EURIM Working Group Minutes

Working Party:	Theme 01/ Working Group
Ref:	02-T02-Min07
Minuter:	Emma Fryer
Date:	05/11/02
Circulation:	Attendees and Apologies
Queries to:	Emma Fryer, Tel: 0191 384 0282 Mob: 07714 803 650 Emma.fryer@eurim.org

Minutes of the EURIM scoping meeting on NHS Delivery (sub-group of the Modernising Government Activity Theme) 5^th November 2002, kindly hosted by Intellect
Meeting Notes
			Action
1		Chairman’s introduction
	1.1	AS kindly agreed to chair in place of TA who was slightly delayed. He asked everyone to introduce themselves and outlined the objectives of the meeting.
2		Setting the scene
	2.1	AS referred everyone to TA’s paper (Ensuring Success in Health reform) that had been circulated. This had evolved from the WCIT Medicine and Health Panel discussions in the light of the NHS plan and budget and the current thrust toward modernising government. All parties had an interest in a successful outcome and the objective for this group was to try and identify how the individuals and organisations present could best help to achieve this.
	2.2	WCIT, EURIM and BCS were all platforms with common interests and the objective of this round table discussion to see if there was scope for collaborative action to ensure the success of health reforms leading to a real 21^st century NHS
	2.3	AS noted that it was extremely difficult to get disparate organisations to work together. Was a collaborative approach feasible, and how could it be fostered? What would they do differently on a collaborative basis than they were already doing independently? Although there might be disagreement on details, there was broad support for what the government was trying to achieve.
	2.4	13bn of spend was planned over the next few years at roughly 2bn a year – approximately double current expenditure and more than had ever been spent in this way on public services in the UK. It was in everyone’s best interest that the money was spent effectively. That was the challenge. AS invited everyone to say how their organisations could add to that endeavour.
	2.5	TA added that it was obvious that this was a very high-risk, high value programme which everybody wanted to succeed. One major concern was the lack of appropriate expertise in the UK. With wide representation from industry and parliament EURIM embodied a lot of expertise on how to get messages through to government and influence policy outcomes. WCIT could offer industry and technical expertise covering the whole 50 year history of IT and BCS were already very active in the health arena. The three organisations had no particular political or supplier agenda in mind and offered complementary perspectives which made them a powerful force for influence.
	2.6	AS agreed that finding the tools and techniques necessary to execute this transformation could present a problem.
3		Comments from the Floor
	3.1	AN noted that comparable transformations were not achieved by pushing from the inside but by external pressures. The health service had to be viewed more widely - not just a publicly funded service but in terms of the global market. They should think about how the UK could be an exporter of health services using ICT - as had been predicted in the 1984 report of the ICT Advisory Panel.
	3.2	SR asked whether the remit of the group was to help government formulate policy or implement it. AS replied that the focus was on how things needed to be done rather than what needed to be done.
	3.3	JJ noted that one key issue around the NHS was non-standardisation and fragmentation. Business communities that had adopted successful IT strategies had tightly formed supply chains and there had always been key influencers who had driven standardisation. In the NHS purchasers were autonomous trusts with their own budgets and ways of doing things. E-Centre’s expertise was in the area of standardisation in terms of global communications, focusing on standard ways of identifying products through to automatic ways of collecting and conveying information. Supply chain management was a particular area of interest and there was much to learn from the large retailers.
	3.4	GH noted that from the perspective of a health service professional with 35 years experience this group had potential to help drive NHS implementation. The problems did not just relate to the size of the organisation or the number of people but also the fact that they were patients. The NHS was a classic complex adaptive system and the fundamental issue was the need for cultural change, without which the technology would never be exploited successfully. He noted that the Health Informatics Committee had organised a think tank when the new strategy was published and he tabled the output of their workshop, which focused on the need for cultural change.
	3.5	AH noted that NCC bridged the public and private sectors and was active in gathering information on best practice to disseminate it to members. The NCC would welcome involvement in work to establish what needed doing in the area of project, programme and change management.
	3.6	SR identified two fundamental differences between the NHS and other organisations – one was the peculiar legal restrictions on how things could be done, and the other was that the NHS was not a fixed or closed system, and in a regulatory envoronmet that promulgated a new law or regulation every 26 minutes, any system had to be highly adaptive.
	3.7	RT noted that although the group planned to focus on implementation there were some critical strategy issues that could not be ignored. One was the health service belief that their circumstances, and therefore their supply chain was very unique, when in fact it was very similar to Tesco’s.
	3.8	AS agreed that this was a very important issue. As a group their means of influencing the NHS plan would be largely on implementation in terms of risk management, programme management, systems integration, etc, because this was where the expertise lay. He was cautious to broaden the scope further. RT noted that these elements covered his area of interest.
	3.9	AN asked whether any comparable projects existed on this scale. The health service had to evolve at revolutionary speed and this was usually only achieved in large organisations in time of war. This was more of an expedition than a project and the driving force would have to come from outside.
	3.10	JC noted that a comparable exercise was being undertaken in the area of criminal justice. The sums of money involved were less but still in the billions and the aim was to join existing silos rather than create a new, monolithic structure.
4		NHS “Czar”
	4.1	RS noted that Richard Granger had been appointed as NHS Czar. Was this top down approach likely to work any better than the bottom up approach that had failed? Did the group intend to support the Czar?
	4.2	GH noted that the czar had so far shown willingness to change things, which was good. However, one part of the strategy was the development of an integrated care record system for the whole NHS, to be delivered before the next election. As a result of the additional effort on this all procurement in the NHS had stopped and suppliers were going bust. The Czar had spotted this and identified the work that had to continue in parallel whilst this exercise was rolled out.
	4.3	LH agreed, Intellect membership was suffering from the effects of this planning blight. He also agreed that change management was the key but that the programme had to be linked to performance and meeting care objectives, which was not currently the case.
	4.4	AH noted that the OeE had responsibility for cross-government programmes that were neither top down nor bottom up. What was needed was a series of frameworks and specifications of policy that encouraged standardisation but were not prescriptive, which set the parameters within which organisations could make their own decisions.
	4.5	It was evident that Government wanted to empower the front line of delivery through PCCs and Trusts and the appointment of Granger demonstrated their desire to bring systems to a more nationally coordinated level, and this should be supported. The existing mess was the result of a fragmented procurement machine and there was an optimum balance – yet to be defined - between national, regional and local. The recent government procurement guide had demonstrated a wrong headed approach, which was yet to be formally corrected.
