“Opponents castigated it [the National Programme for IT] as a failure...it was trying to fix things,” offered John Cruickshank, consultant director at 2020 Health Org, at the start of a panel session on Cloud Computing in the healthcare sector, at the Business Cloud Summit 2010. “Primary care and mental health systems had found success, and we wanted that to continue.”
Cruickshank was joined on stage during the session by Graham Sadd, CEO at Paoga, who argued one of the key issues for NHS IT is that it should be something to trust: “And it’s not trusted to spend the money or handle the bureaucracy properly, the whole privacy issue comes up [too].” Sadd added that in his opinion, the issue laid more with culture, and not the technology.
So what lessons can be learnt from the decisions executed on the National Programme? According to Barry Evans, an independent consultant on the topic, “The first thing one should take is experience and then reflect on that in a very objective way. We really needed to tease out the issues and get them on the table,” he commented. Ultimately, he said, decision makers have to ensure they understand the impact of technology on users.
The discussion turned to Summary Care Records (SCR), with Sadd explicitly stating, “You can’t argue about the NHS central medical records being digitised over the brown paper envelopes”.
Cruickshank explained the ‘journey’ for SCR began with the 2002 concept of the Integrated Care Records Service, though he added it was quickly realised the complexity of such a database was too much. Despite this, even the notion of a Summary Care Record became what Cruickshank kindly described as “quite thick in concept”. The consultant director argued a “lack of joined-up-ness” was something that would frustrate both patients and clinicians alike.
Sadd suggested the digitised records should feature the ability for patients to delegate their information to their own doctors. “I don’t want to be able to take it away from the NHS,” he said. “I want an audit trail; I want to be able to share some of that data with the likes of an insurance company.”
Evans said turning to Cloud-based technologies was “a given” if they can drive down costs of ownership, but stressed only if there were assurances over responsibility and security. “Where does that accountability lie?” he asked. “It ultimately lies with the CEO of the Trust or health body.”
A distinction was needed between personal identification data (PID) and non-PID, said Cruickshank, before assertively adding, “PID can’t go overseas”.
Sadd revealed his belief PID and anonymous data could be separated and said perceived issues of security and technology was more a cultural one. For instance, he said, “People shouldn’t be able to take copies [of data from a master database]. It should be in one place with access controls.”
“The single biggest issue isn’t the technology or the delivery,” explained Cruickshank. “It’s the change management: Coming up with a solution that takes care of the needs of all takes time.”
Asked how he would approach the solution if starting from scratch, Cruickshank added, “We’d start without any paper.”
“So much of the NHS is about the legacy. Never mind the legacy ICT, it’s the legacy paper,” said. “If you were starting from scratch you’d say we don’t need any paper guys.”
Cruickshank concluded: “IT would look very different to what it does now.”
