I wrote it ten times or more

Michael Cross (1978)

Journalist Michael Cross will be chairing the “long view” panel session at E-Health Insider Live ’09. Here he has a “Life on Mars” moment, looking back over 30 years of writing about NHS IT.

Talk about Life on Mars. In summer 1978, I drove my Mark II Cortina from London to Winchester to look at a startling innovation that was in use at the Wessex Regional Health Authority.

It was a Medline terminal, installed in its own special room. I wasn’t allowed to touch it, of course (any more than I’d have been allowed to touch the machines that set my newspaper articles in type) but I watched as the specially trained operator called up a set of references to medical journals.

I was impressed enough to write a short feature article, suggesting that one day soon doctors would routinely call up computerised information in the course of their work and that healthcare would be improved as a result. And, with supreme journalistic arrogance, I assumed that was the story of healthcare computing, done and dusted.

Wessex Tales

It was 14 years before I returned to Wessex, to write a very different kind of healthcare computing story. In the meantime, I dipped in and out of the topic, reporting on smartcard pilots, point-to-point telemedicine systems and a national initiative to equip GPs with what we then called microcomputers.

I’d also become an IT user myself, owning a succession of portable and not-so-portable machines with dial-up links to systems with names like Telecom Gold, Compuserve and Poptel.

But Wessex changed the rules. Before the early 1990s, healthcare computing had been good news. Now, fairly or unfairly, it was a symbol of everything that was perceived to be adrift about the NHS. Fifteen years later, we still live with that mind-set. And unless it changes, the future is bleak for IT-based improvements in healthcare.

The leadership tried, of course. With heroically bad timing, the NHS launched its first information management and technology strategy in 1992, and a national networking plan a couple of years later.

There were some successes: the otherwise unlamented GP fundholding reform weaned a critical mass of GPs onto practice management systems and the first electronic patient records. A handful of hospital trusts such as Wirral started to show that IT could transform secondary care.

And then we had a change of government. Buried in the appendices to Tony Blair’s 1997 manifesto was a commitment to get a grip on healthcare computing by creating a high-powered team to steer information policy and a central IT agency with the clout to execute it. (I think I can now reveal that the document in question was put together in an evening by a freelance journalist, an IT supplier and a political researcher.)

It was a new dawn, was it not?

We allowed ourselves to get optimistic. A few months after the election, the market research firm Kable, with sponsorship from BT, published an 80-page booklet called HealthSmart 2010, written by me and based on interviews with some 20 healthcare informatics experts.

We called it a work of science fiction. We proposed that, by 2010 the NHS would have been transformed by the “information revolution… in ways that affect everybody.” The IT revolution would “offer ways to deliver healthcare more widely and more efficiently than today.”

We also suggested there would be a downside: “A risk of widening the gap between people who have access to the new technologies and those who do not.”

We said that 2010 will be the age of the “informed patient – at least among those social groups that have access to information technology.” We warned that “security is a serious issue” – the book’s narrative hinged on an individual whose electronic medical record had been leaked all over the press.

We warned of “commercial pressures to institute solutions before they have been properly medically validated.” So, we got some bits right.

We also got a lot wrong. We assumed that, in 2010 the internet would still be a dial-up service for wealthy minorities. More seriously, we assumed that, once the political decision had been made to implement electronic medical records, implementation would follow.

Boarding the XPress

Of course, we weren’t the only ones to make that mistake. The following year, Frank Burns’ “daffodil” IT strategy, Information for Health, set a target date of 2005 for all trusts to have EPRs.

A couple of years later, when it was clear that few trusts were responding, it was assumed the problem was one of IT budgets being diverted elsewhere. And when ring-fenced budgets had little effect – and the 2002 budget promised an end to money worries anyway – the solution was deemed to be political leadership on a grand scale.

On 25 April 2002, I wrote in the Guardian that “the success of Tony Blair’s £40 billion gamble on the NHS hinges on the world’s largest single IT project (sic)”.

“Two months ago, ministers and civil servants – briefed by computer companies – persuaded the prime minister at a Downing Street seminar that the only way to change the NHS enough to make a difference by the next general election is to computerise on a national scale,” I added.

I also said the “national plan” would cost £13 billion over six years – and that all the signs were that lessons learned from previous failures were being ignored. Again, I got some of it right. E-Health Insider readers won’t need me to re-hash the story of England’s National Programme for IT in the NHS.

Not yet ashes to ashes

Of course controversy still reigns over the programme’s conception, leadership and execution. But the long view must be that it falls into the Wessex era of NHS computing – an era in which no amount of success could overcome a wider perception of failure.

Is that era finally coming to an end? Call me a hopeless optimist, but I think it may. The catalyst will be the kind of revolution we had a clumsy stab at depicting in HealthSmart 2010; one in which empowered patients call the shots.

Since summer 1978, I’ve put on a lot of waist inches and lost a lot of hair. But I haven’t, quite, lost my excitement about what will happen when healthcare finally makes proper use of IT. Maybe there is Life on Mars.

9-10 November 2009, The ICC Birmingham

Mike will be chairing “the long view – a retrospective of healthcare IM&T” at E-Health Insider Live ’09. Joining him for the panel session will be former health minister Tim Sackville, critical friend of NHS IT Fleur Fisher, Liberal Democrat health spokesman Norman Lamb, Stalis chair Roger Wallhouse, and former director of the NHS Information Authority Dr Anthony Nowlan.

E-Health Insider Live ’09 is the essential, two day exhibition and conference at The ICC in Birmingham. More than 60 exhibitors are booked for the exhibition, which also features a free best practice showcase.

The exciting conference programme, whose principal sponsor is BT, has four streams exploring “the big picture” on healthcare IM&T, benefits realisation, digital patient care and healthcare interoperability.

And there’s no need to be stuck in your hotel overnight, because E-Health Insider has organised at great comedy night at Jongleurs, which should be a fantastic entertainment and networking opportunity. Register now.