The National Programme for Information Technology What’s in it and what’s in it for anaesthetists? SCATA Annual Meeting Manchester, 13th November 2003 Prof P.Hutton Chairman, Academy of Medical Royal Colleges

How did it all begin? Where does the programme start and stop? Who pays for what? Who does what?

The landscape of modern medicine Patients and potential patients Clinicians Managers Premises Pace of change Limitation of resources Information transfer and storage

The scale of the task In one year: 617 million prescription items issued Approximately 300 million consultations in primary care 13 million outpatient consultations Over 5.3m people admitted to hospital 4 million operations NHS already spends £850m on IT each year

What do different stakeholders want?

What do patient’s want? Good care, advice and choice Ease of booking Prompt response Keeping to time Efficient transfer of data Access to information

What do managers want? To get information on: Throughput Cost Quality To run a happy hospital

What do clinicians want? To be able to see: The right patient In the right place At the right time With the right information But, just who is a clinician?

The functional objective To ensure that whoever is making a health decision has available the right information at the right time Not forgetting that this might be the patient, a carer or a manager as well as a clinician

Progress in clinical practice Major changes in 25 years Greatly improved diagnosis Agreed management of common conditions Team working (between specialties and with GPs) Skill mix and non-medical roles

Consequences of information transfer More protocol driven care Does a consultant’s work start where protocols end?

Pressures on the demand-supply balance Demographics and longevity The changing medical workforce Public expectations

Why should we be bothered? All these factors demonstrate that future demand for health care cannot be met by current delivery models

and, not only will teams be more important, the teams will depend on skill-mix and new ways of working All specialties and all clinical and non-clinical staff will be affected. The public need to be given encouragement to be more self- sufficient

What is the clinical task? To keep people healthy To treat and manage those who are ill

National and regional issues

The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities)

Current objectives and issues A common ‘front-end’ Use of a unique identifier Patient consent and personal information IT infrastructure to support national applications (e.g. images) Very basic, nationally accessible patient record (the NHS Care Record) On-line booking & ETP

Tough problems Unique identifier Confidentiality Consent Access Content of stored data Existing records Power shifts in relationships

Plus points Makes a future NHS possible Better use of scarce resources Decision support for safer care Increased clarity of purpose Better access to records Less frustration and time wasting Improved patient experience Valuable information database

Potential downsides Suspicion of staff Suspicion of public Disbelief in success Local support and maintainance Loss of clinical autonomy Power shifts in relationships Disruptives and malcontents

What will the future look like? First point of contact non-medical Many consultations not face to face Many more non-medical people delivering care More explicit that care is based on chance Protocols used whenever possible Patient access to records at any time Less acute receiving sites Less clinical freedom Greater cost-effectiveness in decision making Clear limitation on resources

The relevance to: anaesthesia, critical care and pain

The NASP Better historical data Good for pre-operative assessment Good for accessing results Clinical support (prescribing and decisions) The LSP Must provide for the NASP ? Additional functionality

Anaesthetic records Data sets Critical incident reporting

Where to from here?