News & Views December 2007

December 2007
News & Views
The Newsletter of the Association for Informatics Professionals in Health and Social Care
www.assist.org.uk
Newsletter
During the existence of ASSIST those people who have
held office have tried to be open with members about what
was and is being said and done on your behalf. For over a
dozen years there has been a quarterly newsletter in paper
form. The production of this has to be planned to take
account of the physical processes. This results in a long
lead time and is relatively expensive. There will continue
to be a newsletter, in paper form, four times a year but
members can elect to have it sent to their mailboxes in pdf
format. It will continue to appear on the ASSIST web site
for review and download.
In 2008 ASSIST will initiate an e-newsletter. The enewsletter will also be published four times a year, inbetween the paper newsletter. Its publication dates will be
content driven rather than dictated by the calendar; that is
it will be sent to members when there is something to say. The intention is that it will have a succinct précis of each
article to give you the opportunity to decide whether you
wish to read a fuller article, for which there will be a link,
on the ASSIST web site.
These publication schedules will be kept under review. There is a need for you as members to ensure that your
postal and email addresses are correct. Please update your
contact details whenever one or both of your addresses
changes. There are two ways to do this. One is via the web
site and the other is to tell Elly Stimpson-Duffy the BCS
– ASSIST group coordinator. The details of both these
methods are on the back page of this and every newsletter.
John Leach
Events and Issues
The disappearance of 2 CDs
containing details about half the
population of the country from
HM Revenue and Customs brings
the issue of data security and
confidentiality into prominence. The debate, about the security and
confidentiality of health records, has
been long detailed and protracted. Whatever emerges must deliver the
benefits of shared records between
clinicians and their patients without
jeopardising the individual’s privacy. This is a tall order, which is not
helped by the illusion that paper
records have been and are secure. Many of the issues that have been
exposed in the move to electronic
records pre-existed the technology
but were never robustly addressed.
It has always been possible for
records to be “lost in the post” or
just lost. The introduction of PACS
and electronic clinical records has
made on-line x-rays and information
available whenever and wherever
required. Somewhere there are
statistics about how frequently
paper records and physical x-rays
w w w. a s s i s t . o r g . u k were unavailable at a consultation. It is also not unknown for patient
information to be lost in when
clinicians’ cars or laptops are stolen. The implicit assumption is that
health records are mislaid rather than
them being obtained by a miscreant
with malicious intent. This contrasts
with the HM Customs and Excise
example where there appeared
initially, at least by the news media,
to be concern that the data could and
would be used for fraud.
about people with a particular health
profile who are more likely to be
susceptible to buy those goods and
services; or by employers or insurers
using such information to assess
risk. There is a balance here between
making people aware of something
Continued on Page 4
In this Issue
Policy disabled IT
2
Resources on Data Security
4
Data Security –
Our Staff Make It Happen
5
There must be systems in place to
guard against human frailty and
mistakes, such as the mislaying
of records. There also have to be
processes and mechanisms to stop an
individual’s privacy being breached. There is a constant stream of attempts
to obtain details about individuals
whilst we have paper records. These
attempts will not disappear with the
advent of electronic records.
Early Impression of the Health
Service
5
Building and Information
Rich NHS
6
Collaborative Working
8
Consultations
8
Capacity and Capability
9
The advent of electronic records also
brings other risks, such as a purveyor
of goods or services obtaining details
Annual conference
Delivering Health Informatics
10
11
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Policy-disabled IT: 18 weeks
Definition: “policy-disabled IT” - the implementation of policy
without due regard for the IT and information consequences,
generally resulting in costly ad hoc solutions which drain
resources and undermine strategic systems.
[Success will be defined by] “a patient survey which will
focus on patient’s level of satisfaction with their wait from
referral to treatment, and their overall satisfaction with the
service they have received." A brief history of (waiting) time
“The waits for admitted patients will now take into account
delays introduced because patients turn down offers of
admissions made with reasonable notice. We are working
with you to introduce this approach, so that progress from
March 2008 onwards can be judged on this basis.”
The goalposts for the 18 weeks Referral to Treatment (RTT)
continue to move relentlessly. Even the formal policy
commitment has changed radically. In the beginning was
the NHS Plan (2000):
“Our eventual objective is to reduce the maximum wait for any
stage of treatment to three months. Provided that we can recruit
the extra staff, and the NHS makes the necessary reforms, we
hope to achieve this objective by the end of 2008”
Which begat the NHS Improvement Plan (2004):
“By 2008 no one will wait longer than 18 weeks from GP
referral to hospital treatment.”
Nothing succeeds
The DH Powerpoint policy announcement contains the
following guidance on RTT measurement:
• All patients who attend their first appointment will have
their referral to treatment time reported (patients who
do not attend their first appointment will start a fresh 18
week pathway as and when they are re-referred or book a
fresh appointment)
Which has now become (DH Powerpoint slides dated
October 2007):
• Patients will be told that they are being referred onto an
18 week pathway and what to expect
“Everyone who chooses to be treated within 18 weeks and for
whom it is clinically relevant, will be.”
