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Far from free


Blog headlines

  • Reflections on a ‘new’ NHS and its impact on general practice
    10 September 2021

    This week’s blog we are sharing reflections by William Greenwood on the direction for the health service and potential impact on general practice.

  • When facilitation could turn into mediation
    3 September 2021

    Requests to attend a meeting, to help find a way forward, to help with planning, to redesign a care pathway, and numerous other reasons are not always what they seem. Sometimes you will be asked to facilitate, or just asked to attend. What then happens in the room may not be the meeting that you are expecting. Other situations, such as tensions between practices, departments or teams may give a more obvious sign that what is needed goes beyond just attending or facilitating a little.

  • Population Health Management?
    26 August 2021

    One of the frequently heard phrases of the moment is population health management – but what is it and does it work. The blog is from a longer article by Monica Duncan exploring the topic.

  • The future must be primary care
    19 August 2021

    The blog this week is by Professor David Colin-Thomé, chair of PCC.

  • Preparing for winter 2021/22
    13 August 2021

    One of the hottest days of the year saw people from practices, primary care networks (PCNs) and federations gather to start to think creatively about managing their winter pressures in this session hosted by PCC and the NHS Confederation PCN Network.

  • Building the collaboration
    5 August 2021

    Prior to COVID-19 primary care network (PCN) community pharmacy leads (representing a group of pharmacy contractors in their locality) were starting to contact the clinical director for their allocated PCN to discuss how pharmacy services could develop and adapt to help address community health needs.

  • Audit into action… with a pandemic thrown into the mix!
    29 July 2021

    A blog from the Clinical Leads for the National Audit of Care at the End of Life (NACEL).

  • GP partnership uses new video to highlight benefits of its merger-led transformation
    23 July 2021

    An East Cheshire-based GP practice, the Middlewood Partnership, which formally merged in order to successfully transform its clinical and business models, is sharing insights, via a new video, with colleagues across the health and social care sector.

  • Early evaluation of the Children and Young People’s Mental Health Trailblazer
    15 July 2021

    The Birmingham, RAND and Cambridge Evaluation Centre (BRACE) is funded by the National Institute for Health Research to conduct rapid evaluation of promising new services and innovations in health and social care. The BRACE Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit have published findings from the early evaluation of the Children and Young People’s Mental Health Trailblazer programme.

  • Learn from reflection
    8 July 2021

    We are sharing an article by Helen Northall, chief executive, PCC this week on learning from reflection.

  • Link of the week: National Thank You Day
    1 July 2021

    This week we are featuring National Thank You Day.

  • North East Essex integrated discharge single point of access - implementing the Coronavirus Act 2020 and Covid-19 hospital discharge service requirements
    24 June 2021

    The blog this week is from Frank Sims, chief executive of Anglian Community Enterprise and shares learning on collaboration and redesign to support hospital discharge.

  • Helping your patients making an informed choice: Medical or Surgical abortion?
    17 June 2021

    This week the blog has been submitted by MSI Reproductive Choices UK and is about supporting patients to make an informed choice based on NICE guidance.

  • The potential for case finding patients with cardiovascular disease in a dental setting
    10 June 2021

    The blog this week is by Wendy Crew, PCC adviser, considering the opportunity to case find patients with cardiovascular disease in a dental setting.

  • Using population health data to inform ARRS recruitment
    3 June 2021

    Funding for the additional role reimbursement scheme (ARRS) has increased nationally from £430m (2020-21) to £746m max. (2021-22) with an allocation available for each primary care network (PCN) depending on the size of the population it covers. Clinical commissioning groups (CCGs) draw down the funds but only as new roles are recruited within PCNs. PCNs are therefore being strongly encouraged to make use of their ARRS allocation to ensure people in their neighbourhoods benefit from the funding available.

  • SHAPE Atlas mapping tool
    27 May 2021

    As the themes of the NHS Long Term Plan start to become reality through plans for legislation to support integration, we need to work out where the best place is to deliver services.

  • Cancer Care Map
    20 May 2021

    The blog this week has been submitted by Robin Pritchard, co-director of Cancer Care Map. Cancer Care Map is a stand-alone, comprehensive, independent, free to use online directory of cancer support services in the UK providing verified and trusted information, regularly checked and updated and accessible to all.

  • Understanding and aligning link worker and community capacity building activity: A place-based approach in York and Wakefield
    13 May 2021

    The blog this week is by Sian Lockwood, chief executive officer of Community Catalysts.

  • Virtual group consultations and Why skip/send it to landfill?
    6 May 2021

    An article on group consultations that celebrates the patient perspective and experiences of receiving care this way from Alison Manson. Blog on reusing/recycling and saving money for a NHS Trust from Alex Ford.

  • Experience of Care Week
    30 April 2021

    This week we celebrate Experience of Care week which is an international initiative, which runs from 26 - 30 April, to celebrate the work that is happening across health and social care to keep improving experiences of care for patients, families, carers and staff. PCC governing body member Lesley Goodburn explains more below.

