS organisations.

In reality, most provider services are too small to exist independently and will merge; if not with acute and mental health trusts, then with other provider services to become community foundation trusts. Whatever the configuration, the impact on IT across the NHS could be significant.

A few issues...

Most provider services comprise around 60 widely differing clinical services; for example community nursing, school health, minor injuries, HIV, health visiting, physiotherapy, health improvement, dentistry, dietetics and child protection.

These are provided across a wide range of care settings, including acute hospitals, community hospitals, day centres, health centres, schools, and - for a significant number of patients – their own homes.

Some will be commissioned by GPs, and GPs and community matrons may be able to refer directly to them. They often result in onward referrals. And provider services have a close relationship with social services, sharing care and information.

All this means that many aspects of community provider services’ IT will be at the difficult end of the health IT spectrum.

Two big challenges

Care is often provided by more than one clinical service, so patient data will need to be shared within locality care teams. GPs and community matrons coordinating long term conditions will also want access to this patient data – and so will others.

Community provider services will therefore be at the leading edge of deploying role-based access control (RBAC) and procedures for safely sharing patient identifiable data. “One solution that will immediately benefit community provider services is NHSmail.”

They will also be the proving ground for complex pathways that encompass multiple clinical services and shared care between primary and community care.

I assume some clever person at NHS Connecting for Health (NHS CFH) knows how this will work across multiple Local Service Provider (LSP) solutions. Personally it makes my head hurt.

Four further challenges

At the moment, paper records and / or IT are only available to clinicians at their bases. They need real-time, or - as a compromise - off-line access to patient records and to be able to record clinical procedures and to share information with patients wherever they are working.

So making NPfIT community applications remotely capable is one challenge. The availability of mobile 3G broadband outside of metropolitan areas is another; and finding and providing secure, transportable mobile devices is yet another. Finally, clinicians often need to leave printed guidance with patients and will therefore need access to a small mobile printer.

The good news: NHSmail

One solution that will immediately benefit community provider services is NHSmail. In its current form, this enables patient identifiable data to be included within encrypted correspondence - but only between NHSmail users.

The new, Microsoft Exchange 2007-based NHSmail service that is being developed by Microsoft, Cable & Wireless and NHS CFH, provides a ready-made solution for provider services, since it will have wireless synchronisation, off-line access and automatic contact updates.

Summer fun

PCTs have funded provider services’ IT and can be expected to continue to do so until there is a community tariff. As arms-length organisations, provider services may still get their IT support, directly or indirectly, through a PCT.

But as independent organisations, provider services will require their own IT support arrangements. At the very least, those organisations with a will to survive and flourish will need a board level, experienced IT professional.

They will also need to set up basic back office functions; ledger, payroll, supplies and performance management. And they may need to do this from scratch where a shared or hosted service is not available.

Perhaps, during this quiet period, it might not be a bad idea to sharpen up your CV. And for those IT directors not yet involved with provider services, mergers and acquisitions - there is always Darzi to look forward to.

About the author: Iain Marsland has been in the NHS for 34 years, most recently as chief information officer for Essex Strategic Health Authority and previously as director of IM&T for acute trusts in Brighton, Sussex and Bristol. He is now an independent consultant.