• Patients will be encouraged to book their first
appointment only when they are ready to proceed
Analytically-minded informaticians will readily appreciate
the significance of the latest revision.
• Patients will be given clear written information about
the need to attend booked appointments, be helped to
remember appointments by really good communications,
but also reminded about what happens if they do not
attend, as set out in locally agreed and publicly available
policies
Hitting the target
A DH letter (David Flory, 17 November 2007) confirms the
NHS targets:
March 2008:
• 85% of admitted patients within 18 weeks from referral
to treatment (with sufficient data completeness to make
the result valid)
• 90% of non-admitted patients within 18 weeks (with
sufficient data completeness to make the result valid)
• Maximum in-patient stage of treatment wait of 26 weeks
(at the end of each month in 2007/08)
• Maximum out-patient stage of treatment wait of 13
weeks (at the end of each month in 2007/08)
• Maximum diagnostic stage of treatment waits of 6 weeks
(for all tests - monthly 15 and census) judged against
LDP trajectories
December 2008:
“The likely tolerances for December 2008, to take into
account patient initiated delays and clinical exceptions,
are 10% for admitted patients and 5% for non-admitted
patients, making the operational standards 90% and 95%
respectively.”
• Policies must be fair and reasonable, allow for exceptions
and must protect potentially vulnerable patients.
The very complex (and still unstable) rules for RTT
measurement add to the challenge of ensuring that patients
are clear about their rights and responsibilities. Local policy
variations – which sit very uneasily with the notion of a
national, patient-centred commitment – may mean that
patients referred between health communities face different
‘rules’ as they move along their pathways.
Counting: the cost
Informatics consequences include:
• The Healthcare Commission’s Annual Healthcheck. This
is to include a standard for 18 weeks data completeness.
Failing this standard will be equivalent to failing the 18
weeks RTT targets.
• Inter-Provide Transfers. A new minimum dataset is
about to be mandated from January 2008. This must
accompany all patient referrals between providers,
including: from primary care Clinical Assessment
Services/Referral Management Services to the acute
sector; acute secondary to tertiary care; and private sector
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to NHS. Without this MDS, RTT start dates will be
unknown and 18 weeks data incomplete.
• Local waiting times policies. Local health communities
are required to determine local policies on the RTT
impact of:
• patient DNAs and cancellations
• “reasonable” notice for offers of outpatient and
diagnostic appointments (which if declined result in
clock-resets); DH has, however, required at least 3
weeks notice for offers of admission to hospital.
• Patient choosing to defer appointments and offers of
admission. Deferrals of admission will “pause” clocks
and RTT waits adjusted after the event, in effect akin
to traditional “social suspensions”.
• Conventional “stages of treatment targets”. Outpatient,
diagnostic and inpatients must continue to be recorded
and reported according to existing rules. The operation
of two parallel but different sets of waiting times targets
will make life very complex for junior clerical staff. While DH has ended the requirement for weekly reports
of outpatient and inpatients, at least some SHAs have
insisted that these continue.
• RTT events not linked to patient attendances. Clinical
and other decisions affecting 18 weeks clock stops
may be taken outside of formal outpatient or inpatient
events. These include: diagnostic test reports leading
to clinical decisions not to treat; patients changing
their minds, moving home or switching to private care
between outpatient attendances. These events will need
to be captured and recorded, implying a requirement
not only for clinic outcome sheets but also outcome
sheets (and information management processes) for
diagnostics and admission.
• PAS, primary and community systems. Most suppliers
continue to struggle with the torrent of Dataset Change
Notices for 18 week (over 20 at the last count). The
notion of local waiting time policies implies varying
systems requirements, leading to multiple instances and
increased support costs. Strategic Choose and Book
and Secondary Uses Services systems solutions remain
elusive.
• Retrospective data collection and input. All patients
currently on ‘live’ pathways are potentially part of
the March 2008 targets. The requirement for data
completeness necessitates the retrospective collection
and recording of RTT start and stop dates. This could
involve thousands of patients in even moderate-sized
hospitals.
The end of the beginning
RTT definitions and measurement rules continue to
change apace with little regard for the information and IT
consequences. Key DH deliverables on the critical path
continue to move to the right; however, the end-points for
w w w. a s s i s t . o r g . u k the NHS remain stubbornly fixed. Ad hoc, staff intensive,
“tactical” informatics solutions will drain resources from
other priorities, including National Programme for IT
deployments. None of this will increase confidence in
IT-enabled change or the NHS Informatics profession
– ready-made scapegoats, as ever, for others’ failure to plan.
Recommendations
The 18 weeks RTT commitment remains an exemplary
model of patient-centred policy. Its delivery will
undoubtedly bring huge improvements in patient
experience and, potentially, outcomes. The NHS is rightly
being adjured to not hit the target but miss the point,
though DH might reflect more on how they might help. If
the Informatics profession is to play its part in this national
priority – albeit in the absence of proper DH planning
or preparation – then the following are the immediate
priorities:
• A freeze on changes in RTT definitions and information
requirements.
