Lamb sets out ideas for NHS and IT

Tags: A Choose and Book Kaiser Norman Lamb NPfIT

05 Feb 2010

Liberal Democrat shadow health secretary Norman Lamb has called for NHS Connecting for Health to be scrapped, the Care Records Service to be abandoned, and Choose and Book to be revamped as a simple online booking system.

The MP has set out his proposals in a document, The NHS: a liberal blueprint, which the party says is not formal party policy but Lamb’s vision of a decentralised NHS.

The 44 page document also argues that patients should be in charge of their own health records and that they should be given the right to communicate with their GP by email and telephone.

Lamb’s other proposals include linking the GP Quality and Outcomes Framework payment scheme to improving patients' health, changing financial incentives in the NHS to promote the prevention of ill health, and fining people who turn up drunk in A&E and are aggressive to staff.

The Lib Dem shadow health secretary said the NHS was facing an unprecedented financial challenge and claimed Labour and the Conservatives were in denial about the problems.

He added: ““These proposals set out a liberal approach to the NHS which can drastically reduce costs, improve the quality of care and give people a say in how their local services are run.

"The NHS is far too important to the people of this country to ignore this challenge anymore - we must act now to secure its future.”

Overall, the document favours the approach of the US health management organisation Kaiser Permanente to integrated healthcare.

It argues that giving power and budgets to hospital and primary care clinicians - and encouraging them to work together to keep patients healthy - would prove more cost-effective than the present split between commissioners and providers.

It also argues that three steps are needed to tackle the “NHS IT Crisis” – abolishing CfH, reworking Choose and Book and abandoning the NCRS.

Lamb says Choose and Book “should revert back to what it was originally designed for – a simple online appointment bookings system” which he argues would be widely welcomed by clinicians.

The document argues that the Choose and Book programme has caused “enormous frustration for doctors and patients” and failed to deliver choice because of problems such as slot availability.

Lamb argues the NCRS should be scrapped because there is no need for a central database and that while contractual obligations with existing providers would have to be respected, variations could be negotiated “to achieve the desired objectives.”

The document says the national IT strategy should instead be focused on local connectivity between primary, secondary and social care.

It adds: “This approach would also unleash the innovative energy of the small and medium sized IT companies which have been excluded from the development of the national programme.”

On email and telephone consultations, the document quotes a study from Kaiser Permanente, which claimed that use of such consultations cut GP visits by as much as 26% per patient.

Lamb adds: “In so many other walks of life we exchange emails to avoid waiting for a formal meeting. There is no reason why the same logic should not apply in the NHS.”

Fiona Barr

Readers Comments

A wonderful statement....

07 Feb 10 08:43

" the national IT strategy should instead be focused on local connectivity between primary, secondary and social care."

This should not be difficult...should it?

Lamb's Choose and Book comments - misleading

08 Feb 10 14:06

With regard to Lamb's comments on Choose and Book, he doesn't recognise the key point that the IT element of the system works to spec. The slot unavailability issues stem from providers not making their slots available for patients to book into. Choose and Book is a fantastic system when all the 'players' play their part. This is evidenced by increasing numbers of PCTs achieving utilisation of Choose and Book of >80% if not indeed >90% for 1st Outpatient appointments. The key difference on the ground has been local Leadership with a capital L, both clinical and managerial.

Without wishing to sound flippant, you wouldn't buy a new car and then complain that it was no good if you drove it on the wrong side of the road and crashed - in other words, you'll get the best out of it if used correctly. Fortunately, increasing numbers of people continue to use it as designed. And no, I don't work for CfH before you ask!

Lamb's C&B Comments - Misleading or without foundation?

09 Feb 10 10:44

From the article, Lamb is suggesting that CAB should revert back to "a simple online booking system". This is confusing, I believe, to any reader. As someone who has been involved with the development of C&B for a number of years and as an end user in recent times, it remains as exactly as intended - an online booking system offering choice to patients. If used as designed by all involved, it is a wonderful tool that does indeed put choice in the hands of patients.

The problem C&B has, which is not isolated just to C&B, is there is no mandate with regards to its use. It is often becomes its own worst enemy as a result of its flexibility, allowing any organisation to bend the product to fit their organisation. This is great when it works but it is not always the product that needs to bend, in my experience.

So I ask where is the evidence that C&B needs to change or is not meeting its intended design?

More stunning illogic

10 Feb 10 08:40

So we can save money by scrapping a cetralised system? Strangely enough the alternative proposal, 'local connectivity' is supposed to come free of charge, it seems.

To illustrate - say there are 4 organisations needing to communicate. With a central point of reference, that is four communication channels need to be set up (8 if yiou say that the central system needs to set up its end as well). Now let a us look at the alternative of 'local connectivity' which, I presume, is everybody sorting out their communications with everybody else. So now we have 4 x 3 x 2 x 1 = 24 channels. - bound to be cheaper!!

don't slaughter the Lamb

mr.acute.cio@live.co.uk

10 Feb 10 12:31

Some of the letters talk about the need to mandate systems such as CAB in order to ensure its success. While I have some sympathy with the need for a disciplined approach to the adoption of systems and procedures, unless the NHS changes this is unlikely to happen. One can also argue that if a system is so obviously advantageous, it doesn’t need mandating. Unfortunately CaB is not that impressive, and its intention seems more to support the political objective of choice. Though if all hospitals were of an equal quality the need for choice would be limited to practical issues. But as of now, CaB is limited and in some ways (letters, etc), not as good as systems it displaced.

The Lamb proposal highlights the divisions between primary, community and acute services. Through political, historic and cultural structures they are set up in conflict. The original NPfIT vision (overarching single database) could have provided an integrated IT package, but GPs argued they were different, while hospitals resented imposed solutions offering less functionality than they already had.

I fear there is no easy solution, and now the money has run out we will all be increasingly making do with what we have, while CfH press on with laudable Darzi type targets, but without the systems envisaged to deliver. I doubt the answer is either centralisation or local, certainly not the NLOP compromise.