England sets up task force to hasten use of electronic records
London
Michael Cross
Plans to create a shared electronic care record for every NHS patient in England are to be accelerated, despite auditors’ reservations and a call from BMA members for GPs to consider boycotting the system.
Norman Warner, the minister responsible for reforming the NHS in England, announced the plans after the first independent audit of the four year old project was published last week.
In a long awaited report the National Audit Office calculated that the project, the largest of its kind in the world, would cost £12.4bn (€18.1bn; $22.8bn) over 10 years. This is double the contract value normally cited by the department but lower than previous estimates, which had put the total cost at £20bn over 10 years (Financial Times 30 May, p 1).
Although the NHS and its national programme for information technology, Connecting for Health, had made "commendable progress," it would be "some time before it is possible fully to assess the value for money of the programme," the audit office said. It confirmed previous reports that the core of the new system—the national shared clinical record—is at least two years behind schedule.
At a packed press conference Lord Warner, sitting alongside Richard Granger, chief executive of Connecting for Health, described the audit verdict as "extremely positive." He said critics of the programme should consider the alternative: paper based systems that "create additional costs [and] cause delay, inconvenience, incorrect care and treatment, and, in some tragic cases, needless loss of life."
He said that he did not have "a flicker of doubt" that the care records service being created under the national programme for IT would be in place by 2010.
He announced the creation of a task force to speed up implementation of the records service and called on doctors to "conclude the ongoing debate" about the ethics of loading clinical data onto the system.
The programme’s next phase, a summary care record available from any NHS computer terminal, will be piloted early next year. The original target date was December 2004. One reason for the delay is a dispute with the medical profession about procedures for loading clinical information onto the system. Lord Warner called for "leadership" from the profession to conclude the debate.
However, on the same day 400 GPs meeting at the BMA’s local medical committee conference reaffirmed their position on the central sticking point of the dispute: on whether patients should be assumed to have agreed to their data being on the system unless they opted out. Under the current proposals summaries of information such as prescriptions and allergies will be uploaded without patients being individually asked permission.
Richard Vautrey, the IT lead on the BMA’s General Practitioners Committee, described this policy as "fundamentally wrong" and a threat to the relationship between patients and their GP.
The conference passed a resolution urging that "all patients should be given the autonomy to opt in to having their records held centrally." A rider to the motion asked GPs themselves and their families to consider opting out of the care records service personally.
Dr Vautrey said he shared Lord Warner’s enthusiasm for an end to the debate but could not see why the NHS, which has already agreed that patients should give informed consent to electronic records, could not go further. "There hasn’t been a widespread public debate," he said. However, he said the GP committee would accept the results of the first pilot of the summary electronic health record—provided that the pilot is "robust."
Lord Warner told last week’s press conference that successful implementation of the programme would present "significant challenges" in three key areas:
- Ensuring that IT suppliers deliver products that meet the needs of the NHS and to agreed timescales, without further slippage—such as through paying IT suppliers only on delivery, which means that suppliers bear the cost of delays
- Ensuring that NHS organisations fully play their part in implementing the new systems, and
- Winning the support of NHS staff and the public.
The National Programme for IT in the NHS: Report by the Comptroller and Auditor General is available at www.nao.gov.uk.