• The early consolidation of the many incremental
changes to 18 weeks and the publication of stand-alone
guidance on the scope of the target and RTT clock start
and stop events.
• A central definitional advice service, focussed on
providing transparent, practical, unambiguous,
operationally-meaningful answers.
• Consistent SHA- and clinical network-wide waiting list
policies and patient information.
• SHA- and clinical network-wide electronic forms for
the transmission of Inter-Provider Transfer Minimum
Datasets.
• Measures of 18 weeks data completeness that
discriminate between external and internal provider
problems, specifically the attribution to referrers of
incomplete Inter-Provider datasets.
• Recognition by the Healthcare Commission that many
healthcare providers do not have the information
systems necessary for the effective monitoring of 18
weeks, for reasons entirely outside their – and systems
suppliers; - controls. • The earliest possible demise of “stages of treatment”
reporting and parallel waiting list rules.
• Clarity about the timing of strategic solutions with
Choose and Book and the Secondary Uses Service. • The appointment of an NHS Chief Information Officer
with the authority and resources necessary to ensure
that new NHS policies are not forced through without
proper regard for the informatics, IT systems and
informatics workforce implications.
Brian Derry
ASSIST Chair
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that might be useful for them (by
advertising) and brow-beating the
vulnerable into parting with their
money. Such security breaches could
be made by trusted individuals who
have access to the data or by hacking. It should be noted that the directorgeneral of MI5, Jonathan Evans, has
warned banks and financial services
companies that commercially sensitive
information is at risk of being
compromised by Chinese computer
hacking1. This reminds us that there
are new risks associated with the new
technology as well as modern forms of
the pre-existing ones.
Other potential technological risks to
patients’ privacy range from mobile
‘phones with digital cameras to web
cams. Identifiable pictures of patients
are common on clinical training and
other web sites. This is fine if explicit
patient consent has been given and
can be evidenced but is this always the
case?
So far, the national strategy for
preserving the privacy of electronic
records has relied almost exclusively
on technical barriers, such as closed
networks, firewalls, hacker intrusion
alerts, continuous system monitoring
and user audits. This is necessary
but not sufficient. None of this can
prevent a malicious individual with
the necessary system access rights
from taking details from (or even
photographing) PCs screens (or,
indeed, paper records). There is now
a pressing need for much tougher
penalties for breaches of the law:
prevention should be reinforced by
deterrence.
There is the potential for vast benefits
from using electronic clinical records
both for individual patients and for the
population in terms of public health. It is timely that two members have
written about security in this issue and
that one of the twelve NHS graduate
informatics trainees, Tom Logan, who
has written about his initial experience,
is working on information governance.
This is an issue that will have to be
addressed and resolved. It cannot be
ignored as I recall some senior people
suggesting as recently as three years
ago!
John Leach
1. http://www.ft.com/cms/s/0/b3e357b8-9fa3-11dc-8031-0000779fd2ac.html
Resources on Data Security
The effective security of information is
a fundamental requirement for modern
health systems. The traditional view
of information security as a means
to create and maintain barriers that
prevent bad things from happening
has evolved. It is therefore important
to recognise that good information
security will help to improve the
quality and reliability of information
used in health systems, and to help
underpin and sustain stakeholder
confidence generally.
The ‘mainframe’ model of computer
security is now outdated. Equally,
the threats and vulnerabilities to
health information systems are quite
different to those that existed only ten
years ago. Electronic health systems
now exist within an increasingly
interconnected, diverse and complex
world of networked data repositories
and end-point devices that access and
process the information locally and
in a wide variety of locations. Such
access may be possible through a range
of e-communications services that
may or may not have security features
designed-in at their points of build.
Within the NHS, considerable
steps have already been taken to
determine the nature of risks faced, the
information security standards required
and the good practice expected of
system users. A new NHS Information
Security Management Code of
Practice has now been published
that provides an updated high-level
NHS Information Security Policy. This also contains pointers to useful
methods and resources that will help
NHS organisations and their business
partners to determine and implement
consistent information security
measures in their organisations.
In order to further enable NHS
organisations successfully assess and
address their local information security
needs, a lower-level practitioner
package of guidance, templates and
checklists has been developed and
is now available through the NHS
Information Governance Toolkit. This
package has been recently updated
to refresh and extend its product set
in different views and for different
security related topics. These will
further help NHS organisations to
strengthen then local capabilities
within a consistent overall information
security management framework.
http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_
074142
In addition, Information Governance
guidance has also been recently been
published dealing with the related
issues of Professional and Legal
Obligations.
www.igt.connectingforhealth.nhs.uk
Alistair L Donaldson M.Inst.ISP
NHS Information Security Policy
Manager,
Digital & Health Information Policy
Directorate,
NHS Connecting for Health
http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_
079616
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Data Security – Our Staff Make It Happen
Role based access controls, legitimate relationships, sealed
envelopes, encryption technologies, smartcards, data sharing
agreements… we now have (or at least soon should have) a
plethora of data security ‘tools’ at our disposal in the NHS. For quiet optimists such as myself this should mean, in the
long run, the future for security of personal information
held electronically in our hospitals and GP surgeries,
will offer real reassurance to all. The development of the
national electronic patient record, associated Connecting
for Health initiatives and the increasing need to share
patient information across organisational boundaries have,
of course, been the drivers for the development of these
security tools we find ourselves having to get to grips with.
