Government’s CIO praises NHS progress

Tags: A Choose and Book CIO Efficiency Government GP Information iS Open Source Reform Savings

20 May 2009

The government’s chief information officer has praised IT systems in the health sector but has highlighted the need to “drive value out of IT investments” throughout the recession.

The comments come in the government’s latest Transformational Government progress report.

In a year when the government spent £13.7 billion on IT, the report says the recession means that there will need to be “even more focus on driving value out of the IT investments we make.”

The report says this must be based on three main priorities: “putting the citizen at the heart of what we do”, “shared services” and “professionalising IT-enabled business change."

The report points to savings including £50m at the Department for Work and Pensions using shared services, with a total of £100m expected by the end of 2008/09.

In the government’s third annual assessment of its own IT investments, the government’s CIO, John Suffolk, applauds systems including PACS, Choose and Book and GP2GP.

He says: “PACS helps patients to be assessed and treated more efficiently by supporting clinicians in providing the best possible diagnosis.”

He also says that more than half of outpatient appointment referrals from GPs are now arranged using Choose and Book, with the number of bookings made using the system doubling over the past year to more than 12m.

However, the report shies away from the troubled subject of the National Programme for IT in the NHS. No mention is made of the delays, changes in key contractors or implementation problems experienced in the hospital sector.

The report states: “The National Programme for Information Technology… is already delivering new systems and applications to hospitals and GP practices to provide improved services and safer care for patients.”

The report also states the need for expansion on the government’s use of open source as well as the introduction of user focused web 2.0 tools and technologies.

At the launch of the report, Tom Watson, the minister for digital innovation, claimed that use of information technology will save £35 billion in two years by improving efficiency, and said public sector reform will help Britain meet the challenges involved in overcoming the recession.

He added that the government has already achieved £26.5 billion of efficiency savings through the transformation of the public sector, underpinned by technology.

Link

Transformational Government Annual Report

Readers Comments

..while NHS patients increasingly die from medication errors

20 May 09 14:30

The Daily Mail ran a story today on the increase in deaths from adverse events caused by medication errors (see below) and the Lib Dems are calling for an enquiry. Reducing deaths that resulted from medication errors was a PRIME GOAL of introducing multi-billion pound systems into the NHS - it has failed. In this new age of transparency that we are told is around the corner it would be good to see the govt CIO recognising this abject failure rather than 'bigging up' in other areas.

Why is the NHS killing so many with drugs?

http://www.dailymail.co.uk/news/article-1184591/Why-NHS-killing-drugs.html

In April 2002 Computer Weekly ran this story which described why the centralised approach was being taken.

Corporate NHS approach to get records online faster

www.computerweekly.com/Articles/2002/04/04/186245/corporate-nhs-approach-to-get-records-online-faster.htm

Credibility will only be given to statements from the Cabinet Office if the failures are also recognised.

We're hearing a lot about getting rid of the Gentlemen's club in parliament - let's now hear honest and open assessments from other organs of the state - this is serious!!

Questions

20 May 09 17:03

1. Please can we see the breakdown of the £50m savings in DWP at to put it bluntly I suspect that's all smoke and mirrors?

2. “professionalising IT-enabled business change” - isn't it the kind of professionalism that has been brought in that has caused it all to go down the tubes i.e. the bigger you are the more professional you must be. I wouldn't argue for being "less professional" but I'd rather get my dictionary out and have a look see what that means first?

3. "referrals from GPs are now arranged using the national electronic booking system" - Notice they are not "booked", just "arranged". There's so much smoke here I'm choking. Can we see the split?

4. Why are we giving airtime to Daily M readers?

the facts appear universal

21 May 09 10:31

..as other media also report

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/nhs-60000-medication-blunders-in-18-months-866484.html

http://www.telegraph.co.uk/news/1527359/Blunders-by-NHS-kill-thousands-of-patients-each-year.html

Doesn't matter whether it's the Daily M the Telegraph or the Independent as the recurring facts appear to be the same and I've drawn attention to this because significant improvement in patient safety was one of the major justifications for ploughing ahead with the gargantuan programme in the way that it was (regularly quoted publicly by CfH as a key goal in the early days). Moreover the cost in compensation to the NHS, nothwithstanding the personal tragedies involved is huge and (probably) far outweighs the cost benefits described so far in the CIO report.

The National association of Primary Care carried this brief but alarming story on Tuesday (not sure of their political leaning)

"Deaths From NHS Drugs Have Doubled Under Labour

The number of patients killed by drugs handed out by the Health Service has more than doubled during Labour’s time in power, according to official figures.

There were 1,299 deaths caused by adverse reactions last year, up from 520 in 1998, and up by more than a quarter on the figure of 1,030 recorded the year before."

ref: http://www.napc.co.uk/news/344-news-in-brief-19-may-2009

Medication Errors

georgebrown@bulldoghome.com

21 May 09 11:00

The software vendors delivering software to support the NPfIT have concentrated their efforts in delivering a working PAS, and order comms systems - which I think is probably the right thing to do.

However this has meant that the development of systems to support safer medication prescribing and administration have not had the same level of input (in terms of development effort): Reinvention of the wheel seems to be commonplace and where that development has gone on in some small way it seems to still be building in the same failings as older legacy systems (e.g. manually built medicines lists rather than professional third party supplied decision support such as the MDDF).

There is also the issue of the political will within the acute trust's themselves who seem to get themselves hung-up on pharmacy stock control issues (interfacing) rather than getting a working prescribing and medicines administration system in place first.

On top of all of these issues is the fact than some people (where significant knowledge and experience lay) simply refuse to work for some LSPs because of the atrocious reputation they have (in some instances rightly) gained themselves.

"The facts" are unknown

21 May 09 12:41

The lack of progess in secondary care prescribing and associated decision support IS a major disappointment in NPfIT.

However I am cautious of all centrally collected NHS statistics - they vary by fashion, how hard people look [ascertainment bias], definitions [or lack of them], differing local data collection standard's , political pressure etc.

These factors can make things look 'bad' for a government - almost as often a 'gaming' them can make them look good.

Furthermore an increase in 'bad thing' figures is often a welcome sign that previously unrecognised or ignored failures are being investigated and put right!

Adverse drug reactions are particularly slippery in the area of definitions.

All (effective) drugs have side effects / adverse reactions.

Damaging adverse drug reactions often occur in (already) seriously ill patients - in whom it is hard (or wholly arbitrary) to determine the relative contribution of the drug and the patient's disease(s). Such patients are also typically on several drugs whose side effects may overlap or multiply each others.

Consider also this: a disease has [say] a 100% chance of killing you while the drug has a 50% chance of killing you and a 50% chance of curing you - you take the drug. Rational choice - but the drug still 'kills' 50% of the patients. Now play with those probabilities on an infinitely sliding scale of probabilities and goodness/badness of outcome - only you often don't have those figures for populations of patients - let alone the individual in front of you. And you can't tell if the drug or the disease killed them - only that they're dead.

Now tell me how many drug related deaths there are in the NHS. Then tell me how many were avoidable (which is what we really want to know).

While it would not surprise me that prescribing >errors< (a different thing - and not quite as slippery) were rising in the NHS - but the case is not proven here. Much less is the case proven that a technological fix could prevent all of this. Changes in training, skills, case mix and the increasing complexity of treatment options may be contributing (more) to any such rise.