Friday, 13 November 2015

Far from free

The NHS will not be paperless in 2020. This is not a cynical assertion, but common sense. One clue is the flurry of new guidance on the subject, where “less” (negative) has been replaced with “free” (positive). Way to go, comms team. The guidance – and if you haven’t had yours yet, don’t worry there will be something for everyone – tells us that this is a distributed programme. Not devolved or co-ordinated but distributed, literally all over the place. That’s the first problem.

The second, of course, is the money.

Let’s get the most amusing of these issues out of the way: the guidance. NHS providers will need to complete a “digital maturity self-assessment” by next January. The point of this exercise is to “support planning and prioritising of investment decisions within commissioner-led footprints to move local health and care economies towards operating paper-free” and to “provide a means of baselining/benchmarking nationally the current ability of providers to operate paper-free”.

There’s a lot more in the jargon-rich 19-page document issued by the National Information Board about baselining, identifying gaps and capabilities, and supporting investment decisions – enough to tell you that no one has a clue what to do.

Anyone worried that digital maturity self-assessment is just a form-filling exercise will be reassured to know that there will be several parallel form-filling exercises to assess the self-assessments. CCGs are under orders to produce “local digital roadmaps” and from 2018 “digital maturity [will] play a role in the CQC’s inspection regime”.  

The sheer multi-agency collaborative thickness of the project tells you that it won’t be long before it is crushed to death by its own weight.

Meanwhile, somewhere in South America a forest the size of Wales is being cleared to make way for all of the baselining documents, roadmaps and inspection reports.

So much for the project management, now let’s talk about money. Mr Hunt’s enthusiasm for paperlessness is based on a 2014 McKinsey report that identified £13.7bn in potential savings from better NHS IT by 2020.

That’s a lot of money, about a third of the projected £30bn shortfall. But the same report also estimates that it would take £8.3bn in new investment to make the saving. Where will this cash come from? Not from commissioners, whose budgets are being cut, nor from providers whose income is being squeezed to produce unfeasible efficiencies. And not from the Treasury unless someone has a plan to spend every penny of the £8bn of extra NHS funding pledged at election time on computers.

The efficiencies we’re seeking from a digitally mature NHS are not cheap and certainly not free. Expect much hollow laughter from directors of finance when it comes to filling in the section on investment decisions.

One man who took a bold investment decision was Keith McNeil, under whose command Addenbrooke’s made a 10-year commitment to spend £200m on a digital patient records system. (This decision almost certainly contributed to Dr McNeil’s departure from Addenbrooke’s, because Monitor already had a beady eye on the hospital’s finances before the CQC report which administered the fatal blow.)

According to one report, the Addenbrook’s system saves £270,000 a quarter by making better use of resources and a further £77,000 a year on paper costs. “This could well be the sort of argument the government uses to justify a paperless NHS”, the article concludes. But get your calculator out and check how many years it would take to get a return on investment based on these figures.

Even so, Dr McNeil was clear that the system was “absolutely the right thing to do” and that it cost no more “than we would have had to spend to keep a broken system running over the next 10 years”.

Therein lies Mr Hunt’s dilemma: the enormous cost of running the NHS on broken systems versus the enormous cost of doing something about it – a damned if you do and if you don’t problem on a multibillion pound scale.

Without the money, the paperless NHS won’t happen. That will mean some injured ministerial pride and some dramatic goalpost-moving before the end of the parliament, but it could be worse. According to research, 68% of IT projects fail and half of these failures are classified as “runaways”, defined as having at least two of the following characteristics: going 180% over time, 160% over budget or falling short of functional expectations by 70%.

One more statistic is worth noting, which is that 17% of big IT projects are so catastrophic that they threaten the existence of the organisation. That figure comes from a McKinsey report too, but probably not one that Mr Hunt has read.

So thanks to his colleague Mr Osborne, Mr Hunt will be denied the chance of a heroic failure. What he has to look forward to instead is just another unmet target.  

Digital editor: NHS Networks 


Harry Longman
Harry Longman says:
Nov 13, 2015 01:03 PM

You are so kind to ministers, hinting they should shuffle goalposts now rather than face them being bulldozed in 4 years time. Sweet.

Julian Patterson
Julian Patterson says:
Nov 13, 2015 01:13 PM

Harry, you may be aware that today is World Kindness Day, so I think of it as doing my bit.

Sam Toms
Sam Toms says:
Nov 13, 2015 01:48 PM

Working on IT related projects, I could be accused of bias - but labeling such investments as IT projects in the first instance could be part of the problem?

For fun, try asking an IT system vendor what they mean by the phrase "Smoothing the patient pathway" that has been plastered all over their sales literature.

Julian Patterson
Julian Patterson says:
Nov 13, 2015 02:25 PM

Love it. There's a bulldozer theme developing here.

trevor jenkins
trevor jenkins says:
Nov 13, 2015 04:10 PM

World Kindness Day. That's WKD. Being easily influenced by TV adverts that interprets up as something other than kindness for me. Isn't "bulldozer theme" a module in the standard NHS Management Technique Handbook?

Julian Patterson
Julian Patterson says:
Nov 13, 2015 07:07 PM

I had no idea you were an alcopops man, Trevor. Perhaps the advertisers need to rethink their demographic.