As an information security and confidentiality practitioner
working within large NHS organisations I enthusiastically
await this new era of electronic data security. I am pleased
my own health information and that of my family will in
the not too distant future be subject to such stringent access
controls, as promised by the patient care record guarantee. Having worked within an information governance remit
for a number of years, however, I believe one of the biggest
challenges to ensuring robust data security measures across
electronic as well as paper based information systems, is that
of ensuring that the principles of sound data security are
deeply embedded within organisational cultures and in the
day to day practices of staff. In my experience NHS staff
take confidentiality extremely seriously… and data security,
once they understand why they need to take it seriously.
Induction, mandatory training, policies and procedures,
good practice reminder bulletins, data security poster
campaigns, a point of contact for staff such as a
confidentiality helpdesk, an incident reporting culture, a
strong Caldicott Guardian presence and having a senior
management team wholeheartedly on board with the
principles of good data security are all important ingredients
for developing a data security conscious workforce. We all want our personal information handled securely by
organisations especially in these worrying days of hacking,
identity theft and the like. The data security ‘tools’ now at
our disposal are an essential element towards reducing the
risk of inappropriate access and misuse of data. I feel that
the challenge to practitioners such as myself however is to
continue to influence a culture change amongst all staff to
ensure that sound data security practices become second
nature to busy clinicians and Healthcare support workers
who have far more important issues to concentrate on. This
should then ensure that patients and the public have every
confidence in the way that their health data is handled.
Caroline Squires
Confidentiality and IM&T Security Officer
The Health Informatics Service
Email: [email protected]
Editor’s comment: The Health Informatics Service is hosted
by Calderdale and Huddersfield NHS Foundation Trust. Its
web site is http://www.this.nhs.uk
Early Impression of the Health Service
Hi! My name is Tom Logan, I’m 21 and have recently started
on a pilot project for graduate, trainee informatics managers.
I joined the scheme straight from University and when I
first read the advertisement I had no idea what informatics
even was! However after a quick Wikipedia search I decided
to apply and now, several online tests and interviews later I
am in a placement with South Staffordshire and Shropshire
Healthcare Foundation Trust. The first eight weeks of my
placement were dedicated to my induction to the NHS.
For someone coming into a huge organisation with no prior
experience there has been a lot for me to take on board but I
now feel like I have taken my first (very small) steps towards
gaining an understanding of how the NHS works.
The idea of a comprehensive induction for trainee managers
appears to be a very popular initiative. I have met almost the
entire spectrum of NHS employees from frontline clinical
staff and non-clinical staff in the boardroom and beyond.
As well as being an invaluable experience for me I feel those
that I have met felt valued and happy to see the NHS take
a holistic approach to training future managers. This good
reception meant everyone I met was more than helpful and
took a keen interest in what I am doing.
w w w. a s s i s t . o r g . u k Of course, as anyone will tell you, the NHS is not perfect but
I have been struck by the level of organisational commitment
and passion I have come across throughout my induction.
Improving the standard of service to users always seemed the
universal aim even in professions where this may seem easy
to lose sight of. Unfortunately, not everyone always seems to
pull in the same direction, even if they are chasing the same
end product. This often seems to occur when information
governance is involved as those that are responsible for data
collection rarely see the benefits of their extra workload.
However this is not always the case and certain systems
such as PACS help encourage a positive attitude towards the
process of better managing and sharing information. It was
promising to see many other likewise projects on display at
the ‘Looking to the future for the national programme and
introducing some real clinical benefits’ ASSIST event this
October.
I am now very much looking forward to the rest of my
placement here in Staffordshire where I will have a role in data
quality as well as to next year when I am keen to get some
experience in an acute setting hopefully leading to a long and
productive career in the NHS.
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Building and Information Rich NHS
The Department of Health (DoH) recently announced a
review of informatics – focussing on building an information
rich NHS. As Trust Informatics staff know, there has never
been a greater need for high quality clinical and management
information within the NHS. This article outlines the drivers
behind the review, and why the current environment in the
NHS provides an excellent opportunity for it.
Information Technology has become increasingly important
to the running of government departments, and with
it a growing need to access up-to-date management
information at all levels, whilst at the same time not placing
unnecessary demands on constituent organisations. NHS
expenditure is now over £90 bn – nearly 9% of UK GDP.
