COMMENT
Could local authorities take a larger role in NHS IT provision? PSE talks to president of public sector IT body Socitm, Jos Creese, about the technological transformations bearing down on the health sector.
tion drew many in-depth responses from the IT industry, including radical proposals from Socitm that would see local authori- ties become more involved in health service IT provision.
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Would this involve a complex culture-clash and a hotch-potch of different systems?
Not according to Jos Creese, president of Socitm.
He explained: “It is our view that local au- thorities are best placed, with their demo- cratic constitution, technology infrastruc- ture and the work they have done on social care, to play a key part in health record management and in supporting GPs in the future. Information systems to facilitate personalised health and social care choices are already being delivered by the market and this should be further encouraged.
“Central government services need to be devolved wherever possible, and merged locally. Gone are the days where large scale national programmes – whether they are for public protection agencies or the National Health Service – are finding favour. Smaller scale local join-up is what the public want and where the greatest value will lie. This does not mean there should not be a national vision, standards and policy, but implementation should be much more heavily driven in the future by local priorities.
“This is not about local authorities taking control – far from it. It is about support- ing health professionals and commission- ing GPs by sharing existing public sector IT investment and expertise at a local level, rather than every GP practice setting up and running separate back office functions. In my view groups of local authorities, could readily lead on provision of information systems to support allocation of health and social care resources as GP commissioning is introduced.”
18 | public sector executive Mar/Apr 11
he Government’s ‘Liberating the NHS: An Information Revolution’ consulta-
“There is precedent for this argument,” Creese adds. “If you go back to the time when schools were given their own budgets in the 1990s, one of the downsides was that they often set up their own small, discrete IT infrastructures. Over the years, this ap- proach has carried a growing cost and risk, as well as being a diversion from core edu- cation functions.
“It would be sensible to avoid this mistake now by re-using IT networks, data process- ing, key systems and services already in ex- istence, jointly managed at a local level be- tween health and social care professionals.”
Is it really time for a revolution in NHS and public sector IT provision, considering the cuts organisations are having to make, and the ministerial insistence these fall as much as possible on the ‘back office’?
Creese admitted: “The public sector cuts will be as hard on IT as they are on all service areas. But in IT, the cuts present an opportunity as well to re-focus scarce resources on IT-driven improvements and efficiencies across public services. There is a balancing act to be struck between cut- ting IT and investing in IT.
“Frankly, any IT cuts will be small com- pared with the potential value from tech- nology to underpin reform of services design and delivery. This may be through shared services, integration of front line so- cial care and health teams, or greater adop- tion of mobile and flexible working. These sorts of changes can generate large savings, although they are not easy to do.
“In particular, they require a willingness to change and, in some service areas, an in- creased understanding and trust between professionals from different disciplines. It also needs some really competent change leadership from within the public sector and acceptance that traditional sovereignty may need to change. It must be a priority to achieve a closer integration of healthcare with other local public services, overcom-
ing some of the barriers which still exist. That requires shared IT infrastructure and shared systems.”
These sorts of solutions are far preferable to simply outsourcing to the private sector, Creese insisted.
“Outsourcing is not necessarily the right answer,” he said. “Evidence that Socitm has compiled over the years suggests outsourc- ing arrangements in the public sector in particular have often failed to meet expec- tations. They have often tended to result in something which is initially attractive and low cost, but later proves to be expensive and inflexible. We need a new approach, and I’m sure I won’t be alone in suggesting that a different type of partnership, such as public/private co-operatives, may well be more effective in the future. The tradi- tional ‘client/supplier’ model is outdated, and simply labelling such arrangements as ‘partnerships’ doesn’t help matters.”
Doctors kicked up a storm over proposals to increase the use of email for patient con- tact, potentially reducing unnecessary and time-consuming face-to-face contact, with concerns about quality of care, data secu- rity, and a detectable concern about being swamped by patients’ concerns.
But Creese said it is the way the world is go- ing and clinicians will need to adapt.
He explained: “GPs, like any public service professional, will need to be much more accessible in the future, and keeping email contacts secret for fear that patients will use them seems odd in the modern world.
“We are in an age of technology where social networking and being close to your customers – or citizens – is expected and generally more efficient. Channel shift is part of this, and email, web self-help and administration, such as booking online can reduce, not increase, burdens and costs.
“And in the future, tele-medicine and home
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