Learning to change through systems innovation

We all have an interest in the NHS: as a patient, a clinician, a politician, as someone who will need its services in the future; the list of interests is extremely varied. Most of us will have stories of where the NHS has excelled and where it could have done better.

Stories that have recently made the national headlines include Sorrel Mason, the toddler from Suffolk for whom a life-saving bone marrow match was found in Japan, or Collette Mills denied top-up cancer treatment, despite being prepared to pay for it.

Many of us have similar tales to tell from the experiences of our family and friends. Such experiences illustrate how the NHS often demonstrates sheer brilliance alongside dismal practice, meaning few experts are in doubt of the need for a step-change in performance.

Sir Derek Wanless’ 2002 report on future funding for the NHS recognised the pressures of medical and technological developments. Increasing demographic pressures meant the NHS had to change, with technology as an important enabler. The result was the NHS National Programme for IT.

Six years on and one area where most experts agree that the NHS could do better is with the implementation and use of information systems.

The London Hospital, for example, is one of the leading teaching hospitals in London and had computers on the wards in 1972. The systems helped staff order pathology tests for patients and receive results; quicker access to results can mean quicker diagnosis and more rapid treatment.

As such, everyone wins: the patient gets well, treatment is safer, the clinician is able to do a better job and the cost is probably lower.

But some 35 years later, most hospitals cannot achieve even a relatively simple level of technical functionality.

There are notable exceptions, such as electronic patient records in general practice, and the National Programme has had notable success in infrastructure development.

But other systems, for example technologies supporting the basic operation of hospitals and other NHS organisations, have been delayed by years, leaving many organisations attempting to transform services while not having access to a key enabler.

I have been involved in a number of good national approaches that have not been followed through. A few leading organisations excel, but most are stopped by the time they get to the head of the queue, while the strategy is reviewed, a different approach often adopted and the cycle started again.

The applications will never perfectly support the latest in medical thinking or the latest government policy, just as a computer is obsolete almost from the moment it is bought.

One size does not fit all, but leading health organisations need a way to stay ahead and the systems do exist. Many organisations need full functionality immediately, while phased implementation suits others.

Local capabilities need to be improved and transformation efforts integrated. Success is within the grasp of the NHS again, so let’s not stop it this time.

Sheila Bullas is a director of iBeck and secretary of the BCS Health
Informatics Forum