The recent introduction of new policy initiatives such as
patient choice, increased integration between the private,
voluntary and social enterprise sectors into the NHS family,
the creation of Foundation Trusts, and the move towards
an NHS accountable to its members not Whitehall – all
require access to timely quality data.
Patients, empowered by greater choice, now have greater
needs for easily accessible and available information
regarding care, providers and treatments. Clinicians are
working in an ever increasing complex environment and
they have the right to demand comprehensive clinical
information at their fingertips when they are treating
patients, regardless of where the patient has been previously
seen. Thirdly, the public have an entitlement to ensure
that the people managing the nation’s healthcare system
are making decisions based on evidence. Finally, increasing
public access to the internet at home, work or through
public locations such as libraries, are pushing expectations
higher as comparisons are made between the high quality
information tools available (e.g. via Google!) to those
available in the NHS.
At present it cannot be said that the information that
could be available is fulfilling these needs, to the required
standard consistently across the NHS. The NHS has a
great deal of data, but a lack of information. Information
is often only available to a limited number of people, and
often not available at the point of need.
Therefore we feel the time is right for the review, as the
DoH and the NHS are ready to make changes to improve
the information service currently on offer. This is a positive
review- it is building on the significant existing investments
and achievements of the NHS to date. Three such examples
would be
1) the local collection and automatic feed of data into the
NHS Secondary Uses Service (SUS) for wider NHS use
2) the national Electronic Staff Record supporting a
centralised data-warehouse which will facilitate better
planning and allow a reduction in workforce data returns
3) the secure national infrastructure established by
NHS Connecting for Health (CfH) enables the safe
interchange of clinical data. Building on this progress, the Informatics Review will be
looking at three areas to achieve maximum benefit:
Project 1.
Meeting the information needs of DoH and NHS
The project will examine the current management of
information and the information systems across DoH to
reduce duplication, maximise integration and ensure that
the DoH and NHS has the information it needs to do its job.
The project is to assess what information the NHS and
DoH needs to do its business, how the NHS and Arms
Length Bodies, such as the Healthcare Commission, gather
data whilst ensuring no further burden is placed on the
NHS and Social Care. It will also look at how information
is then presented and ‘played back’ to internal and external
audiences, and integrated into policy development. More
timely access to HES data is on the shopping list for Project 1!
It is also important that there is a review of the work
programmes the DoH is currently conducting, whether
there are joined up and coherent practices in place, and if
these can be improved to increase efficiency.
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Project 2.
Maximising the benefits from NHS NPfIT
(NHS CRS and SUS)
Since NPfIT was established the NHS has changed
significantly. It is now the right time to look at NHS Care
Records Service and SUS to ensure that they meet the
needs of the NHS as it is formed today, can support the
future changes, and that their benefits are maximised.
To do this, NHS CFH is to run engagement workshops
with the NHS and representative patient groups, seek
problems, identify solutions, and play these back to the
NHS in an iterative process until end points are agreed.
Project 3.
Creating an information system and management
structure for delivery.
It is important to make sure that the informatics
management structure within the DoH supports
the information services and ensure they provide the
governance necessary to engage in the development and
implementation of policy, and support the delivery of NHS
core objectives.
The DoH or NHS has not recently addressed the question
of professionalism of informatics staff. Project 3 of the
review is examining what professional governance there
needs to be for informatics staff. ASSIST will obviously
play a critical role in shaping the conclusions to this.
So that’s it in a nut-shell. We’ll provide an update as the
review progresses, and its conclusions in future issues of
News and Views.
Frequently Answered Questions
There are many ways. For project 1 we are already gathering
feedback from members in targeted interviews. Project 2
will be working with SHAs to run a series of SHA based
deliberative events- so although places are likely to go fast,
there will be an opportunity to attend these in January and
February 2008. The ASSIST leadership are being actively
engaged to help shape the outcome of Project 3- this
project won’t succeed if it’s a top down view. If you have specific contribution you want to make to the review, please
contact [email protected], who is the Programme
Manager for the review (and an ASSIST member), and he’ll
put you in touch with the NHS team leading each Project.
3.Does this signal a lack of confidence in the delivery of
NPfIT?
No, NPfIT and NHS CFH have been subject to ongoing
scrutiny in line with good management practice. Project 2
of the review will ensure NPfIT fits with the NHS vision
for healthcare in the future. It will provide assurance that
the approach being taken reflects the changes in the NHS
since the launch of NPfIT, ensuring they will deliver
maximum benefits to the NHS. This and Project 1 are the
elements of the review referred to by Lord Ara Darzi in his
NHS Next Stage Review ‘Our NHS Our Future’.
4.Who will be replacing Richard Granger as Director
General of NHS IT and Chief Executive for NHS
Connecting for Health?
Project 3 of the review will include looking at the
management and governance of DH Information Services
(the internal IT function in the Department of Health),
aspects of NHS CfH, and the Information Centre for
Health and Social Care. It will determine future necessary
roles and responsibilities and leadership. So watch this
space!
1.When is the review due to conclude?
