Like me, you may have ‘Government document fatigue’. Page upon page of optimism and bureaucratese after a while resembles looking at a blank wall. And life, after all, is too brief a spark.
Such were my uncharitable thoughts one hot evening this week settling down to read: The power of information: putting all of us in control of the health and care information we need. Yes, blancmange is in there, but the paper is the best attempt I’ve seen to weave together a lot of threads into what could be a unique rich cloth.
‘Unique’ because the NHS is probably the only health system in the world with such comprehensive data on health and health care for the whole population, plus the network of groups and institutions affiliated to the NHS which collect relevant data that can be linked.
This major inheritance of having a single payer and universal comprehensive coverage has hardly been drawn upon. Now is the time to do it and The power of information... does a good job of tracing a pathway for the next decade. The basic task is to speed up, join up, open up.
In these documents, the ‘making it happen’ chapter is usually the shortest. And given the now Health and Social Care Act, the levers have changed so the chapter is even shorter.
No targets now, but actions usefully summarised as what is commitment, planned central action, necessary local action or encouraged local action.
Planned central action includes setting standards for national and local networking of systems to allow data sharing and to make huge datasets available for analysis. What exactly the Department of Health (DH) will do versus the NHS Commissioning Board (now NHS England) and others, e.g. the Care Quality Commission and Monitor, is opaque in places – clearly much still to be worked out.
As ever, most action will be local, but what will speed change here is less explicit except that there will be a capital fund – held by DH – for investment. With national standards ensuring interoperability, the emphasis is on local talent to link a patchwork of clinical systems and develop them.
Open source is mooted as a possible way forward – we will report on the relevance of the Veterans’ Health Administration’s VistA system to the NHS shortly. IT development will be a good place to test the benefits of local autonomy in the new NHS.
One obvious omission is if the future is all about eking out more value for money, where do data on NHS finances fit in? Our forthcoming analysis of what can be done with patient-level costing systems shows the power of these data.
Ironically, the power of information can also stall action: the recent suggestions from the Dilnot Commission on funding social care look in danger of being ignored by the Government.
What does it take for some leadership here? Our Chief Economist Anita Charlesworth and Senior Fellow Ruth Thorlby suggest that the annual surplus from the NHS (around £1.5 billion) and some welfare resources to wealthy pensioners should be redirected to social care.
The former will prompt howls from the NHS, but visit any acute hospital and you will see the NHS is substituting for social care anyway. The latter will draw howls from middle England about withdrawal of state benefits, but check out this figure from the report.
The wider theme of intergenerational fairness will be explored at our summer debate on universalism, by David Willetts, Frank Field and Julia Unwin amongst others.
Dixon J (2012) ‘NHS information: speed up, join up, open up’. Nuffield Trust comment, 31 May 2012. https://www.nuffieldtrust.org.uk/news-item/nhs-information-speed-up-join-up-open-up