Speech

Speech: 8 March 2012, Andrew Lansley, E-Health Insider launch of Chief Clinical Information Officers Network

This speech was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Andrew Lansley talks at the launch of the network of Chief Clinical Information Officers.

CHECK AGAINST DELIVERY

Thanks Richard [Thompson, President].

I’m very glad to be here today to help launch the network of Chief Clinical Information Officers.

I was at the Smoking and Health Conference on Tuesday, so it’s my second visit this week - just one indication of the impact and the importance of professional work being done by the RCP.

I’m particularly glad to be able to applaud the progress of the campaign.

It’s great to see growing recognition for clinicians innovating with imagination and creativity.

My vision is of a health service increasingly led by clinicians, with patients and shared decision-making at its heart.

Clinical leaders respond positively to evidence and data.

As we increasingly harness the power of information, I can see that clinical leadership will use information to transform patient care in the NHS.

I’ve always been committed to putting doctors, nurses and other clinicians in charge. Freed from the burden of bureaucracy and top-down micro-management to focus on the best results for their patients.

At the front-line of care; in consultation rooms, wards and operating theatres, nobody is better placed to know how to meet their patients’ needs. These patient-focused insights are critical when innovating in the NHS to improve patient care.

Making meaningful, up to date information available to patients and clinicians, and making sure it can be shared securely, offers a tremendous prize: consistently high quality, safe, efficient care.

This is our vision for the Information Revolution.

I know many of you contributed to our consultation and are eagerly anticipating its launch.

I’d like to thank you all for your many valuable insights and ideas. It’s important to get it right.

Because, as we all know, introducing change as crucial, as fundamental to the future of the NHS as this, is far from easy.

National Progamme for IT

If there’s one thing we’ve learned from the National Programme for IT, it’s that top-down edicts from Whitehall do not work.

The programme often boasted about its size.

The centre, mammoth and remote, dominating a marginalised local NHS.

Not recognising that it must meet users’ needs and would fail to deliver if it didn’t do so.

Imposing national systems that couldn’t adapt to local circumstances, the programme shackled the health service with rigid, expensive IT contacts.

Contracts which forced doctors and nurses to bend over backwards to fit in with the needs of systems rather than the other way round.

The result? I.T. became the enemy.

Innovation was stifled, enthusiasm sapped and real progress delayed.

Now, the NHS has benefitted from some elements of the National Programme which have become part of everyday business and are continuing.

  • The Spine.
  • Digital x-rays.
  • A secure broadband network.
  • The Electronic Prescription Service.
  • The Summary Care Record.
  • Choose and Book.

These will stay.

In particular, we’ve made renewed progress with the Summary Care Record.

We know we can move these services forward in the future; and there is no logic in cancelling them.

But the programme overall hasn’t reaped anything like the rewards you’d expect for the time and money invested.

And it’s been spectacularly overtaken by the explosion in information and technology which is re-shaping the world beyond the NHS.

So, you have the bizarre parallel life of a consultant who uses her smartphone to video chat with colleagues and friends across the world, but who spends weeks waiting for patient information sent to her by post.

Or the GP whose three-year-old plays confidently with his iPad, but whose patients can only make appointments by phone.

But, if we’re going to close that gap, we have to accept that change no longer happens just because someone on high decrees it.

Just recently, we ran a competition to find the best health apps. We got a fantastic response - 500 entries and over twelve and a half thousand votes and comments online.

I was at an event showcasing the most popular entries. Apps to track blood pressure, to manage long-term conditions like diabetes, to find NHS services.

It was so encouraging to see patients taking control; benefiting from smartphone technology they use every day.

Doing it not because someone like me told them to, but because it’s useful, convenient and makes their lives easier.

Learning from the revolution that’s happening all around us, it’s right we make the leap and shift power decisively from the centre to the front line NHS.

So clinicians are in the driving seat, supported by national systems and services only when there’s a single, clear need across the health service.

Trusting those closest to the front line to make decisions they know not in theory, but in practice, will make their job easier and services better for patients.

We’re already making headway on this. By devolving power, we’re on course to make big savings on the IT contracts we inherited from the last Government.

Contracts which are not fit for purpose in a rapidly changing NHS.

We’re in talks about with our largest supplier, the Computer Sciences Corporation, about a new deal.

A deal which gives trusts in the North, Midlands and East freedom to choose which systems they use.

Our overriding priority in this is to maximise value for money and be open about costs and benefits.

Around £1.8bn in overall savings will be secured across the system.

I’m hopeful we’ll achieve an outcome that will be good for patients, good for the clinicians and good for taxpayers.

After years of waste and delay, this is an incredible breakthrough that will free up clinicians in the NHS to exercise control and flexibility.

Control over what systems they use and develop.

Over the pace of change, so it’s manageable for staff and patients.

