No NHS will work until attitudes change

Katie Davis, director general and managing director NHS informatics at the Department of Health, will be launching her NHS information strategy "real soon". This launch was originally planned for the end of 2010. I can understand that it is difficult to create an information strategy that makes sense right now. May I pre-empt her with a few principles that seem relevant to a geriatric patient who has spent his life in the IT industry? As I am just a simple patient, my information strategy would like to achieve very simple things. My first aim is for all communications between me and my GP, my GP and the many hospitals where I receive treatment, between these local hospitals, and with any centralised NHS databases, to be carried out at electronic speeds, ie instantaneously. The technology has been there for years. The rest of the world does it. Why not the NHS? The task is simple; just implement the necessary data and content standards, and we're away. There is however, an elephant in the room, or rather several elephants, which are all cultural, not technological. They are about attitude. The first one is that it has seldom occurred to hospital clinicians that, if I am being treated by two or more hospitals, that what the other hospital is doing to me has any relevance to it. It seems all too obvious to me, the patient, that this attitude is both dangerous and wasteful. I am encouraged by the feeling that patients commenting on this blog may agree with me. The second elephant is related. Hospitals consider an electronic patient record to be something to be designed and used just in the hospital – a secret garden. They have no concept of the records being useful for other parts of the NHS, like GPs – or patients. Nor do they see any benefit in sending timely discharge letters and outpatient reports to GPs (or patients) within 24 hours. The idea of an EPR following a patient through life is quite foreign to them. And, of course, they reject any idea of data and content standards for patient records across the NHS. They look at any common standards as nasty top-down stuff promulgated by evil people like Richard Grainger and Connecting for Health, when, according to them, every sane person knows that every hospital is different – and very often every department of every hospital needs its own patient record standard. Nor do they seem to be aware that, even if they cannot agree an all-singing, all-dancing unitary EPR, there has been loads of middleware, XML and stuff, around for about 10 years, which can link to some extent the incompatible EPRs together. The first thing any information strategy should do is to explode these attitudes, somehow. Until they change, no information strategy will work. It will be even more difficult in the Lansley world of localised commissioning by clinicians than it was in the pre-Lansley top-down "bureaucratic" era. The Department of Health cannot create this culture shift among clinicians. It has to come from the clinicians own trade associations, the Royal Colleges and the BMA. But first, someone has to persuade these deeply conservative bodies that medicine cannot move on without digitalisation and data standards. I hope, rather desperately, that the impetus will come from within their ranks, because they never seem to listen to anybody else. I was encouraged, and amazed, at the HC2012 conference by a speaker, Professor John Williams from the Royal College of Physicians, who was arguing that present EPRs were not comprehensive or "clinically rich enough". He wanted something more all-embracing. I had thought that this kind of "thinking differently" had gone out of the window with the 2010 general election. And he claimed that he was getting a sympathetic response from other his colleagues in other Royal Colleges. He is, of course, only one thinker in a sea of cynics. Maybe, miracles will happen, and digitalisation will spring fully formed from the least likely bodies, the royal colleges. I doubt whether it will result from an "information strategy" coming from the DH. I see the information strategy when it finally appears, gathering dust very soon on a DH shelf, like the National Plan for IT before it. This article is published by Guardian Professional. Join the healthcare network to receive regular emails and exclusive offers.