Life on Marsland takes stock of the New Year

In the second of his columns for the NHS Resource Centre, former NHS chief information officer Iain Marsland looks at the priorities and concerns of NHS IT leads as they head into 2008.



New Year is traditionally the time for taking stock and making resolutions. So what about NHS chief information officers and directors of IM&T? How do they see the coming year and what are their priorities?

Smooth succession at the top

Starting at the top of the tree, there is an underlying nervousness about the impending transition of director general of NHS IT, Richard Granger.

Mr Granger has crafted and shaped the billion-pound contracts that make up the National Programme for IT in the NHS (NPfIT). He has also put much of his personal authority into holding the suppliers to account for delivering the programme.

“NPfIT was founded upon ruthless standardisation. The future may require flexibility and agility.”

Chief information officers’ first priority is for a smooth transfer to an authoritative leader who can ensure that Local Service Providers and National Application Service Providers maintain the steady progress now being made.

Effective devolution

Over the past few years, NPfIT has been rocked by two seismic events. Commissioning a Patient-Led NHS reduced the number of strategic health authorities (SHAs) from 30 to just 10, while the subsequent NPfIT Local Ownership Programme (NLOP) transferred significant further responsibilities to them.

However, just as CIOs have been dealing with this whirlwind, local directors of IM&T have been wanting to see local ownership working better for them, by giving them more influence over the Programme and enabling them to extract better information from it.

One of the strengths of the National Programme, with its standard applications and data sets, should be its ability to support care free from organisational constraints. Early NPfIT deployment planning was undertaken by local health communities – coordinating, for example, child health, community and primary care implementations. “Against the background of recent high profile data losses ... ensuring compliance with the information toolkit, auditing information movements and reviewing security policies have become early priorities for CIOs and directors of IM&T.”

Collaborative planning and investment do not fit comfortably with foundation trusts and tariff based funding, especially where local funding for NPfIT is embedded in tariff. Yet CIOs and directors of IM&T believe that primary care trusts should undertake cross community NPfIT planning as a priority, in order to maximise the value of this investment for patient services.

A practical reassessment of today’s Programme

While all this has been going on, Lord Ara Darzi has published two significant reports: Healthcare for London and his “interim” report on the future of the health service: Our NHS, Our Future. These make clear the need for the new NHS Care Record Service (CRS) to support new models of care.

Yet the specification for CRS is already four years old and there have been few opportunities to stress-test its architecture, contracts and capability. NPfIT was founded upon ruthless standardisation. The future may require flexibility and agility.

The CRS may have been delayed but it is inevitable and – at least in its summary form - may well appear in volume in the next 12 months. It is now seen as a priority for trusts to re-engage - or rather to participate in and influence the Programme.

Trusts and PCTs may wish to develop or refresh their business case for local investment in NPfIT. This exercise can not only re-engage clinicians and managers but also reaffirm local expectations in the Programme’s deliverables and identifies any shortcomings in capacity or capability. "Both CIOs and directors of IM&T are aware of the cost of delays in CRS. Trusts have invested in document image management to alleviate the strain on their health records storage."

Technical competence

Capacity and capability are seen as particular priorities. The skills required to implement and exploit complex clinical IM&T do not appear to have increased over the past four years and may have even decreased. Few trusts and PCTs have invested in process change and information specialists; CIOs and directors of IM&T wish to see this addressed.

One particular technical skill is in particularly short supply. Trusts are challenged by the growing need to interface legacy systems to CRS and to one another; yet there is no NHS-recommended integration engine, minimal support from LSPs and few skilled integration engineers within the health service.

The cost of buying in these interfacing skills is prohibitive and limited by the Agenda for Change skills and pay structure. Directors of IM&T are asking for help with interfacing as a priority.

Dealing with inertia

Both CIOs and directors of IM&T are aware of the cost of delays in CRS. Trusts have invested in document image management to alleviate the strain on their health records storage. Legacy system contracts have been extended and interim solutions put in place for orders and results processing and discharge summaries.

Meanwhile, desktop and server infrastructures grow ever older and often become obsolescent. Investment in, and effective management of, technology infrastructure remains a priority in preparation for CRS and the primary care GP Systems of Choice initiative, especially.

Compliance, compliance, compliance…

Finally, against the background of recent high profile data losses, NHS chief executive David Nicholson wrote to all chief executives on 4 December 2007 and set out a number of tasks; ensuring compliance with the information toolkit, auditing information movements and reviewing security policies.

These have become universal, early priorities for CIOs and directors of IM&T. And these New Year resolutions really do need the backing of the chief executive…