Healthcare IT and Devolution

The health services in Wales, Scotland and Northern Ireland were detached from the English mother ship as part of devolution. This can be seen in terms of policies: in this week’s elections for the Welsh Assembly, Labour promised free prescriptions if it regained power.

But it also means that IT is procured by each nation, rather than for the whole of the United Kingdom: the local service provider contracts being set up under the National Programme for IT in the NHS only apply to England, although the concept could be extended to the other home nations.
This raises the issue: how will electronic patient records move between different systems? This applies particularly to Wales, where patients are routinely sent across the border for specialist treatment.

David St George, director of Celtic Dimensions, says that patients from north Wales who cannot be treated within the principality tend to go to Liverpool or Manchester, and some from mid-Wales go to Birmingham. Neurology cases from both areas are airlifted to Liverpool, and children requiring specialist treatment often get transferred to the city’s Alder Hey hospital. Some patients from south Wales go to Bristol or London. Very few come the other way, although a new children’s hospital in south Wales could change this.

Furthermore, there is scope for Welsh-English transfers to increase. “They tend not to take advantage of shorter waiting lists in England,” says Mr St George of Welsh primary care providers. But he adds that this became an issue in the Welsh Assembly elections, and as a result “this may happen more in future”.

So how do data flows work? The Department of Health says that the National Health Applications & Infrastructure System (NHAIS), also known as the Exeter system, already acts as a data-exchange for a number of programmes, including cancer screening call and recall programmes, blood and organ donor programmes, patient registration and GP contractor payments."It is currently being updated to support primary care trusts in their new responsibilities," says a spokesperson.

But NHAIS, which works through NHSnet, does not cover Scotland or Northern Ireland. It uses the NHS number to identify patients, and this only covers England and Wales, although there are parallel numbering systems for the other nations.

Other data interchange systems such as the NHS-Wide Clearing Service, for those commissioning healthcare and producing statistical data, and the new NHSmail encrypted email system, only cover England, although Wales has the option to join the former. Scotland and Northern Ireland use different measures of activity, so would not be able to use the clearing service, according to the Department of Health.

The NHS Information Standards Boards and UK IM&T Forum, the latter co-ordinated by the Department of Health’s Information policy unit, bring together all four national divisions of the NHS. “Having representation from all the home countries helps to facilitate the development and use of information standards that are consistent and compatible across all of the home countries,” says the Department of Health.

Murray Bywater, managing director of healthcare IT analyst, Silicon Bridge, says that pragmatism will mean that data transfer systems will remain open. “All the English regions have different systems, and the local service providers are not going to replace them willy-nilly. The LSP contracts will have to arrange to pass data between these, which means it will not be a huge step to pass them beyond national boundaries.”

And as Mr Bywater points out, the NHS has already started exported patients to Europe. This too will require flexibility in how records are transmitted, as will greater use of the private sector. “It’s about picking up the diversity of systems, and making them work together. It’s not economic to chuck them out and replace them,” he says.

But there are another problems in getting patient data to flow freely between the home nations, according to David St George: language. “Our experience is that doctors don’t write in Welsh,” he says, but adds that social services records may well be written in the principality’s other official language.

Of course, given that local authorities are usually unable to exchange information electronically with health organisations, this is not likely to present any new problems in the near future.

(c) SA Mathieson