Management by Press Release

The Secretary of State for Health and Care seems to have taken over direct management of NHS England with a new technique: MBPR or Management By Press Release.

Discovering that the NHS is the last major organization to be using fax machines, he issued a press release on 9th December to ban them. GPs then explained that faxes were necessary because they cannot be hacked and are more reliable that the NHS IT email systems that cannot communicate with each other. No problem, a further press release set out a shiny new IT system: “The future of healthcare sets out the government's vision for digital, data and technology in health and care and outlines what is needed to enable the health and care system to make the best use of technology to support preventative, predictive and personalised care.”

Well this all appears new and shiny, ambitious NHS IT plans should ring alarm bells. Billions have been wasted on them in the past. “Back in 2013 then health secretary Jeremy Hunt, who left the department this week, said he wanted the health service to be paperless by 2018.”

A total NHS IT revamp deserves considered thought, not least about why previous ones were disasters.  Consultation is necessary and the DHSC wasted no time. The press release was issued at 12.22pm on [Friday] 28 December 2018 along with the consultative questionnaire: “Please provide comments and feedback on the vision in this questionnaire - it will close to responses on Monday 31 December 2018

Yes. You read that right. Today.

Naturally we are all at our desks during the post-Christmas weekend. And the vision is not just for a national NHS IT system but one to be used worldwide. With no knowledge of overseas health IT needs, or present systems, and a track record of nothing but disasters at home, the DHSC will design a “Global Digital Exemplar”.

The questionnaire itself is as unworldly as the timetable for its completion, reflecting the mindset of the authors, not reality. The second question, for example, reads:

“We have set out the guiding principles we should operate by: user need, privacy and security, interoperability and openness, and inclusion. We have also articulated our architectural principles:

  • put our tools in modern browsers

  • internet first

  • public cloud first

  • build a data layer with registers and APIs

  • adopt the best cyber security standards and

  • separate the layers of our patient record stack: hosting, data and digital services.

What do we need to take into account when applying these principles to different parts of the health and social care system?”

According to the 28 December press release: “The changes will free up staff time and reduce delays by allowing seamless, digitised flows of information between GP practices, hospitals and social care settings.” The current problems have been created by the DHSC’s refusal to use the email used by the rest of the world and insistence on different providers re-inventing email systems of their own. The given reason is confidentiality but that is, to quote a senior GP, a “smokescreen”. Private medicine in the UK uses standard email with special arrangements to cover confidentiality as does health systems overseas and large organisations worldwide – even Whitehall.

The same senior GP wrote: “the current Byzantine e-mail arrangements mean that we have to copy and paste all outgoing and incoming e-mail correspondence (plus details of sender, recipient, time etc) by hand into a text box, a time consuming process which results in the e-mails being stored in the clinical journal (i.e. as medical notes), not in the correspondence section of the clinical record. To add to this irritation, hospitals, laboratories etc insist on using just one "generic" e-mail address per practice rather than sending e-mails to individual clinicians, meaning that a member of staff has to waste time logging into the generic mailbox on a periodic basis then redirecting e-mails, whose receipt by their intended recipient can therefore be delayed substantially.”  

For many conditions, notably cancer, the speed of these communications is crucial. The DHSC could implement its NHS internal communications vision at a stroke by simply insisting on the sole use of standard email.  The last thing we need is a new generation of email reinventions that claim to speak the same language but fail to do so.

The overall IT problem is not so much that the DHSC does not know what it is talking about but that it thinks it does.  At the ministerial level, the requirements should simple enough, not much more than:

  • Shared data storage

  • Ensuring only those entitled to data access can have it.

  • Cybersecurity

There is nothing anywhere in this “vision” about learning from the private medical or care sectors in the UK or in other countries or from other large modern organisations. There is nothing about timetables or costs. The “vision”, or rather phantasmagoria, has all the hallmarks of many more billions down the drain.

These “visions” and press releases, intended to give the impression that progress is being made, have the opposite effect after even the most cursory glance.

We employ, at no little expense, a CEO for NHS England.  In the real world, CEOs run their businesses, they make realistic plans and they deliver them. The Secretary of State should set the broad targets, the funding and the timetable for their achievement. He should clarify what England expects, let Mr Stevens do that or find another.

MBPR not only makes the CEO redundant but also removes the responsibilities of the Secretary of State and his department. The ideas, visions and plans for NHS England should come from its CEO. The Chairman, and then the Secretary of State, should be ensuring that they are not just realistic but the best they can be. Because it usurps the role of the CEO, MBPR can only give the illusion of improvement. In the case NHS IT, the damage may be far greater.