All the projects will conclude by the end of this financial
year, with interim recommendations in December 2007.
Tom Denwood and Leticia Thomson,
Informatics Review Team, Department of Health
2.How can I, as an ASSIST member, contribute to the
review?
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Collaborative Working
It is a long and arduous journey we are travelling. Whether you consider the ICT components or the use of
information in the delivery of health and health care to
implement successful systems and maximise benefits are
massive tasks; together they could be daunting. It is a journey on which we need all the help we can
get if we are going to travel successfully and reach our
goal. ASSIST National Council has always tried to work
collaboratively with other people and organisations. Building on this approach, it has established memoranda
of understanding with Tribal Consulting and BT and
accepted an invitation to provide regular articles for the
publication “Smart Healthcare”.
Originally through Secta, Tribal Consulting has been
an active supporter of ASSIST for many years. With
the fundamental changes in the NHS, specifically the
National Programme for Information Technology
(NPfIT) and the performance agenda, Tribal Consulting
and ASSIST have agreed to formalise and strengthen
their partnership arrangements.
BT and ASSIST have similarly established a formal
partnership agreement based on the shared commitment
that information and technology are central to the
change agenda for the NHS. • Testing ideas and assumptions with a trusted partner.
Announcements about these can be found on www.
assist.org.uk with links under the news section. There is
a link for ASSIST members to register for free copies of
“Smart Healthcare”.
Further, ASSIST is running a series of national seminars
with Connecting for Health on the national “Capacity
and Capability” programme, which was still underway
when we went to press. This enables ASSIST to alert
members to these events, attract participants who are
informed about the issues of implementation and create
an environment where people can be constructively
critical. It is anticipated that in future ASSIST will
host more such events in the role of independent critical
friend. This means that we will support the goal while
testing and influencing the mode of implementation,
where our aim is to make the process at the sharp end
smoother and more successful.
National Council would welcome feedback about these
arrangements that collectively we believe will bring
additional benefits to members.
John Leach
The shared objectives between ASSIST and its partners
include:
• Strengthening understanding within the health
informatics community of each organisation
• Exchanging information, intelligence and knowledge
fully to understand the issues and challenges facing
informatics professionals in the NHS
• Participating in regional and national events to
support our mutual aims
• Providing networking opportunities via ASSIST’s
regional and national structure
• Providing workshops and seminars around issues of
mutual interest
Consultations
In the last issue of the newsletter I provided the
essence of the contribution of ASSIST made to
the BCS response to the National Audit Office
(NAO). The full response by the BCS was published
on the BCS web site (http://www.bcs.org/server.
php?show=conWebDoc.1461) at the end of
November.
John Leach
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A S S I S T
N E W S
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Capacity and Capability review
For any organisation to spend large amounts of time
and money on a particular topic, shows the perceived
value of that topic to the organisation. For NHS CFH,
assorted CIOs, ASSIST Chairs and other worthies to
spend the amount of time needed to produce five such
events
- first in Leeds, then in Nottingham, London,
Staffordshire and Bristol
- shows how important they indeed are (the events,
not the people!)
Some 50 people attended the Leeds event. It was opened
with an incisive address by Phil Molyneaux, CIO for
Yorkshire and the Humber SHA, describing the concerns
within the service arising from the rapidly changing
circumstances, and the need to provide both capacity, in
the number of appropriate staff, and capability, of those
staff, to deliver “challenging” objectives. Brian Derry,
National Chair then followed this with a spirited context
setting, delivered in his own acerbic way - never one to
miss an opportunity to stress the need to develop our
own staff and capabilities! John Willshere, Director for
the NHS CFH Capability and Capacity Programme,
further developed this theme, explaining how his role
was specifically designed to bring together the local,
strategic and national needs, then introducing us to
the members of his team, who were to facilitate the
workshops.
Didn’t I mention the workshops? This was not a static
session, but one where there was grass root interaction! The three strands of the workshop were the leadership
agenda, the programme, project and informatics
workforce and the tools, techniques and methods to
deploy them.
Any session that is expected to deliver multiple outcomes
for each strand, but instead produces copious and
voluble discussion on just the first element of each
strand, shows the depth of feeling within each group. The moderators did a sterling job in trying to move us all
on, but in the end bowed to pressure and allowed an in
depth discussion to take place. The presentations to each
group, and the plenary debate chaired by Phil, showed
the breadth of experience, and the depth of feeling that
this subject created.
All in all, a very stimulating, thought provoking and
enlightening session, well worth half a day of our time.....oh yes, the lunch wasn’t bad either!!
Notes are also being produced on the other four events,
and an integrated report will be published in the next
ASSIST Newsletter.
Adrian Purcell
Vice Chair, ASSIST
Smart Healthcare
ASSIST has accepted an invitation to contribute regularly to the journal Smart Healthcare.
Smart Healthcare focuses on developments in information management and technology as they affect health and social
care. It aims to demystify the use of IT and health informatics, and includes investigations of the use of technology,
examples of best practice, reports on key initiatives and projects, interviews and more.
