There is a relatively new, coalition Government in the UK with a commitment to cut public spending. Therefore, large-scale contracts are being renegotiated to reduce cost and hence scope. There have been recent highly-critical Public Account Committee hearings (group of MPs who are responsible for the value-for-money of public expenditure).
CSC has a new ‘Letter of Intent’ and an expectation of a new contract by the end of March. Notwithstanding, the future of CFH is in doubt, so who will be the customer? Will it be the Department of Health/new ‘clusters’ of Clinical Commissioning Groups (CCG’s)/Commissioning Support Organisations (CSO’s)/individual Trusts? How do we get closer to the customer? One way is through collaboration with existing health service providers such as HIS’s. For example, ‘The Health Informatics Service (THIS)’, based at Calderdale and Huddersfield NHSFT is interested in partnering with CSC in some way, but is also talking to other private sector organisations. THIS is not sure how to progress, e.g. remain part of an NHS Trust, become a Social Enterprise Organisation, etc. It is likely that the emphasis on ‘Shared Services’ by the Government will mean IT services will increasingly be provided across several organisations of several million people. THIS estimates that the spend on IT per citizen will be about £1-£1.50 maximum. Strategic Health Authorities (or their successors) ‘will welcome’ joint bids from public/private partnerships.
Doctors are ‘being put in charge’ according to the Health and Social Care Bill. One way this is manifested is through ‘Medical Senates’. These are ‘think tanks’ of local clinicians who will provide thought-leadership to CEO’s of CCG/CSO’s. How do we influence these?
The Economic context
The economy in Europe is one of low-growth/recession for the foreseeable future. Thus, there may be less appetite for large Government IT contracts. On the other hand, IT is seen by many as a way of producing efficiency savings. The imminent ‘Information Strategy’ from the DH is likely to stress this. All Trusts in the UK are struggling to control costs. It is estimated that the total health IT spend in England will reach £3 billion by 2016, a 12% increase from 2010 levels. (1)
Many Trusts have ageing ‘legacy’ systems and these will need to be replaced at some point. Therefore, there is huge, potential demand for modern systems.
The Sociological context
In the ‘West’, these are well-rehearsed, e.g. an ageing population, increase in long-term conditions, e.g. diabetes, obesity, and overlap with social care, e.g. Alzheimer’s disease. There is an overwhelming desire to provide ‘integrated’ care. This means the integration of care delivery, i.e. co-ordination of care, home and self-care, efficient scheduling of care, etc. Multi-resource scheduling, eg. Ultragenda, could play an important part here.
There is a need to solve genuine healthcare business problems, such as, integration of services across organisational boundaries, including social care. The US model of ‘Accountable Care’ organisations is being scrutinised in the UK as a potential model. Can we leverage US expertise in Health Information Exchanges in this context? A crucial aspect is how individual providers will be rewarded for their contribution to patient care. The current ‘Payment by Results’ system will need to be altered to accommodate patients being treated in the community. There is a clear need to combine financial, administrative and clinical information across organisations.
The Technology context:
Portals (dynamic, federated integration) are potentially a relatively easy and rapid solution, without the need for large data repositories, (e.g. Clinical Portal), and can provide simple access for patients (as well as clinicians) – another Government priority. However, there is also a universal desire to develop much better Business Intelligence (BI), which almost certainly does require a data repository of some sort to allow analysis and manipulation of data. BI is needed at patient level in order, for example, to optimise a patient’s medication. It is also needed at group level, for risk stratification. This allows targeting of high-risk groups for intervention. At organisation level is the need to streamlining of processes and comparing performance and productivity of individual clinicians. This is highly relevant, for example, in primary care to compare referral rates by individuals GP’s (so-called ‘micro-commissioning’), and at hospital level, to provide information for clinician revalidation.
At Trust Board level, so-called ‘Quality Accounts’ are mandatory for Trusts, in much the same way as Financial Accounts are already. Being able to provide automatic reports for such accounts would be a differentiator for a BI provider. Business intelligence will become increasingly important, as a higher-margin, value-adding proposition. Other IT advances, e.g. assistive-living technologies, telemedicine/health and genomics/proteomics are beginning to move from pilot to mainstream.
The Legal context:
In the UK, DH directives carry the weight of statute. Clinical safety directives and medical device legislation will impact on our solutions, and also offer the opportunity for selling consultancy.
Healthcare regulators, such as Monitor and the Care Quality Commission, are requiring more and more information to license providers.
The Environmental context:
The ‘Green’ IT agenda has been adopted by the UK Government. This includes, political imperatives e.g. QIPP, some of which can only be achieved electronically, others which would be extremely difficult to do without electronic systems. Document management, e.g. ePF, would save paper and space, mobile solutions, and telemedicine, eg eMEDlink.
Outsourcing: IT departments in hospitals are often low-status and variable quality. HIS have developed but often experience similar problems. There is the opportunity for the provision of high-quality, reliable, modern IT facilities, especially in ‘cloud computing’ environment. CSC’s Health Cloud is a great example and could probably host all the NHS’s IT requirements! However, its continuance is under threat as it is not being utilised at the moment.