	4.6	TA noted that the NHS reform had deliverables, budget and timescales but no obvious plan. The NHS “Czar” did not have control over all the resources and objectives had been set before he had started the job and his remit was limited to IT and did not extend to business transformation. He agreed that the group’s most constructive approach would be to support the Czar. Were there any precedents for a change programme of this scale. He suggested that some research might be appropriate here. Other systems such as airline reservation systems might be comparable.
	4.7	NH noted that past concerns concerned lack of money, and now it was a case of spending the money constructively and not wasting it. LR agreed. How were the benefits of this extra funding going to be measured?
5		Relative progress in Primary Care
	5.1	SR noted on the specific level of technology vs. culture, the NHS was keen to build up a database at trust level of clinical data from GPs and primary care trusts. This was fundamentally, methodologically flawed because there was no standardisation as to the meaning of the data they were collecting nor even any recognition that there should be standardisation. ICRS would simply not be functional until that flaw was addressed.
	5.2	GH noted that efforts were being made to address that. An NHSIA project was sending facilitators to practices to train them in inputting to ensure the data was usable, but this was not nearly enough. Primary care was already 90% computerised but data could not be transferred or exchanged and this had only been achieved because GPs funding had depended on it. The biggest challenge was getting clinicians in hospitals to adopt these systems because they delivered no obvious patient benefit.
	5.3	PV noted that the 1 million people involved in different aspects of NHS service had to support these changes or they would never happen. AS agreed, the carer community had to actively support change and the roles of GPs and Clinicians was vital yet had not formed part of the debate.
	5.4	GH felt that this was true outside primary care and would persist until clinicians could see the benefits. Busy staff would prioritise patient care over entering data. There were only three efficient EPR systems in operation in hospitals. Once clinicians were persuaded these systems improved patient care, they would adopt them.
	5.5	JJ referred to Burton-on–Trent where an excellent EPR system was running, supported by clinicians and junior doctors. However elsewhere it was back to manila envelopes and stubby pencils. Standardisation at EPR level was needed, the procurement process needed re-invigorating. At trust level the clinicians would make or break this but industry could help by lobbying on procurement strategy issues and best practice standards.
	5.6	PV asked whether lessons could be learned from the use of systems in private practice, which in some ways was more advanced. GH replied that BUPA had done much work on what a medical record should look like. In private practice the record of the work was the thing that enabled payment and so clinicians were motivated to complete them properly. In terms of primary care, the knowledge gained and good practice were not being applied elsewhere. It was not just the data collected that mattered, but the way it was structured, used and stored.
	5.7	NH noted that in a project of this complexity, the initial stages of implementation would deliver no value to stakeholders, and they had to be persuaded that the benefits would indeed be delivered in later stages. Improving patient care depended on how information was used, and fundamentals such as the basic structure of the patient record should be standardised.
6		Points of Leverage
	6.1	PV identified the Royal Colleges as the real point of leverage, since they must be seen to work for the benefit of their members who dominated the information and procurement committees of trusts. AS noted that these issues were not at the top of their agenda – how could this be changed?
	6.2	PV suggested they look at the area of liability – if there was evidence that the better records and communications enabled by EPR reduced risk and therefore led to lower medical insurance premiums, then this was a major incentive for the people who really mattered – medical practitioners.
	6.3	GH agreed. The only reason that GPs were online was that providing data had become part of their contracts in 1990. All doctors had to provide evidence of good practice and could not do that without good clinical records.
	6.4	PV noted that the best points of leverage were enthusiasts spreading good practice internally, which was actually achievable within the existing framework and low risk. He also suggested the Unions.
	6.5	AS proposed they look at the issues in terms of stakeholders – ministers, officials, carers, patients and suppliers. The key stakeholders were the carers – the clinicians – in terms of this group moving the agenda forward. He asked whether it was feasible to get a representative body for clinicians involved this would be the best way forward. An alternative was the consultancy committee that sat above the royal colleges.
	6.6	GH agreed and also suggested the ACIE (Academy of Colleges Information Group) which was a lower level group.
	6.7	AH noted that there was also a national patient organisation. TA noted that they would provide a useful insight because they too had vested interest in the outcome but did not have the key influence in blocking or enabling of the clinicians.
	6.8	PV reported that he was holding discussions with John Riley regarding an editorial lunch for editors of medical journals once some actions had been negotiated.
	6.9	AS asked whether there were any other non-commercial professional supply side bodies that might have an interest. PV agreed to ask Dave Todd at Norwich Union who handled the medical insurance and professional indemnity for contacts.	PV
	6.10	PV also suggested IEE and agreed to investigate, and also agreed to find out who in CIPFA looked after healthcare or, if not, establish whether a separate body existed.	PV
	6.11	It was agreed that the group should approach these representative bodies.
7		Conclusions
	7.1	AS summed up. It was not a case of what had to be done, but how to go about it. The information they wanted to transmit would take the form of a supply-side proposition from representatives of the ICT industry and related professions.
	7.2	It was agreed that Alan Milburn MP should be the target for their messages. Failing that, they should approach Sir Richard Patterson or Richard Granger, (the new Health “Czar”),
	7.3	TA proposed, and it was agreed, that their submission should ask the Secretary of State for Heath to outline the strategic plan for health service modernisation. If there was no plan, the group could provide a valuable service. If there was indeed a plan, with performance measure and stages clearly defined, so much the better.
	7.4	AS warned that if this proposition was accepted by Government, then they would have to be prepared to deliver the advice and help they offered. TA noted that WCIT members were individuals who had pledged to devote some of their time to good work, and this was certainly a worthy cause.
	7.5	TA noted that WCIT were scheduled to hold a number of networking dinners with royal colleges.
	7.6	AS proposed that the group submit a letter for Alan Milburn outlining how they could be of help, setting expectations and use this to test the water. This was agreed.
8		Other Actions
	8.1	AS agreed to draft the letter to Alan Milburn and circulate it to the group for comment before it was despatched.	AS
	8.2	EF agreed to make contact with Alan Milburn’s PPS.	EF
	8.3	PV suggested that AS also approach Alistair Bellingham	PV/AS
	8.4	LH agreed to circulate a copy of the paper produced by Intellect’s Health Group to this group. The paper had been sent to Alan Milburn and Sir John Patterson and many of its messages had been echoed at this meeting.	LH
	8.5	RS noted that he was writing an article for the House Magazine on IT in the NHS and kindly agreed to mention the group. There had also been a PITCOM debate on these issues in April.	RS
9		Date of Next meeting
	9.1	A further meeting would take place depending on the response received from Alan Milburn
	9.2	AS thanked everyone for attending and closed the meeting

