Dr Gwyn Thomas: The NHSIA as a Service Provider

Understanding the complex shifting relationship between the NHS Information Authority and the National Programme for IT (NPfIT) in the NHS has been difficult over the past year. However, in an exclusive interview with E-Health Insider, NHSIA chief executive Dr Gywn Thomas, argues that the NHSIA’s role has remained largely unchanged.

“As a special health authority our job is to do what is best done nationally,” said Dr Thomas. What has changed he says is definition: “We’ve got a differentiation between what the national programme is doing, which is designing and building things; and what we are doing, which is operating national services.”

He added “With the new NHS clusters beginning to form we are now talking about what services we can offer them to support implementation. So it is very much about service provision.”

Dr Thomas pointed out that many of the development activities previously undertaken by the NHSIA have either been completed or reached the end of their duration. Projects pointed to included ERDIP, SNOMED and the email and directory services project.

The NHSIA chief executive compared the relationship between the national programme and the NHSIA to the design, build and operate cycle in industry. “Development work is being done by the national programme, and we weren’t doing much of that anyway quite honestly, but the operation of national systems is ours.”

Dr Thomas stressed that this represents continuity rather than change, as the NHSIA has always been mainly focused on delivering national services, such as NHSnet and the National Clearing Service. “Although people have looked at us in our three years of existence as doing things like the ERDIP (Electronic Records Development and Implementation Programme), SNOMED and other developmental activities, about three-quarters of our budget has always gone to providing national services.”

Less than a year ago it was being rumoured that the NHSIA might be scaled back in size. In fact it has continued to grow, reflected in a burgeoning annual budget. “When we were set up around three years ago it was around £50-60m, this year it is around £250m,” said Dr Thomas. “That’s a big leap.”

The reason for the leap, explains the NHSIA boss, is increased workload resulting from implementing government policy. “It’s because all the government policy has now moved into implementation on things like increasing the bandwidth across the NHS.”

According to Dr Thomas one of the challenges facing the NHSIA will be to strengthen its culture as a service provider organisation. “With the reorganisation going on in the Department of Health we’ll have more potential customers, such as the new Commission for Healthcare Audit and Inspection, who have responsibility for the national clinical audit support programme.”

Dr Thomas said the NHSIA’s infrastructure service fall into two broad categories. First, systems-based infrastructure services such as NHSnet, the clearing service, the tracing service, the GP payments system and NHS Numbers for Babies. The second set of infrastructure services he describes as focused much more around “healthcare information and knowledge management”.

He also predicted that, increasingly, the NHSIA will become identified with what is currently referred to as the National Patient Record Analysis Service (NPRAS), and other analytical services.

The concept of NPRAS was first set out in ‘Delivering 21st Century IT Support’. “It’s a bit of a mouthful, but it’s basically a national analytical service to collect, analyse and report on information. And that’s increasingly going to be information about the quality of care,” said Dr Thomas. Consultation on the second-stage Outline Business Specification (OBS) on NPRAS closed in June and the task of implementing the service has now passed to the NHSIA.

The second main area of activity that will grow in importance is supporting health informatics professionals “We’ve been working over the past year to try and put health informatics in the UK onto a far more professional footing,” said Dr Thomas. He adds that the goal is to do the same for informatics professionals as has been done for finance professionals.

To this end the NHSIA has been working with bodies such as the British Computer Society (BCS) and the Association of Health IT Professionals (ASSIST), and have now set up the UK Council of Health Informatics Professionals (CHIP). The new organisation has begun to set up a voluntary register of UK health informatics professionals.

“This is a significant step if you look at where we’ve come from and the way that health informatics is perceived,” said Dr Thomas, who said getting health informatics established on a professional footing was a prerequisite for getting health informatics specialists in the boardroom – a key objective set out by NHS IT Director General Richard Granger.

Dr Thomas added that the NHSIA’s human resource strategy for health informatics professionals, ‘Making Information Count’, launched in October 2002, marked an important step in helping NHS IT professionals make the progression into the board room. “For the first time ever health informatics professionals have their own HR strategy, and associated with that now is an implementation plan.”

He explained that the importance of the document is that it sets a direction of travel. The NHSIA is now working with bodies like ASSIST and the BCS to help build a professional consensus and demonstrate the value of working as a coalition.

Asked how many health informatics professionals there are in the NHS, Dr Thomas quoted a figure from the BCS of about 27,000. “But I don’t think that includes clinicians who use information on a daily basis as part of their job,” he added.

Summing up the changed role of the NHSIA Dr Thomas said it boiled down to “keeping the lights on”. He concluded “It’s a sort of underwhelming change in a sense, its business as usual.”