Information Technology (Hansard, 28 November 1989)

§ Mr. Roger Freeman

The reforms outlined in "Working for Patients" will assist in integrating the NHS. There will, for example, be better links between primary and secondary care. District health authorities will need to work closely with GPs to take account of GPs' views when agreeing patterns of provision. GPs holding their own funds for elective and diagnostic services will be involved in direct transactions with hospitals.

These changes come into effect in April 1991, and health authorities, hospitals and GP practice fund holders will need to be ready for them. In the first instance, block contracts will predominate, but with experience contracts will become increasingly sophisticated. To reap all the considerable benefits of these changes, the NHS will need to make major progress in such matters as the letting and management of contracts, the definition and measurement of quality of care and costing and resource management. To do all this they will need improved information systems and investment in technology to support them.

We can, however, build upon present information systems for the task ahead. Implementation of the Körner recommendations put in place a range of minimum data sets that provide an excellent foundation for the post-review NHS. Some changes in the data sets will be necessary, of course, and one of the review implementation projects is considering what these should be.

Spending on computing in health authorities has risen from £36 million in 1983–84 to around £130 million in 1988–89. This very considerable resource indicates the priority which we—and health authorities themselves—have given to information and IT in managing the delivery of health care. Computerisation is not, of course, an end in itself. District health authorities and the family practitioner services need to base IT developments on careful assessment of their information needs and the best means, clerical or IT, of meeting them. That is why the information requirements of the proposals in "Working for Patients" are being considered by working groups involving both the NHS and the Department. We expect the development of IT to be an evolutionary process. The past developments in IT already complement the general direction of the proposals in "Working for Patients" and the IT systems now in use in the NHS provide a firm base on which to build. For example, the new arrangements for contracting for services in the NHS, which will be introduced in April 1991, will initially be able largely to operate on the basis of existing information systems. In the longer term, as more sophisticated forms of contracting develop, we would expect changes in the information which is needed and the way it is provided. We believe that IT will have an important role in supporting such developments.

Starting with the hospital and community health services, we propose to make available the following resources for 1990–91:

227W

	£ million
	Capital	Revenue	Total
Resource management	39	39	78
Hospital information and support systems	21	4	25

"Working for Patients" set out our plans to extend the introduction of resource management to 260 acute hospitals by April 1992. The £78 million now available for resource management in 1990–91 will enable progress to be made in many sites. I expect to announce very soon the names of the 20 sites which will move into full resource management this year, following a period of preparation and the commencement of training, and the details of the programme for the remaining sites will follow. The management executive have evaluated the progress made at the six pilot sites and are still discussing some details of the evaluation with the joint consultants committee.

It is important to emphasise that resource management is important in its own right in involving clinicians in hospital management and in giving both clinicians and managers the information they need. A major part of the funds available will be directed at these aspects. The proposed system of contracts will be supported at the outset by existing information systems. In due course, resource management systems will provide much information which will allow contracts to become more precisely specified. But the pace of implementation of resource management set out in the White Paper and now matched by the funds which will achieve it will not be rushed for this reason.

We believe strongly that IT systems can benefit patients, not only by making NHS administration more efficient and by helping healthcare professionals to manage their resources better, but in more direct ways, such as the Eurodiabeta project at St. Thomas' hospital, which is developing better management of care for diabetics.

We have made funds available to enable the two HISS projects in Darlington and Greenwich to move ahead towards completion and for work to continue on the Nottingham HISS project—which is using new methods of specifying and designing hospital computer systems. We shall also fund other projects in this field in 1990–91 to broaden our experience both in achieving integrated systems and in obtaining the maximum benefit from them.

District health authorities, too, will need information systems to help them carry out their new functions such as placing and monitoring contracts and, most importantly, assessing the health needs of the population they serve. A study is under way to assess how best to meet districts' information needs. We will make a further statement next year on support for such systems.

Although we are intending to fund a number of different initiatives at sites throughout the country, we will take steps to ensure that the money is spent in a co-ordinated way, irrespective of the level at which the initiative takes place. We also believe that the NHS could make more use of its considerable purchasing power to get even better value for money in IT and we will be taking steps to encourage this, in concert with the NHS procurement directorate and the centre of responsibility for computer procurement based at South Western RHA.

We are well aware that information systems require expertise—people to design, build and operate them, as 228W well as to use the information they produce. These people need training and we have established a number of centrally financed projects—some £41/2 million will be spent over the next two years—to build up a training infrastructure for information management and technology in the NHS. As the need for exchange of information between different parts of the service grows, there will be increasing need for an electronic network which facilitates this exchange. The Department has therefore recently entered into negotiation for a private network for the NHS under the umbrella agreement between the Central Computer and Telecommunications Agency and Racal Data Networks Ltd. for the Government data network. The first links to the network will be between family practitioner committees (FPCs) and the newly computerised NHS central register, starting in mid-1990. Thereafter, it is planned to link other FPS administrative bodies and those FPS practitioners with computer systems meeting the required communications standards. We expect this FPS network to evolve over time to be capable of handling most of the needs of the wider NHS.

FPCs are already working to improve the quality of the data they hold—data which will assume an increasing importance in a contractual environment. The management information requirements for FPCs arising from "Promoting Better Health" have been examined and work has begun to develop some of the information systems required.

As far as IT in GPs' practices is concerned, the Government have already made it clear that we are fully behind the movement towards more and better computerisation. Quite apart from the importance of IT to link family doctors to family practitioner committees and hospitals, we are keen to encourage them to use computers to secure clinical benefits for their patients, to provide a wider range of services and to manage their practices more effectively.

To encourage that, we announced earlier this year that, from 1 April 1990, GPs will be able to claim 50 per cent. direct reimbursement of their computer maintenance costs, the balance to be reimbursed indirectly through the setting of general fees and allowances. I am now able to announce that in 1990–91 additional resources amounting to £24 million will be made available for computerization in general practice. From 1 April 1990, all GPs will be able to claim 50 per cent. direct reimbursement of the costs of purchasing, leasing, upgrading and maintenance of their computer systems, together with 70 per cent. of the initial staff costs of setting up the systems. The balance of these costs will be reimbursed indirectly. These allowances will be subject to upper limits based on a sliding scale according to practice list sizes and will take account of systems obtained in 1989–90. We shall be discussing the details with representatives of the medial profession and in due course will publish them in the statement of fees and allowances. These revised arrangements will be reviewed after three years. Additional assistance will be announced shortly for GPs who choose to be funded through practice budgets to reflect their special computer needs.

We are also making available additional sums from 1991–92 to set up a central GP computer development and research fund to examine and evaluate developments in this field.

We have also set aside funds to develop and pilot systems to provide GPs with information on waiting times for hospital treatment. This, together with other 229W information relating to availability, cost and quality of service, will enable them to refer their patients to hospitals which provide a good quality service in a reasonable time.

As well as information about their patients and practices and the contracts held by their DHAs, GPs will also require information about their prescribing costs. This will help them to monitor expenditure against their indicative prescribing budgets. We are funding the changes necessary to provide them from the enhanced prescription analyses and cost (PACT) system being developed at the prescription pricing authority. All GPs will be able to monitor such information without computer assistance but, over time, information technology will be of growing assistance in this field.

A more detailed document setting out our strategy for the information needs and use of information technology in the NHS will be launched for consultation on 17 January 1990.