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Published 13 August 2015
From a technological perspective, Jeremy Hunt's speech setting out his "25 year vision" of the NHS is to be warmly welcomed.
His goals of using technology to not only speed up referrals, but permit more informed choice by patients about the most appropriate care provider for them (based upon quality criteria and waiting time), and facilitating more collaborative working arrangements across distributed teams, providing easier and quicker access to all of the information that is necessary to enable clinicians to deliver better patient care (and possibly save cost in the process) are, of course, laudable ones. So too is the focus on aiming digital innovations in healthcare at those who would benefit most from it. However, as lawyers are wont to do (!), it is important to temper that zeal with a few observations.
To boldly state that our electronic health records will be available seamlessly in every care setting within the next 5 years, such that they can be accessed, shared and have preferences marked upon them, has resounding echoes of the much maligned integrated care record service that was the keystone of the now defunct National Programme for IT in the NHS. This also seems to be remarkably forgetful of the associated data protection implications that were a considerable factor in failing to get clinician buy-in.
It needs to be recognised that, from a service-user perspective, whilst it is easy for those that use technology as a daily working tool to just assume that the use of electronic communications is all pervasive, this is simply not the case. There are segments of the population (perhaps the very ones that are the heaviest users of the NHS) who do not work in an office environment or have ready access to email or online facilities, or are unfamiliar with and do not routinely use information technology.
And what is it about "5 years"? This seems to be a magic number that comes up time and again – who can forget the bold promise of a paperless NHS within 5 years, in a similar speech given in 2013?
Having said all of that, we heartily applaud Mr Hunt's passion for improving the NHS. We, too, are passionate about the potential of health technology to transform patient safety and patient experience, as well as enabling health providers to better manage their businesses and gain competitive advantage.
It is deeply satisfying when, having assisted a client in the smooth procurement of a new generation electronic patient record system, to later hear that its successful implementation, when coupled with the (properly supported) business process transformation activities that necessarily accompany its use, and the right end user education (to foster willing adoption of changed working practices) is proving to be truly transformative, both from an employee and service user perspective. Patients often say that one of the most frustrating aspects of the current system is the requirement for them to constantly repeat information about their personal details and health history from one department to another, so to be able to move that information seamlessly within and across care settings can only be a good thing.
As far as electronic communication is concerned, we believe that the inexorable rise of the smartphone could well be the single most important factor in finally unlocking the kind of democratic access for all users of the health service that Jeremy Hunt wishes for.
Similarly, although it may be unrealistic to hope for every risk relating to patient safety to eventually be eradicated from a system that will always rely heavily on human interaction and interpretation, it nonetheless can be shown to be immeasurably improved by the greater adoption of sophisticated electronic decision support tools, and clever electronic prescribing and medicines management systems.
And finally, the engagement of Dame Martha Lane-Fox ought to be a genuine catalyst for a step-change in pushing forward use of technology to improve and enhance patient interaction with the NHS, encouraging the taking of more personal responsibility for health-related matters.
Taking all of this into account, the endorsement from Mr Hunt of the huge part that technology has to play in the NHS – from simple (and yet fundamental) improvement of patient experience to smoother care pathways, more informed clinical decision-making, enhanced patient safety, more personalised care, better and more efficient working practices and improved choice and convenience in accessing and receiving care – what's not to like?
Patrick Hill, Graham Ludlam