McClelland review of ICT infrastructure in the public sector: our response

Health

The McClelland report recognises that the ' health service compared to the public sector is somewhat more advanced than the public sector in general in its adoption and deployment of ICT for enabling internal processes and in areas of service delivery' and also that ' there is a strong track record of sharing ICT and other capability'.

Achievements

The detail of eHealth achievement and plans is contained in the eHealth Strategy for 2011-17 ^[4] which was published on 12 September.

The eHealth Strategy builds on its predecessor which ran from 2008 to 2011. Priorities over that period were closely aligned to the key health service patient care challenges. Convergence around common technologies with the benefits of lower costs and simplified maintenance was also a key ambition. This strategy set up the eHealth governance structure praised in the review. Its purpose is to provide a framework for agreement across NHS Scotland about the way forward on healthcare IT and to drive convergence.

The McClelland review referenced the new Patient Management System ( PMS) for Hospitals, new IT systems for all GPs in Scotland and the development of a clinical portal as examples of programmes where there have been collaborative and regional working to deliver them. The success of the collaborative and regional working can be seen in the way in which the PMS has been procured and implemented. Over the course of a year the PMS will have been implemented in five NHS Boards who worked together as a consortium which will covers over 75% of the population with other Boards expected to follow.

The NHS Scotland has a strong track record of shared ICT and business solutions of various types, examples include:

• NHS Scotland uses a single broadband contract, N3, to connect over 3,200 premises and providing links to nationally hosted ICT systems supporting approaching 160,000 staff and over 95,000 desktops/ PCs.
• There are a variety of successful nationally provided screening programmes funded by the Scottish Government (e.g. bowel screening, cervical screening, breast screening, diabetic retinopathy screening) each of which is supported by national IT systems.
• The national Emergency Care Summary, improves patient safety by providing up to date information on what medicines a patient has been prescribed anywhere in Scotland. It covers over 5 million patients.
• NHS Scotland has a national eFinancial technical shared services for all Boards and includes supporting eExpenses and payroll.
• A national Picture Archiving System which stores images of X-Rays, MRI equipment is in place across Scotland allowing clinician to information quickly. The national system now contains approaching 9 million studies.
• GPs use the national SCI gateway electronic referral system for 99% of patient referrals.
• National Services Scotland Practitioner Services Division provides ICT- enabled national shared services supporting payments and other services to General Practitioners, Dentists, Opticians and Community Pharmacists.
• NHS Scotland maintains a national identifier for patients, the Community Health Index ( CHI) which helps link disparate records and supports the provision of both local and national services.
• The national ePharmacy system providing support for the delivery and future development of community pharmaceutical services and improvements in communications across the healthcare team.
• New nationally shared contracts currently being implemented include identity and access systems which will improve the ability of clinicians to access a variety of systems, a national Human Resources contract, a National Operating Theatre Management System and improved support for the safety of chemotherapy prescribing.

There are also well developed regional consortia approaches to developments such as the Clinical Portal which brings together patient data held in separate systems into one place for the clinician offering the opportunity to reduce current reliance on paper case notes.

The McClelland review commented favourably on the NHS Scotland Architecture Vision principle of - 're-use before buy, buy before build'. The McClelland review has adopted this approach as one of its strategic principles.

Going Forward

The eHealth Strategy for 2011-17 has 5 Strategic aims; to use information and technology in a co-ordinated way to:

• Maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money.
• Support people to communicate with the NHSS, manage their own health and wellbeing and to become more active participants in the care and services they receive.
• Contribute to care integration and to support people with long term conditions.
• Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality.
• Improve the safety of people taking medicines and their effective use.

The new eHealth strategy focuses IT activity on the Scottish Government's Quality Strategy through these 5 aims. In addition it recognises the importance of citizens having more direct electronic access to healthcare services and work is underway to develop a Citizen eHealth Strategy. It also focuses on improvements in integrated health and social care by committing to developing a Health and Social Care IT strategy in partnership with local authorities.

The strategy continues to drive system convergence across NHS Scotland through the development of agreed strategies on IT applications and infrastructure. These strategies are built on 4 main drivers: rationalisation, improving value for money, improving the capacity of NHS Scotland to respond flexibly and choosing solutions strategically.