Tuesday, February 15, 2011

The Information Management and Technology Strategies of the NHS Executive

This is a second document from Philip Virgo on the history of the NHS National Programme for IT.



The key high level statement in Information for Health is:
"The challenge for the NHS is to harness the information revolution to use it to benefit patients"

We have taken this as the principal benchmark against which all investments must be measured. The core purpose of the strategy is to ensure that information is used to help patients receive the best possible care. The strategy will enable NHS professionals to have the information they need both to provide that care and to play their part in improving the public's health. The strategy also aims to ensure that patients, carers and the public have the information necessary to make decisions about their own treatment and care, to access efficiently and conveniently the services they need, and to influence the shape of health services generally.

In order to achieve these benefits the strategy commits to deliver:
  • Lifelong electronic health records for every person in the country;

  • Round-the-clock on-line access to patients' records and information about best clinical practice, for all NHS clinicians;

  • Genuinely seamless care for patients through GPs, hospitals and community services sharing infoimation across the NHS network;

  • Fast and convenient public access to information and care through on-line information services and use of telemedicine services;

  • The effective use of NHS resources by providing health planners and managers with the information they need.

These benefits when realised will improve both the quality and convenience of healthcare for the population.

The strategy breaks the work to be done in three implementation phases (1998-2000, 2000-2002 and 2002-05). Given that this seven year strategy was launched at the end of September 1998, the Committee may find it helpful to know our expectations of the key deliverables for:

December 1999
December 2000
December 2002, and
December 2005

together with a brief synopsis of the benefits to be delivered. Annex 1 sets out these expectations.

Performance Management

The NHS Executive will ensure that all Chief Executives are aware of the importance of all this as the fundamental underpinning of many of our other objectives such as achieving clinical governance. They will be performance managed against these plans. A process is being put in place which will relate local spend to local progress against the national targets. This will be closely monitored for each local community at Regional Level, with quarterly reporting nationally.

The full Local Implementation Strategies (plans) will be costed and identify how money from both the Modernisation Fund and other investment sources is being used for specific tasks.

Every effort is being made to clear away previous obstacles to progress, but we must take a long-term view and provide commitment to the NHS in terms of resources being made available in order to achieve our vision and get best value for money out of the investment.


The PAC Chairman suggested that benefits would be fairly measurable. We will be developing more specific measures of progress having assessed the full Local Implementation Strategies. Although we can easily measure results of activity such as the numbers of practices with network connections etc, the real test of all this is whether we have changed the culture and service environment so as to maximise the opportunities provided by information and communications technology to provide a modern and dependable health service.

The ultimate measures of success should be demonstrated through improved patient outcomes, and improvements in patient perceptions of the convenience and quality of care as measured through patient surveys.

Annex 1


Dec. 1999Arrangements in place to ensure the NHS Continuity of service over the millennium
1999 copes with the millennium problem
Continuity of service over the millennium period
Health Informatics Services establishedSkilled staff able to support the development and implementation of Local Implementation Strategies for Information for Health
National IM&T Education, Training and Development Strategy published Direction for the development of information proficiency, professional development, and information-related learning opportunities for all staff.
Dec. 2000Patients attending 10 per cent of Acute Hospitals to have integrated Electronic Patient Records that support electronic ordering of tests and results reporting, electronic prescribing and care pathways (Level 3 EPR) Supports the delivery of better patient services, clinical governance, closer working relationships with Primary Care and supports the flexible management of services.
All Health Communities have full costed Local Implementation Strategies [1]By December 2000 all Health Communities should be implementing their Strategies for improving information. These will support Health Improvement Programmes, and Clinical Governance by addressing practical ways of supporting the delivery of joined up and patient-centred services across Health and Social Care organisations.
Evaluation and dissemination of the work of Electronic Health Record demonstrator communities begun To demonstrate as early as possible to the rest of the NHS the benefits and issues associated with the introduction of modern electronic record systems.
National Advisory Body on Confidentiality and Security established To provide advice and guidance on key issues in improving arrangements for ensuring confidentiality and security in the management of information about health and healthcare.
Dec. 2002To have enabled primary care staff to take advantage of modern and well managed information technology and information services to achieve better and more consistent patient care. Examples of the benefits [2] will include:
  • Access to accredited information on treatments and conditions that can be shared with patients
  • Ability to communicate more effectively with secondary care staff to support more efficient transfer of patient care and ongoing shared patient care (eg, electronic referral and discharge; on-line booking of appointments)
  • Faster and higher quality of clinical communications such as test results, second opinions etc between primary and secondary care staff
  • Better internal communications within general practices and primary care groups/trusts
  • Faster communication between the Department of Health/NHS Executive and primary care staff (eg, medical alerts)
Substantial progress in implementing integrated primary care and community EPRs in 25 per cent of Health AuthoritiesEither implemented, or agreed and funded plans for implementation of, systems that will deliver integrated information about patients to support better quality care. This will mean practice-based community Trust staff do not have to enter data twice.
35 per cent of all acute hospitals to have implemented a Level 3 EPR See above.
Telemedicine and telecare options considered routinely in all Health Improvement Programmes Clear assessments made of the benefits to be had from using telemedicine services as part of delivering the Health Improvement Programme priorities.
A National electronic Library for Health accessible through local intranets in all NHS organisationsBy enabling NHS workers within a local health community to have ready access to the National electronic Library for Health from their normal place of work high quality knowledge, eg, concerning guidelines, will be readily available.
Information strategies as appropriate to underpin completed National Service Frameworks (NSF)Starting with local implementation of the national cancer information strategy, local information strategies will be developed that support a "whole system" approach to providing better services across local health communities to support the roll-out of specific NSFs.
Demonstrator Electronic Health Record sites have an initial first generation Electronic Health Record in operationCommunity-wide Electronic Health Record demonstrators, and those sites demonstrating more focused aspects of Electronic Patient Records, to have disseminated good practice and lessons learnt.
Dec. 2005Full implementation at primary care level of first generation person-based Electronic Health Records
100 per cent of acute hospitals with level 3 EPRs
Electronic Health Records (that can provide secure and confidential links to organisation-specific Electronic Patient Records) are in place and used to support the delivery of patient-focused joined-up care across local health communities.
The electronic transfer of patient records between GPs The electronic transfer of patient records from any GP practice to any other will improve access to relevant aspects of patients' histories and provide the basis for developing improvements in Electronic Health Records.
100 per cent of acute hospitals with level 3 EPRsSee above.
24 hour emergency care access to patient records:The ability to access the key information from patients' records that is needed to support the provision of emergency care whenever it is required will improve the delivery of good quality care.

[1] Once these plans have been agreed between local health communities and NHS Executive regional Offices in spring 2000, we will have a precise picture of the local activity which will need to take place in each local health community. The sequence and detail of these activities will vary across the NHS as there is not a common starting point. We are clear that over the lifetime of the strategy the sum of all the activity must ensure that all the local health communities have accomplished the common nationally uniform targets.

[2] While many of these benefits are partly quantifiable and measurable, the most significant impact on both patients and the services offered will come through the cultural change and education of staff that will be associated with them.

NHS Executive

17 December 1999

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