Attendance – 5^th November 2002

Name		Organisation
Tom	Abram	Mantix
Jon	Clempner	Fujitsu
George	Evers	RBoS
Emma	Fryer	EURIM Rapporteur
Laurence	Harrison	Intellect
Glyn	Hayes	BCS
Nick	Hirst	CISCO
Andy	Hopkirk	NCC
John	Jenkins	e-Centre UK
Adrian	Norman	BCS / WCIT
Matt	Oakley	Accenture
Lord	Renwick	EURIM
Stuart	Ritchie	BCS
Richard	Sarson
Camilla	Shaughnessy	Interregnum
Alan	Stevens	EDS
Roger	Till	e-Centre UK
Philip	Virgo	EURIM

Apologies:

Bob	Assirati	OGC
Margaret	Bell	Belle Associates
Marion	Broomes	BSI
Ian	Bruce	EMTA
Debbie	Clarke	Lord Chancellor’s Department
Peter	Daniel	Marconi
Dot	Hodge	Grant Butler Coomber
Val	Lloyd	OGC
Ashley	Mcdougall	NAO
Tom	McGuffog
Baroness	Noakes	House of Lords
Emma	O’Brien	e-CentreUK
Richard	Paton	OFT
John	Perkins
David	Rippon	BCS
Simon	Stone	IBM
Karen	Taylor	NAO
Dave	Wright	EURIM