For more information see:
http://www.kablenet.com/kd.nsf/shcAbout#?expandtab=lyrKB9
ASSIST members may register for free copies of Smart Healthcare at:
http://kablereg.crl.uk.com/signup.asp?EventID=46
w w w. a s s i s t . o r g . u k A S S I S T
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National Conference
The planning of for an ASSIST national conference and
the annual general meeting in 2008 has already started. After several years in Birmingham the venue switched
to Leeds for the last two years. There is now a proposal
that the venue should move to London for 2008. Set out
below is a resume of this year’s conference. I hope it will
stimulate ideas of what you want in the 2008 conference. The conference committee comprising Siobhan Roberts,
Ian White and Brian Derry would welcome your
suggestions on content and venue.
John Leach
Reflections on the National Conference
This pinnacle event of the year had a strap line
“No one said it was going to be easy”.
The Main Messages introduced by Andrew Haw who
highlighted the changing landscape of the NHS.
• NLOP is restructuring the CfH programme and
integrating IM&T planning.
Keynote speakers, Richard Granger who was in bullish
mood, trumpeted the call to get smart and Lord Philip
Hunt extolled the virtues of the programme and its future
challenges.
• Integration Agenda: More use of corporate systems
like NHS Mail, CfH Systems, Common user interfaces
and Enterprise wide architectures.
• Streamlining primary to secondary care, Patient
consent and confidentiality.
Denise Lievesley highlighted the services of this new
Information Centre.
• including collection and sharing of data and services
via their new website and publications covering various
areas.
and Bernard Crump delivered a powerful message on how
change in the NHS will continue at a faster pace.
• Opportunities to make a difference are in the areas
of indicators within Better Care Better Value, Service
Improvements and using these approaches to make
changes.
10
Making Communication Work “Café Conversation”.
The conference workshop “Café Conversation” was an
invigorating addition to the day.
Overview of the process:
• Delegates are seated around tables and divided into two
groups (Red and Blue) per table.
• A question is posed for consideration then delegates
write issues and thoughts onto the table cloth in text or
pictures.
• After a period of time delegate groups are moved to
another table to review and draw conclusions of the
discussion.
• Feedback to the question is then sought from the
whole group (by table).
This is a good approach for sharing thoughts and
experiences across a diverse group of people and can be
used for collecting information like “lessons learned”.
The following point highlights some strengths of the
approach:
• Sharing ideas and innovations, Promotes discussion,
Raising issues and challenges, Discussing good practice,
Teasing out tacit knowledge and getting it down.
The Accolade Scheme.
This is a powerful marketing tool as it showcases
improvements in patient care that have proven concepts
and provided solutions that can be replicated by other
trusts.
Closing Statement.
The conference offered the chance to hear key messages,
meet key figures and the potential for networking was
excellent. Next year the opportunity should be seized to
invite more mainstream NHS colleagues.
“No one said it would be easy but we can make it easier
by collaborating !”
Steven Tuitt
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Delivering Health Informatics
In early December the North West Branch heard about
some local successes of IT enabled change.
Helen Walsh, NHS
Change Consultant
in Greater Manches
ter.
Helen Walsh, NHS Change Consultant in
Greater Manchester described the theory about change
management and was followed by her colleague, Sally
Chadwick-Rock who contrasted two organisations where
the same product had been installed. In the one that
saw the introduction of new software as an opportunity
to examine organisational strategy, service redesign, seek
out benefits and took the trouble to manage people’s
expectations and communicate what was happening they
were improving service delivery. In the organisation that
regarded the new software as an IT project the process
was a burden and there are complaints that the system
does not do what is required. It was a clear message that
users have to be engaged in the project!
Julie McCann, Practice Business Manager, Eric Moore
Partnership, Warrington and her colleague described the
process of being the first practice in the North West to
implement “Choose and Book”, two years previously. They described the meticulous preparation and training
but one human element had been overlooked. The
booking staff at the local hospital finished work before the
w w w. a s s i s t . o r g . u k practice close and the first referral on the first day of live
operation was at 5:30! They also described the procedures
they have in place to ensure that all the patients who can
be referred using “Choose and Book” are referred that
way. This prompted an interesting discussion about the
denominator used nationally to calculate the proportion
of patients that are referred by practices via “Choose and
Book”.
The third strand was Johan Taylor and Kathryn
Hargreaves from Marple Cottage Surgery describing their
Secure on line Remote Consultations, see Kathryn’s article
in the June 2007 issue of this newsletter. They described
how they started this scheme for asthma cases, who are
difficult to reach. Although take-up of this additional
service has been slow they have diabetic patients asking
for similar facilities. There was a discussion about how to
communicate to these patients that this service now exists
but the take-up might be low until the winter when they
have more asthma attacks.
John Leach
Sally Cha
dwick-Ro
ck from Greater M
anchester.
