“If you want things to change, things will have to stay as they are”.

I’ve been meaning to post about the Tory plans for NHS IT for a while. They published an independent review of NPfIT, way back in August. Since then various things have happened to make the picture seem even more complicated, even harder to sum up in a single post. One is that the state of the public finances has forced the government to comment on whether it wants to continue with the Programme. Or at least it has forced the chancellor to say rather threatening things about the future of the Programme (“not essential for frontline services”), which in turn has forced the health minister to speak out in its defence (“the NHS couldn’t function without it”). Of course, they could both be right, the Programme is a large and complex beast and it probably doesn’t help to talk about ‘it’ as if it was a single unitary thing. The government, presumably, will cut elements to save money where it can, but other elements will be recognised as worth completing.

In fact this pragmatic approach possibly isn’t a million miles from Tory thinking on the topic. Except that, for obvious reasons, their public pronouncements are rather more critical than that. Large government IT projects are exactly the kind of thing that the Tories hate. These projects are created to enable the kind of centralising, meddling over-powerful government that the Tories are philosophically opposed to, and their all-too-predictable failures, mired in bureaucracy and political interference, illustrate exactly what the Tories believe is bad about big government in practice. So Tory pledges to dismantle the National Programme should come as no surprise. The new Tories, however, add an intriguing ideological twist to the debate. Because as much as they hate information technology, they quite like information. To quote David Cameron:
“We’ll measure those things that people really care about: how long will my Dad survive if he gets cancer, what happens after my initial treatment, how does a hospital do on issues like infections? We will collect patients’ views on all aspects of their care via a simple questionnaire. And we will allow patients to give immediate feedback to hospitals about any bad care they have endured. We’ll compile all this information in a meaningful and accessible way that can be easily understood and let every patient compare and contrast different care providers. And we’ll then let patients, with their GPs, pick precisely where they want to be treated.”

Given that the Tories are committed to: (a) dismantling the IT infrastructure, (b) releasing clinicians from paperwork and (c) getting rid of bureaucrats, there could well be some difficulty collecting all this additional data. However, here’s another quote, from a paper the Party produced in April, ‘An NHS Information Revolution to Save Lives’:
“As well as allowing different providers to compete to manage NHS information, we will drive greater innovation by allowing them to develop new ways of using information to provide better services to patients. For example, we want to see a system where people could download an NHS application with real time updates on their i-phone and where online internet forums like ‘facebook’ provide a powerful way for patients to group together and share their views.”

Apart from the eye-catchingly stupid idea of the ‘i-phone’ app with ‘real time updates’, the other big problem with this is that the promise of more and better information sounds hollow without an enhanced commitment to patient choice. Otherwise what’s all this information for? But it isn’t clear that patients want more choice. It, actually, isn’t clear that they want the amount of choice that they have already. Of course, it was the Labour government’s decision to insert choice into the NHS direct booking system that made ‘Choose and Book’ such a complicated and unpopular endeavour with GPs and hospital doctors. So will the Tories scrap that element of the National Programme for IT?

Earlier this year, David Cameron spoke about NPfIT:
“Now I want you to imagine how we’d have gone about updating NHS computers, if we’d had the chance. We would have said: today, you don’t need a massive central computer to do this. People can store their health records securely online, they can show them to whichever doctor they want. They’re in control, not the state. And when they’re in control of their own health records, they’re more interested in their health, so they might start living more healthily, saving the NHS money. But best of all, in this age of austerity, a web-based version of the government’s bureaucratic scheme services like Google Health or Microsoft Health Vault cost virtually nothing to run.”

I find many things about David Cameron irritating, but few them are more irritating than his way of characterising NPfIT as an attempt to purchase one really, really, really, big computer. The rhetoric is saying:
• Labour = information technology = old-fashioned, bureaucractic, centralising, failed
• Tories = information = contemporary, streamlined, democratic, empowering

The problem is that although a passage like this might look like good copy to someone writing a political speech, it doesn’t really fly as policy. Google Health and Microsoft Health Vault are products aimed squarely at the US market. When the Tories commissioned Glyn Hayes to write an independent review of NHS IT, Google declined to provide information and the Hayes’s final report makes it absolutely clear that, valuable as patient-held records might be for some people, they can’t replace the NHS’s need to keep its own records.

Glyn Hayes’s team, very wisely, said that NPfIT should not be abandoned, but should be restructured. For example there should be more scope for local decision-making about purchasing. Very sensible, but slightly problematic politically because that’s kind of happening already.