Policy responses and statements
- Name of organisation:
- Department of Health
- Name of policy document:
- Liberating the NHS: An Information Revolution
- a consultation on proposals
- Deadline for response:
- 14 January 2011
Background: An Information Revolution is one of
a series of documents for consultation published subsequent to the
White Paper Equity and Excellence: Liberating the NHS. It is part of
the Government’s
agenda to create a revolution for patients - “putting patients
first” - giving people more information and control and greater
choice about their care. The information revolution is about transforming
the way information is accessed, collected, analysed and used so that
people are at the heart of health and adult social care services.
The Government wants the information revolution to benefit everyone
who uses health and adult social care services. Early work on equalities
has identified some areas on which there needs to be a focus, such
as ensuring there is sufficient support and access to information for
people who need it. Questions in the consultation document and the
Easy Read version invite comments and suggestions on how we can address
this and other equalities challenges. There will also be engagement
directly with groups and representatives at consultation events, as
part of ensuring that the information revolution fully promotes equalities
and patients’ rights.
COMMENTS ON
DEPARTMENT OF HEALTH
LIBERATING THE NHS: AN INFORMATION REVOLUTION
- A CONSULTATION ON PROPOSALS
The Royal College of Physicians of Edinburgh is pleased to respond
to this consultation on the important issue of improving information
within the NHS for clinicians and patients. Comments are referenced
to the consultation questions and are largely restricted to the perspective
of physicians on the services they provide within the acute care sector.
General Comments
The College supports the aspirations within the consultation document,
as all clinicians would welcome improved access to relevant and accurate
clinical information and recognise its contribution to high quality
clinical care. The paper covers the full range of information
sources and systems which, if improved, would indeed transform the
delivery of patient care.
A key barrier to successful implementation, however, will be the financial
pressures facing the NHS and the scepticism of clinicians following
a series of information projects which have been highly disruptive
in their development and introduction and failed to deliver the promised
benefits. A culture change will be required, driven by effective
and reliable (secure) information systems, to encourage the use of
information and support systems by clinicians and patients.
The pace of change will necessarily be slow and may dictate the time-table
for other related reforms, especially patient choice and control and
effective commissioning. Public expectations should be managed
carefully given the implication in the White Paper that these reforms
will be in place within the next 2-3 years. The College has also
responded to the consultations on greater choice and GP commissioning.
Points relating to consultation questions
Q.1: What works well currently
in information for health?
Examples of what appears to work well include the largely charity
based health awareness schemes and, to a limited extent, the public
information style healthcare awareness campaigns. Data on standardised
mortality ratios and healthcare associated infection rates also seems
to work well. However, data on activity levels either by named
professional or diagnostic code have proved unreliable and added to
the low confidence of doctors in the resulting statistics.
In sharp contrast to what fails to work well, data capture at the
point of care works particularly well for unplanned emergency work. This
includes quality measures which are very difficult to capture in other
ways. Quality measures are essential if effective commissioning
and patient choice are to become realities.
Q.2: Important uses of information
Undue importance has been put on the use of information by the financial
departments of NHS Trusts for the purposes of benchmarking activity,
contract monitoring and attracting funds. Quality measures have
taken second place and should acquire higher status within Trust monitoring
systems. The information types listed within the consultation
document all have an important role to play. The most important
users of information are patients and medical professionals, enabling
them to deliver the best care at the right time, although the
importance of overall performance monitoring is also recognised
Q.3-Q.5: Is the vision for an information revolution
comprehensive and/or affordable?
The description of information capture appears comprehensive and relevant
although highly ambitious and the College fears is unrealistic, certainly
in the short to medium term, given the current state of rudimentary
information systems within many hospitals (eg medical records) and
the continuing “scattergun” approach across England with
the implementation of many different hospital-based systems.
The document makes regular mention of standardised datasets but little
is said about a national IT system. The challenges of inter-operability
between different local information systems should not be underestimated.
The consultation document makes little reference to information published
in the media that may be of dubious accuracy and lead to loss of patient
confidence eg recent problems with the MMR immunisation levels. A
strategy to “kite mark” information may be helpful for
patients.
Q.6-Q.8: Patient records
The College welcomes the recognition of the work undertaken by the
medical Royal Colleges in setting standards for medical records, which
takes into account the future challenges of electronic records and
record sharing between providers and across sectors. However,
implementation of robust electronic record systems that will function
effectively across the UK (including private providers) remains a significant
challenge and will be among the highest priorities for financial resources,
limiting other aspirations in the short to medium term. A robust
electronic patient record system is central to all patient care and
failure would have dire consequences.
Q.9: Supporting patient use of Information
The College has responded to the linked consultation on choice and
control and stated that consultation time will be critical if patients
are to be supported to understand options and make choices. The dangers
of misinformation and/or patients misinterpreting accurate information
should not be underestimated. To address this, consultation time
for doctor and patient must be increased - technology has its place
but patients value the direct input of their named healthcare professional
to support their choices and decisions, particularly at times of personal
stress.
Patient access to computerised records is an evitable and largely
welcome development and will both inform and increase the accountability
of patients for their own health. However, safeguards must be
put in place for those less able to access and/or interpret the contents,
as clinicians need to use medical terminology and shorthand in the
interests of efficiency and functionality. Misunderstanding records
may lead patients to be anxious and/or raise complaints unnecessarily.
Q.16 and Q.17: Creating a seamless/joined up information
service
The College agrees that the benefits of a truly seamless and joined
up information service would be tremendous. The obvious links
are between general practice and secondary and tertiary care and within
secondary care, between the private and public sectors. This
may bring particular benefits for emergency care in larger urban conurbations
where patients may attend different providers and where each will have
their independent set of notes.
Q.24 and Q.26: Information for professionals
The ambition to deliver timely, high quality information for healthcare
professionals based on their own data is hugely important; the
College believes this would be supported by most clinicians and will
generate ownership and support accuracy. Thus far, a rather top
down approach has been used, which is seen as rather bureaucratic and
irrelevant and therefore of much lower importance than other daily
pressures on busy clinical teams. However, local data capture
will require resourcing in terms of both technology and time for healthcare
professionals to limit the impact on direct patient care.
The availability of information to support professionals is essential
for maintaining up to date practice (CPD and revalidation) and supporting
individual patient care. Ensuring access to a range of reputable
on-line resources from the workplace is essential but not always available,
even in the larger teaching hospitals, and could be facilitated by
universal PC based links to multiple resources supported by local library
resource. Central negotiation by the NHS may provide a cost-effective
solution to expensive annual subscriptions.
Standardised datasets with clear definitions will be critical to deliver
useful and accurate information (including comparators) for patients,
clinicians and managers alike.
Capturing patient feedback through an anonymised central data set
brings problems of objectivity and a lack of accountability. Such
opinion must be treated cautiously and subjected to triangulation before
triggering action.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[14 January 2011]
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