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On December 15, 2011

As an ardent believer in the need for progress in healthcare I shouldn’t suffer nostalgia for the NHS of yesteryear. But, like many others, there are moments when I have the sense that something has been lost. You know the sort of thing – the lament for a golden era where the GP was almost an extension of the family. We popped to the surgery to chat things over with a wise and genial doctor who had known us for years, and whose assessments were backed by an intimate knowledge of our medical history and social circumstances. If they couldn’t sort things out a letter was popped into the bright red pillar box and we would soon have a consultation with a white-coated, fatherly specialist at the local hospital.

Of course the overwhelming reality is that we have better, quicker treatment than in years gone by. Improved medication and transformative IT are among the forces which have helped extend life, alleviate suffering and streamline services. And yet the nostalgia persists. I suspect that this is because it is not really about the past at all, but has to do with a sense that things are not as they should be in the present. It’s about anonymity; that feeling people get when they have to repeat their story and symptoms time and again to clerical staff and clinicians. It’s the sense that people should understand us holistically rather than just seeing the immediate set of symptoms.

Modern society is too big, complex and mobile for us to expect that those who treat us will know us. But with good IT we can ensure they know about us. And that is the important part. Everyone in a patient’s care team should have secure access to the relevant information they need to provide the best possible care. That demands extensive electronic records holding full medical histories and demographic data – effectively what people hark back to when they think of the old-fashioned GP who was aware that their mum had a heart condition and dad was in a care home with dementia.

Progress beyond paper
Healthcare IT has developed so far and fast that by now we should have a completely linked and interoperable network, enabling the free flow of information across the entire NHS. Frustratingly many of the basic building blocks are not yet in place. These include electronic patient administration, order communications and bed management systems. Without these, the efforts of providers to deliver quality healthcare on a large scale are severely undermined by paper-based systems. Valuable time and resources are wasted on writing and typing records which are slow to exchange, often incomplete or illegible and are prone to being lost. Many other NHS organisations are struggling with different challenges, like those which come from having a range of specialist IT solutions which won’t readily link up to anything else.

What impresses me, though, is the vision displayed by some trusts, which are working with suppliers to develop electronic systems that will enable them to vastly accelerate the speed, and ramp up the effectiveness of care. St Helens and Knowsley NHS Trust is a good example. They are working with my staff to create a genuinely ‘smart’ electronic healthcare IT system.

Smart systems will hopefully one day be universal. They will provide decision support for clinicians by accumulating a vast library of information about past patients and treatment. Care teams will be empowered to compare treatments and outcomes, in order to inform their decisions on the best way ahead for each individual. This, in turn, will ensure that pathways lose their rigidity. While most patients will continue to follow the expected course, there will be a smooth and immediate response where this is not appropriate.

Empowering clinicians
Smart healthcare IT might also drive a shift towards simultaneous rather than consecutive diagnosis and treatment. A glaring deficiency of the NHS is that people can be put through test after test, month after month, as their illness is identified through a process of elimination. Fuller records and decision support would increase the ability of clinicians to recognise situations where it is better to pursue several courses of action in parallel. For substantial numbers of patients the 18-week wait would become far more meaningful – making it the period from referral to the right treatment, rather than any treatment.

The term ‘meaningful’ is significant. It has been a constant criticism of government and the DH that their efforts to raise efficiency result in bureaucracy and box ticking rather than beneficial change. That is my worry about what might happen to the current big idea for 60 measures of NHS delivery. All the more so when we are in a situation where many healthcare providers, and the emerging commissioning bodies, lack the necessary capacity to capture, analyse and share the amount of patient data that is needed to really propel the NHS forward.

Even where the information is available, the real issue is how it’s used. Dead data has little value – care records, statistics on NHS activity, or registers of patients with particular conditions must be active to be valuable. And the idea of an ‘active care record’ within a smart healthcare IT system is hugely compelling.

Last year‘s decision to give the pharmaceutical and life science sectors wider access to anonymised NHS data was a move in the right direction. It’s especially exciting as it comes at a time of tremendous progress in genetics. It is now possible to look forward to the day when the electronic health record becomes a live map of the patient. This could provide a projection of the future based on their history, genetics, environment and lifestyle. If decision support is baked into the IT systems from scratch then we don’t just get far better reactive treatment, but also have firm foundations for an NHS predicated on predictive and proactive care.

Making 80 the new 50
All of this is perfectly possible if the public and private sectors collaborate effectively. And I would argue that it’s not just helpful, but essential. Young people today have a far higher chance of reaching their 90s, and even passing their 100th birthday, than their parents or grandparents. But the prevalence of chronic and long-term conditions already means that large numbers of our older citizens endure a poor quality of life. This need not be the case. We have already achieved a situation where many in their 60s and 70s quite rightly feel middle aged rather than old. Smart healthcare IT and active care records could start making 80 the new 50.

None of this will happen without NHS determination, political will and commercial drive. Vendors need the agility, ability and ambition to get out there and ensure that their R&D is firmly focussed on customer need (both present and future). And that involves a lot of floor walking – listening to clinicians, talking to patients and genuinely understanding the pressures on commissioners and providers. If we do all this then people will yearn less for Dr Finlay at the surgery and Nightingale Wards in the local general hospital. Rather than feeling like ghosts in the machine they will have a real sense that the NHS is modern, effective and genuinely patient centred.


Shane Tickell

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