Wachter review of NHS IT is 'based on an heroic assumption'

Written by David Walker on 19 September 2016 in Opinion

Bob Wachter’s recommendations for digitising the NHS are measured, realistic and long-term, but could still fail without doctors’ buy-in, argues David Walker.

David Walker says the Wachter review is a clear, concise take on the UK's complex healthcare system - Photo credit: David Walker

Short of disinterment and jumping up and down on the corpse, the Wachter review could hardly have done more to dissociate itself from former chief of NHS information Richard Granger and the Blair government’s big bang approach to digitising hospital care.

For the American doctor, the English NHS needs a dose of softly-softly, some ITLC (IT loving care) and a lot more people like himself – informatician-clinicians.

As for health IT suppliers, he says that sooner rather than later the market has to shrink into a pool of four or five majors and – implicitly – companies must become a lot more savvy about the specifics of trusts and health economies, and be prepared for lots of adaptation of standard products.

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In one important sense, Wachter is a marvel. Here’s a report about the densest of English bureaucracies written by a foreigner that manages to be limpid and concise – unlike the vast bulk of IT-related literature.

His potted history of the National Programme for IT (for which I still believe Granger gets far too much of the blame) is fair. If only Tony Blair hadn’t been quite as star-struck on meeting Bill Gates things might have been very different.

Ditto Wachter’s account of the roll out of electronic records in primary care, beginning as long ago as 1975. He doesn’t say digitising secondary care will take 40 years but does honestly admit that returns on capital investment and in NHS productivity will take decades. HM Treasury, please note.

One step at a time

On these pages, Socitm had a go at Wachter for not paying enough attention to interoperability across the public sector, specifically between the NHS and local government. It’s a fair cop, though for an outsider to get his head round not just the British way of organising healthcare but also the complexities of councils is asking a lot.

One thing at a time. Let’s first get more hospitals moving towards digital maturity. As they do, better links with social and community care can be patched in.

Another criticism of the report might regret its passive view of the public. Wachter says he backs Fiona Caldicott on patient data security. What he should have said is that she ought to have been a lot pushier, saying out loud that public and MPs’ attitudes are an obstacle to joined up healthcare.

Wachter didn’t go there because he knows delivering digitisation can’t be left to the system itself, however well led: it needs senior political buy-in.

Mistrusted they may be, but only politicians can talk the public through.

Recently-appointed national clinical information officer Keith McNeill won’t have to worry about being sweet and engaging with clinicians, his problem will be reaching out to the public to enlist them as agents of change.

Those queues for the iPhone 7 are matched by queues, literal and metaphorical, for NHS services that could – to some extent at least – be reduced by speedier take up of technology.

But getting there means more public ‘engagement’ plus willingness to talk tough to the public about money. Announcing the report Jeremy Hunt – still marvelling at his retention by Theresa May -- naturally enough steered clear of that subject. (As for NHS chief, Simon Stevens, to go by recent interviews IT isn’t evidently in the forefront of his concerns.)

Doctors that ‘do’ IT

Wachter’s American can-do attitude is tempered by realism, hence his elongated timetable for NHS trusts to move into what Hunt (with typical exaggeration) called “global leader” status in terms of IT take up.

But his plan nonetheless rests on an heroic assumption – and it’s one IT suppliers will have to grapple with, too.

Doctors, nurses and ancillary professionals need persuading, cajoling and sometimes to be pressured into change. And they are more likely to move if they have confidence in trust IT leadership.

This is why Wachter prescribed a new generation of doctors-that-do-IT. As of now, they barely exist. IT guys and gals sit in one box; clinical directors in another.

Massive amounts of training are indicated, at a time when doctors’ motivation and morale are real problems.

Reading Wachter, would a junior doctor (being called to strike by the British Medical Association) imagine he or she had a fantastic future mixing patient care with expert understanding of systems, code and digital operations?

If not, it’s hard to see even his relaxed timetable for delivering digitisation being met.

About the author

David Walker is a former managing directorof  public reporting at the Audit Commission and co-author with Polly Toynbee of Cameron’s Coup.

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