And over how they can build on the best of what they’ve already got, so systems can be connected rather than ripped out for the sake of it.

Clinical Leadership

But new technology alone isn’t enough.

One of the National Programme’s biggest flaws, from the start, was a lack of clinical input. How can you impose systems from the centre if you don’t fully involve the people who’ll be using them?

The simple, obvious answer is: you can’t.

People have to be persuaded there’s a good reason to change familiar ways of working, to challenge ingrained habits and attitudes.
“Will it be good for my patients?” is ultimately the only question most clinicians, rightly, care about.

That’s been the unswerving focus for the pioneers highlighted by your campaign.

Pioneers such as Dr Paul Altmann, from Oxford University Hospitals NHS Trust, who is here today.

His introduction of contactless smartcards in A&E has made it easier for doctors and nurses working under the greatest pressure to deliver quicker, safer care.

Before, it was taking too long for staff to manually log in and out of terminals as they moved around the fast-changing A&E environment.

Now, terminals can recognise a clinician’s smartcard wirelessly, meaning they can easily and securely resume their work wherever they are.

A simple, yet stunningly effective solution.
The new system works so well because it was driven not by an idea that looked good on paper to managers or the IT department, but by demand from the A&E clinicians themselves.

It’s a similar story with GPs in the North East.

They’ve developed clinical dashboards which display real-time information from a variety of sources at a glance.

These allow doctors to easily view the latest trends and make comparisons. They provide insights into important issues such as a patient’s risk of readmission to hospital and prescribing spend against budget.

Just the sort of powerful intelligence which will be invaluable as clinicians increasingly commission and control care.

In Bolton, where similar dashboards have been piloted, there’s been a 20 per cent drop in avoidable hospital admissions.

What’s telling, for me, is that these trailblazers have forged ahead, not because they were told to, but because they wanted to.

They’ve come up with new, better ways of working based on first-hand evidence and experience.

They’ve collaborated with their clinical colleagues to understand the challenges and take ownership of the issues.

And they’ve got senior support within their organisations.

How much more effective is this than a one-size-fits-all approach?

How much more confidence does this give suppliers when designing new products and services?

How much more compelling as an example to clinicians in other parts of the country?

They deserve our encouragement to innovate, to share evidence of what works - and what doesn’t.

A more flexible, agile future for NHS IT will support this.

A future where systems can talk to each other so information can be exchanged safely and reliably between organisations.

Where GPs, hospitals and other NHS providers are not told what systems to buy, but are intelligent customers in a market which no longer excludes small and medium-sized suppliers.

And where national standards are championed where they’re needed to underpin local innovation and choice.

The NHS Commissioning Board will lead on much of this work.

It will make sure the needs of patients and clinicians, rather than technology, drive future strategy and that services across the NHS are joined up.

This work includes:

•    Commissioning and sponsoring national infrastructure, applications and services.
•    Finding the right levers to push the adoption of NHS information and IT strategies.
•    Overseeing information standards and information governance.
•    Identifying and highlighting best practice.
•    Promoting informatics leadership and professional development.

The Board will be supported by a leaner delivery organisation replacing NHS Connecting for Health.

This will:

•    Approve and accredit national and local systems against technical and clinical standards set by the Board so systems can talk to each other.

•    Manage and monitor the day to day delivery and performance of key national systems and services such as the Spine.

•    Support the delivery of information standards and information governance processes.

We’re currently looking at where these delivery functions will sit, with the Information Centre as an option to house some or all of this work. We will make more progress on the detail over the coming months.

We’re also developing partnerships with Intellect, the NHS Confederation and the British Computer Society to stimulate a varied, vibrant market of suppliers.

On the demand side, clinicians need relevant information to become more informed customers and to exercise genuine choice.

Our work with E-Health Insider, to provide detailed data about IT implementations across the NHS, is an important tool to help them draw on the experience of others before they invest in new systems and services.

Conclusion

All of this lays the groundwork for the crucial shift in culture that the Future Forum has rightly emphasised needs to happen to make the information revolution a reality.

Information must be seen as the heartbeat of today’s NHS as it is in the wider world around us.

The good use of information must be seen not as an optional extra or a luxury, but as a health service in its own right.

As we’ve seen so powerfully with the National Programme, political pressure alone, however well-meaning, just cannot make this happen.

The role of Government should be to support clinicians to innovate, not presume to tell them how.

Greater transparency; ensuring that precious insights and learning are tapped, that data on how services are working is freely shared, that patient feedback shapes services, is fundamental to this support.

The NHS boasts a wealth of world-beating talent, ideas and new thinking. The challenge is to ensure excellence is no longer isolated, but celebrated and harnessed throughout the health service.

I’m on your side.

To provide support where it’s needed at a national level…

To trust front-line clinicians to lead locally…

To act together in the best interests of patients.

Thank you