11
A S S I S T
N E W S
&
V I E W S
Forthcoming Events
January
February
July
West and Yorkshire and Northern Branches
15 January. 2-4.30pm
National Confidential Enquiries - how health
informatics helps
Speakers from each of the three National
Confidential Enquiries will describe the work
of their organisations and how they use IT and
health informatics to inform their findings and
recommendations. Speakers:
Northern Specialist Group
Choose and Book
12 February. 6.15 for 7pm
Nic Fox, Development Team Manager,
National Choose and Book Team, NHS
Connecting for Health
Manchester Conference Centre, University of
Manchester,
North Campus, Sackville Street M1 3BB
www.bcs-nmsg.org.uk
Primary Health Care Specialist Group
Summer conference
1-2 July
Chesford Grange, Warwickshire
www.phcsg.org.uk
• Marisa Mason, Chief Executive, The
National Confidential Enquiry into Patient
Outcome and Death (NCEPOD)
• Rebecca Lowe, Administration Manager &
Pauline Turnbull, Project Lead for SUDs
(Sudden Unexplained Deaths) Study, The
National Confidential Enquiry into Suicide
and Homicide by People with a mental
illness
• Julie Maddocks, Regional Manager, North
West & West Midlands, The National
Confidential Enquiry into Maternal and
Child Health (CEMACH).
Sedgley Room, Harrop House, Prestwich
Hospital
http://yorkshire.assist.org.uk/
www.bcs.org/assist/northwest
London Specialist Group
17 January. 5.30 for 6pm
The Existing Systems Program
Peter Dyke, CFH
Health Informatics (London and South East)
Specialist Group
BCS, 5 Southampton Street, London.
http://www.hilsesg.bcs.org/fevents.htm
Yorkshire and Northern Branch
24 January 2008 1:30pm lunch from
12:30pm
How Technology Improves Patient Care
Windsor Suite, Cairn Hotel, Ripon Road,
Harrogate. HG1 2JD
25 January 2008 (Provisional) Electronic
Document Management (EDM) - Business
Drivers, The Market Place and Organisational
Impact - The Story so far. Details will be
emailed to members.
The date of the quarterly health informatics
forum seminar had not been fixed at the time
of going to press.
North West Branch
24 – 26 January 2008, HFMA/ASSIST
North West
Annual Conference & Exhibition
“Does the NHS Need a Health Check?”
Blackpool Hilton
www.bcs.org/assist/northwest
12
March
Northern Specialist Group
Clinical information systems enabling clinical
excellence
12 March. 6.15 for 7pm
Dr Phillip Batin, Consultant Cardiologist,
Pinderfields General Hospital
Manchester Conference Centre, University of
Manchester,
North Campus, Sackville Street M1 3BB
www.bcs-nmsg.org.uk
April
North West Branch
3 April 2008 2.30pm - 4.30pm
Nadine Fry and Julian Todd, Tribal
Consulting, “Obtaining maximum value from
consultants”
Wrightington Conference Centre
www.bcs.org/assist/northwest
HC2008, 25 Annual Conference and
Exhibition
Conference organised by British Computer
Society Health Informatics Forum
Exhibition organised by BJHC Ltd
21 to 23 April
Harrogate, North Yorkshire
www.bcs.org/hc2008
June
Northern Specialist Group
Electronic Prescribing
12 June. 6.15 for 7pm
Bob Hammond, Programme Communication
Lead and/or Ann Slee, ePrescribing Clinical
Lead, NHS Connecting for Health
Manchester Conference Centre, University of
Manchester,
North Campus, Sackville Street M1 3BB
www.bcs-nmsg.org.uk
Membership enquiries should be sent to
Elly Stimpson-Duffy,
BCS-ASSIST Group Co-ordinator,
British Computer Society,
1st Floor, Block D,
North Star House,
North Star Avenue,
Swindon, SN2 IFA.
Tel: (01793) 417731
E-mail: [email protected]
Change of address (geographic and electronic)
details can be updated via the web site http://
www.assist.org.uk/ and following the link on
the home page ‘Updating your contact details’
or by writing to Elly Stimpson-Duffy. Previous
issues of the newsletter and the up-to-date
Branch event programmes can be accessed via
this web site.
ASSIST officers act in a voluntary, personal
capacity. They operate independently of
their normal working roles and their views
and opinions, as ASSIST officers, are not
necessarily shared nor endorsed by their
employing organisations.
Copy date for April 2008 issue of the
newsletter is 28 February 2008. Please contact
the editor as soon as possible regarding any
contributions.
Editorial Board
Pam Hughes
Siobhan Roberts
Adam Drury
Dave Miller
Ian White
Brian Derry
Andrew Haw
Editor: John Leach,
Greenways Informatics, 17, Prospect Drive,
Hest Bank, Lancaster, LA2 6HZ.
Tel. 01524 822398.
E-mail: [email protected]
Printer: Miller Turner Printers, The Sidings,
Beezon Fields, Kendal, LA9 6BL. Tel: 01539 740937 | www.mtp-media.co.uk
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