60 years of change

The main aim of the NPfIT is supporting better, safer care. And whilst attention-grabbing headlines have frequently bemoaned the lack of progress or enormous costs associated with what is undoubtedly an ambitious programme, the new ICT systems and services that have been introduced are not only improving how information is stored and shared in the NHS but are transforming the organisation as a whole. The national programme is beginning to extend choice to patients by not only empowering people to choose the best healthcare to suit them, but also where and when they want it.
    
In 1946 the NHS Act, which formed part of a social welfare policy aimed at providing universal and free benefits to all those in need, was brought before Parliament. Just two years later on 5 July 1948 the NHS took control of nearly half a million hospital beds in England and Wales. But whilst the NHS was clearly created in a timely fashion it certainly did not come in on budget, costing £248m to run in its first year alone, almost £140m more than had been originally estimated. In spite of these teething problems the NHS ultimately proved to be one of the major achievements of Clement Atlee’s Labour Government and a source of not inconsiderable national pride.

Innovative delivery
Exactly 60 years later the NHS has become the largest single healthcare provider in the world with a budget of £76 billion and a workforce of 1.4 million making it the biggest employer in Europe. The ability of the NHS to deliver world-class healthcare has been dependent on many crucial factors, just one of which has been its ability to access innovative and proven technologies to deliver improved patient outcomes. A few examples demonstrate the trajectory of change wrought by technology:

• 1972: computer tomography scans are introduced revolutionising doctors’ ability to examine the human body
• 1998: NHS Direct is launched, later becoming one of the largest single e-health services in the world, dealing with over 500,000 calls every month
• 2007: the introduction of the robotic arm leads to the development of groundbreaking operations that are treating patients with fast or irregular heartbeats (around 50,000 people develop an irregular heartbeat - major cause of strokes and heart attacks - each year).

Whilst innovative technologies like these have been delivering clear benefits to patients and clinicians alike, back in 2002 the Prime Minister’s Office brought forward plans to invest in electronic patient records and booking systems that would provide the public with visible evidence that the NHS was being modernised. Recently released papers obtained under the Freedom of Information Act show that the then PM Tony Blair backed increased IT spend while urging accelerated implementation schedules. It was felt that greater central direction would give the programme added momentum and ensure NHS organisations complied with standards.
    
With an ageing population, rising levels of obesity, and growing prevalence of chronic diseases, it is increasingly vital to keep up this momentum. In fact, the rise in type-2 diabetes alone has the potential to bankrupt the NHS by 2015. It is therefore essential that the new practices and new innovations which combat these problems more efficiently, such as telehealth and telecare, are continually developed and deployed.
    
Remote patient monitoring (through telehealth and telecare solutions) enables 24/7 contact with elderly patients, can allow better management of chronic diseases, promotes individuals' long term well being and independence, and enables staff to manage a larger case load. These solutions are not only clinically effective, but also cost effective.
    
Recent projections have put the cost of the National Programme at £12.7 billion, which has led to concerns that the programme is in crisis, delivering key systems late and demonstrating little or no sign of benefit. However, the National Audit Office recently published a report on the programme’s progress since 2006 and overall presents a positive view, with the original vision for the programme said to remain intact and still appearing to be feasible.
    
Amongst the challenges that NHS Connecting for Health still faces is the completion of the care records systems. It is anticipated that the system will support NHS trusts in their bid to achieve improved services and better patient care but is currently running several years late.

Demonstrating value
Whilst the National Programme has certainly generated its fair share of controversy, clear benefits to the health worker and patient are identifiable. As stated in New England Journal of Medicine in 2003: “IT can substantialy improve the safety of medical care by structuring actions, catching errors, and bringing evidence-based, patient-centred decision support to the point of care to allow necessary customisation."
    
Among those who support the National Programme’s ability to deliver improved patient safety is Professor Sir Cyril Chantler, Chair of the Board of the Great Ormond Street Hospital for Children NHS Trust and Chair of the King’s Fund. Sir Cyril recently commented: “I have always fully supported the ambition of the National Programme for IT to provide accurate and timely information to improve the quality and efficiency of patient care…The challenge is beginning to be met and both patients and clinicians are experiencing real improvements in access to treatment, in safety and diagnostic support”.
    
The publication of the keenly awaited Darzi Review along with Matthew Swindells’ report on NHS informatics is likely to give us an indication of what the future of healthcare technology might hold. Already we have seen technology starting to enable the delivery of public services that are more responsive to citizen needs, NHS Choices and HealthSpace are but two examples. However, it is only now that we are beginning to understand the impact that this is having on the dynamics of the producer-consumer relationships. The ubiquity of technology has raised consumer expectations to unprecedented levels stimulating the public sector into the provision of increasingly personalised public services that are accessible through multiple channels.

New service models
Right now we are witnessing the emergence of the self-managed citizen, a paradigm shift away from the traditional model of public service delivery. This change will require more flexible vertical systems that are capable of delivering end-to-end services across organisations, and potentially a more sweeping restructuring of the way public services are delivered.
    
We can also expect the power of social networking to become increasingly apparent. With public opinion capable of being rapidly mobilised in order to challenge perceived inequity and unfairness, organisations are becoming more accountable to their consumers. As patients adopt the role of ‘health consumers’ they will increasingly be involved in making decisions about their own healthcare, and in some cases that may involve buying what they need and having better access to the clinicians that treat them.
    
The National Programme is the framework that will facilitate the emergence of these ‘health consumers’. The spine, which will support electronic care records; PACS (Picture Archiving and Comms Systems), which enables digital images such as x-rays and scans to be stored and viewed on screens; and the provision of decision support systems at the point of prescribing, will all contribute to the delivery of this new vision of 21st century healthcare. We are beginning to see a system that transcends our traditional views of medicine and the treatment of disease and is instead truly oriented towards managing our health and wellbeing.

About Intellect
Intellect is the trade association for the UK technology industry. Its Healthcare Programme represents member companies that operate in the healthcare market and provides a channel for government and other stakeholders to exchange views with the industry. The group also ensures that members are fully informed about developments in the market, including potential issues and opportunities and holds regular speaker-led meetings with senior representatives from relevant organisations (including the Department of Health, NHS Connecting for Health, University of Victoria, the British Medical Association).