On the heels of the EU’s release of the Digital Agenda, discussed in another article of this series, the UK Department of Health released a white paper titled «Equity and excellence: Liberating the NHS». The paper was presented to the House of Commons on Monday, July 12, by the Health Secretary, Andrew Lansley. During the session, the Health Secretary emphasized the importance of NHS for the UK and pledged to «reform the NHS to use resources far more effectively for the benefit of patients». The paper is intended to «set out the long-term vision of the Government for the future of the NHS» through a series of changes to its administrative, managerial and qualitative operations on almost all levels.

From the point of view of ICT in healthcare, the most striking aspect of the paper is the call for an «information revolution» that will provide «new ways of delivering care, such as enabling patients to communicate with their clinicians about their health status online», but will also «boost transparency so that failings do not go undetected». It is important to distinguish between these two meanings of «information», because this distinction stems from and relates to the bidirectional nature of communications; it also makes clear that the authors of the paper were acutely aware of this duality and the fact that this «information revolution» directly translates not to one, but to two main drives for the improvement of healthcare.

On the one hand, and beyond the use of IT for efficient handling of processes and remote access to services, where clients/patients are on the receiving side of information exchange, the paper clearly advocates a more active role for them: it is mentioned that «a range of third parties will be encouraged to provide information to support patient choice». While clearly implying that information will continue to be published on NHS Choices, the paper goes beyond simple reporting, specifically mentioning that clinical teams will be subject to «meaningful, risk adjusted assessment of their performance against their peers», as well as that the results of these assessments will be available in the public domain. Furthermore, patient reported outcome measures (PROMS), already introduced, will be further applied across the NHS «wherever practicable» and patients will be afforded the opportunity to rate a wider range of the services provided to them. This is clearly in line with the drive to patient empowerment, through involvement and widening of available choices – after all, the catch-line for the White Paper is «no decisions about me, without me». Therefore, on a general level, the overriding driving forces are quality and accountability through «comprehensive, trustworthy and easy to understand information» (along with the ability to measure it).

On the other hand, the term refers to the Information Technologies (IT) field and touches on the need for a major push in this area. Telemedicine and eHealth administrative solutions have been for a long time on the crosshairs of governments and significant progress has already been achieved, as the White Paper acknowledges. The authors also seem to be in synch with a general feeling among the public that the progress and advances made have been dispersed on several fronts, some not as successful as others; hence, the paper emphasizes the need for consolidation of these efforts, bringing together the most promising results, while downsizing or completely abandoning initiatives with marginal outcomes. No business in today’s economy needs reminding about the realities of risk taking or the need for prudent allocation of (often scarce) resources and healthcare can be no exception to this.

Complementary to the White Paper, the release of another paper titled «Information on the Quality of Services», published on Friday, July 9, by the National Quality Board, also focuses on more transparency and third-party feedback collection. The board was assigned the task of developing a strategy for information on the quality of health services and had already released an interim report in March-10. The final report’s core strategy is enumerated in 28 recommendations, which will be needed to make information «available, trusted and insightful».

There is little doubt that the two reports have set the stage for major changes within the UK NHS, with emphasis on quality and accountability through the use of IT. The White Paper has been quite controversial in the UK, as should be expected for any such broad-reaching and politically-charged document. However, on the subject of IT involvement, all parties seem to agree that the proposed changes are on the right direction, although elaboration on specific measures will be required. This is also recognised by the government itself that announced the start of an extensive dialogue, with the Department of Health publishing consultation documents in the coming weeks to seek views on more detailed proposals. The eHealth community has already expressed support for the proposed approach and there are strong indications that the consultation process will provide meaningful results on tangible measures to be adopted for furthering the quality of the provided services.

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