News analysis: Conservative plans for NHS IT

Health service technology doesn’t get too much attention in the press, but the Conservative Party’s plans to shake up the National Programme for IT in the NHS changed all that. Lyn Whitfield reports.

The Conservative Party has been committed to a shake-up of NHS IT since its leader, David Cameron, promised to “scrap the NHS supercomputer” back in April 2008.

But last week the party gave the clearest indication yet of what a shake-up would actually look like, should it win the general election that must be held before next summer.

It did this by releasing two documents - an independent review of health and social care IT that its health spokesman Stephen O’Brien had commissioned from veteran IT expert Dr Glyn Hayes, and its own response.

Don’t scrap the programme

The review took a year-long look at the National Programme for IT in the NHS (NPfIT) – the £12.7 billion project that is trying to create detailed and summary electronic patient records while rolling out other projects, such as electronic booking and prescriptions.

The review concluded that while there were problems with the programme – its record programmes are at least four years late - it should not be “abandoned”.

Instead, it said NPfIT should be given “urgent attention” so it could better meet the needs of NHS staff and patients. The Tories’ response made it clear that this “urgent attention” would mean major changes to the very heart of the programme.

It committed the party to dismantling the centralised IT infrastructure the programme has put in place, renegotiating its multi-million pound contracts, and letting NHS trusts purchase their own IT from a catalogue of systems that meet international standards designed to make sure they work together.

It also hinted at radical changes for patients, who could be allowed to use personal health record platforms such as Microsoft HealthVault and Google Health – although Mr O’Brien stressed these would not be a substitute for NHS records.

“Personal health records run by the private sector mean little or no cost to the taxpayer if they are procured in a fully developed form,” he said, adding that such records could also “empower” patients.

“Greater personal control of health records can have significant benefits. It can allow [patients] to share information with third parties if they choose to, drive social and commercial innovation and... improve communication between patients and clinicians.”

Just change it utterly

Both aspects of the Conservative Party’s proposals could prove controversial and difficult. Although NPfIT has been the subject of sustained criticism from some quarters, some experts argued its underlying vision of a national records system was still valid.

Frances Blunden, senior policy manager for NHS Confederation, told the E-Health Insider (EHI) website that five years in, any government should be looking to build on the programme’s successes and “not just throwing it away.”

“Trusts [that have deployed NPfIT systems in London] may have had their problems, but they are learning from the lessons and building on that,” she said. “I’m not saying that the national programme doesn’t need to change but I don’t think we should be throwing the baby out of the bathwater yet.”

Other commentators warned that untangling NPfIT’s local service provider and electronic patient record system contracts could take years and be extremely expensive.

And they raised concerns that while some trusts might push ahead if they were given more control over their IT, others might choose not to spend in a difficult financial climate - a problem that did for earlier attempts to computerise the health service.

A new type of record?

Reaction to the idea of letting Microsoft or Google hold health records, meanwhile, has ranged from cautious to openly hostile.

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said that while it “strongly supports the idea of patients controlling their own medical records” it was worried about the “implications” of private companies holding medical data and about the security of online platforms.

Mik Horswell, UK spokesperson for UKCHIP, and member of the UK council for health informatics professionals and ASSIST, told EHI that he couldn’t really understand why the Conservatives were so keen on the idea.

“The Tories say they want to scrap the monolithic national database but instead of the government having the records, a huge American company will have them. Who do we trust more - the Department of Health and British government or Microsoft and Google?”

These reactions will not have surprised the party. Some weeks before the review came out, The Times ran a story about a report from the Centre for Policy Studies that called for the national programme to be replaced with personal health record platforms, suggesting this could become Conservative Party policy.

In response, Daily Mail columnist Stephen Glover said he’d rather give his records to Osama bin Laden or Vladimir Putin; and former shadow home secretary David Davis attacked his own party for “naive” and “dangerous” kite-flying, while laying into Google’s record on privacy.

This may be why the Conservatives have decided to hold a further consultation on “how much control patients want over their health records” and who should be allowed to see, contribute and remove material from them.

The consultation will run until October. The debate over the future of NHS IT will go on rather longer.