Feature

What’s IT to be?

The government has committed a huge amount of money to its new NHS information and communication technologies plan. Jamie Bend wonders whether it will fare any better than previous ill-fated NHS IT projects

Even for the big-spending Department of Health, £2bn is a lot of money. So the planned information and communication technologies (ICTs) injection into the NHS is a massive gamble when evidence that it will deliver a reasonable return is so patchy.

Despite numerous public sector IT disasters, the government is still hopeful that technology will help to deliver the improvements in public services upon which its electoral viability may depend. In the case of the NHS this belief is worth more than £2.3bn over the next three years, and has led to the appointment of the UK’s most highly paid civil servant, the director general of NHS IT, to oversee the spending.

Prime minister Tony Blair has made clear his faith that ‘for the public services, the real opportunity is to use information technology to help create fundamental improvement in the efficiency, convenience and quality of our services’.¹ And he may be right: anecdotal evidence of effective use in other sectors suggests that IT could offer a real opportunity to improve the services offered by the NHS. At present, however, it remains an opportunity that policymakers and practitioners may fail to grasp.

The challenge is to ensure that before, during, and after the implementation of new projects the focus is on delivering the maximum possible benefit to citizens. This can only be done by looking carefully at where ICTs can and cannot help improve health services, by introducing new systems intelligently and sensitively, and by designing and conducting appropriate evaluations of their implementation and development.

New metrics must be developed so that these evaluations provide a clear picture of the effect of ICTs on the positive outcomes we value — better health, greater patient satisfaction and enhanced trust and confidence in the NHS.

Too often in the past the introduction of ICTs into the health service has been driven by a desire to deploy the most recent technological advance rather than by a desire to solve a particular problem or to improve services delivered to patients. Technological determinism is a critical mistake, particularly in the health sector, where the culture and methods of work are so different from those in an office (the environment for which the vast majority of ICTs are designed).

Policymakers should not be asking: ‘What problem might this technology solve?’ Instead, they should pose the question: ‘What is the best way of solving this problem?’ This would ensure we only use ICTs where and when they are appropriate.

But identifying these situations is likely to involve challenging existing NHS work patterns as well as traditional patient and professional roles. If technology is to be used to its maximum effect a serious discussion between all stakeholders in the health and IT communities will need to take place to identify the problems facing the NHS and areas where ICT use might release gains.

The views of patients must be central, and consultations such as that recently conducted by the NHS Information Authority on the confidentiality of patient information will be crucial. Communication with those working within the health service must also improve dramatically. A recent survey highlighted the fact that fewer than one in 10 doctors feels adequately informed about the new IT plans for the NHS.²

If the integration of ICTs into health sector projects is to yield the maximum benefits, computers should not simply be bolted on to existing practices. Far greater recognition needs to be given to the highly complex nature of the organisational redesign and human resource development issues that must be tackled.

Getting practitioners to buy into this change process will be easier if they have evidence that it will lead to tangible benefits. But empowering them to implement programmes for sustainable change will require investment in training and support. So far it seems that in many projects consultation has been inadequate and the proportion of resources allocated to resolving these difficulties too low.

The evaluation of ICT use in the NHS needs to progress alongside project design and development. This is crucial if we are to correct past mistakes and inform future projects. Evaluations of ICT use in healthcare have often lacked rigour, had methodological flaws and been focused on inappropriate measures of success. There are real difficulties in measuring the impact of introducing new ICT systems into the NHS but a solution must be found if scarce resources are to be used optimally.

The Institute of Public Policy Research is seeking to contribute to such a solution by examining uses of ICTs in health through the lens of Public Value: A Framework to Assess Benefits from Governmental Action.³ This research will help to determine the impact of ICT use on health outcomes, patient experience and trust in government.

ICTs are not a cure-all pill for the ills of the NHS. Proper design, implementation and continuous evaluation of projects is the best way to ensure that the government’s £2bn gamble pays off and that new technology is used to best effect.

Without such an approach, all the e-health initiative will end up delivering is an almighty e-headache.