What's the White Paper going to mean for Healthcare Information?

The need for better information is a theme at the core of the reforms announced in the health White Paper.

The preamble to the document states some of the principles on which the government is basing its approach. For instance, ‘patients will have access to the information they want, to make choices about their care. They will have increased control over their own care records.’ Empowering patients, a core value of the White Paper, will require far greater access to information than in the past.

Another view of the same principle appears in the declaration that ‘a culture of open information, active responsibility and challenge will ensure that patient safety is put above all else, and that failings such as those in Mid-Staffordshire cannot go undetected.’

Poor, much-maligned Mid-Staffs seems destined to be the icon for poor hospital performance for a while longer. This is the case even though it’s not obvious that it suffered from much more than resource starvation as a result of a headlong rush for Foundation Trust status. Indeed, it’s not even clear that it performed substantially less well than other Trusts: even Dr Foster whose figures precipitated the original scandal, classified it ninth in the country within the year, using broadly similar indicators.

Still, the point here is that we’re again talking about information openness with patient considerations at the centre. For our purposes, all we need to take out of the Mid-Staffs experience is the lesson that getting information right is at least as important as making it accessible.

We also read that ‘the NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets.’ The focus on outcomes will be a major theme for anyone involved in healthcare information in the coming years.

All this needs to be set against the background of the increasing shift towards GP-led commissioning and the unravelling of the National Programme for IT.

It may be a little premature to assume that the Commissioning Consortia will get off the ground any time soon. It feels to me as though a lot more money will have to be found to cover management costs. The Tory Andrew Lansley is unlikely to like the idea that he’s following in the footsteps of Nye Bevan, Socialist founder of the NHS, but he may find himself having to deal with doctors as Bevan did, by ‘stuffing their mouths with gold.’

Two aspects are going to dominate a reformed commissioning process. The first is that GPs are going to be interested in buying packages of care – treat this diabetic, remove that cataract, manage this depression – rather than just elements of a package – carry out this test, administer that medication, provide this therapy . So it’s no good saying ‘we provided another outpatient attendance’ if the protocol for the condition doesn’t allow for another attendance: the consortium will challenge the need to pay for the additional care. An approach based on care packages means analysis of pathways, not events.

The second is that outcomes are going to be crucial. So pathways have to be taken to their conclusion, which means they can’t be limited to what happened before discharge from hospital.

It seems to me that this is going to mean moving beyond current measures – readmissions or in-hospital mortality – to look at outcome indicators that tell us far more: patient reported outcome measures, through questionnaires about health status after treatment, and mortality within beyond discharge, through linking patient records with Office of National Statistics data.

Only with these measures will it be possible to see if care is delivering real benefit and, therefore, real value for money.

What about the demise of the National Programme? It always struck me as odd that a drive for efficiency and cost control should have set out to create local monopolies for the supply of software. How could that maintain the kind of choice that we wanted to offer patients, and therefore exercise the downward pressure on price and upward pressure on quality that competition is supposed to generate?

There also seemed to be a fundamental misconception in the idea that it was crucial to get all your software from a single source. One aim, of course, was to ensure that all systems were fully integrated. But if we’re building pathways, we do it with data from different sources linked in some intelligent way. That can be done by imposing on a range of suppliers the obligation to produce the necessary data in the appropriate form. That doesn’t require monopoly but accreditation.

The end of the National Programme, at least as far as local software supply is concerned, has to be welcomed. But, taken with the new pressures for different kinds of data, it will lead to significant pressure on healthcare information professionals, above all to learn to link data across sources and even beyond the limits of a hospital.

A challenge. But, I would say, an exciting one.