Doctors are accustomed to false dawns in the technology and management of clinical information but, for once, real change is occurring. The NHS Connecting for Health programme is the largest and most ambitious public sector IT procurement project to date. This year it begins its main deployment phase.
The programme will connect more than 30,000 GPs in England to almost 300 hospitals by computer. At the heart of this is a health information spine where integrated, person-specific records will be available online for seamless access by relevant staff. It shares a metaphor with Bill Gates’s vision of a ‘digital nervous system’ connecting disparate healthcare databases. The care records service will be fully installed by 2007, with health and social care information systems integrated by 2010.
The National Audit Office estimates that the total cost of the programme to 2014 will be close to £20bn. This is a large figure but equates to only about 2 per cent of NHS expenditure per year. The system will be judged on whether it improves services and patient outcomes by an equivalent amount.
So what advantages will the new digital nervous system bring? Ready access to all information about medical history, allergies, medication and recent investigations will undoubtedly be a valuable clinical resource. This information should help to prevent errors, eliminate unnecessary investigations and streamline the patient journey. Among the users of this resource will be patients themselves, who will be able to view their own records over the internet. The care records service will transform the purpose of medical records from a record of information generated by health professionals primarily for their own reference into a shared resource produced and used by all concerned with the process of care.
However, the disadvantages of the system must also be considered. These include risks to both patient and clinician if confidential information falls into the hands of people with no right to see it, and problems resulting from inaccuracy, misinterpretation and omission of data. Access to the system will be available only to staff issued with a smartcard, which will leave a clear audit trail and alert privacy officers to any unusual requests.
As a programme born and bred under a Labour government, Connecting for Health should be about more than just improving productivity and efficiency within the NHS – though this is a necessary objective. This programme also has the potential to improve health in the most disadvantaged communities.
The most vulnerable people in our society still have difficulties accessing preventative and primary care services. There has been little change in this trend even 25 years after the Black report identified such inequalities.
These individuals require more checkpoints for preventative health
and early treatment measures which often go beyond their general practitioner.
Connecting for Health will collect accurate data about consistently identified patients, collated across a range of health and social care providers. For example, mental health problems are widespread; common problems affect about one-in-seven adults with severe mental illness affecting about one per cent of the adult population. Mental health problems have complex causes and effects, involving social and economic circumstances as well as physical and mental health. Effective intervention requires the united participation of a broad range of health and social care agencies.
Vulnerable groups such as those with mental illness, chronic ill health, the elderly and children stand to benefit the most from such an IT programme. Connecting for Health is undoubtedly an ambitious programme. However, with the objective of decreasing inequality enshrined within it, we should embrace and support it.