pestle 2Political

There is a new Secretary of State in place, Jeremy Hunt, who appears determined to ‘pick a fight’ with the medical profession over, by-and-large, productivity.  A new contract appears likely.  Remember that GPs are not employees of the NHS, unlike hospital doctors, who are.  Productivity continues to fall in the NHS (or, at best, stagnate).

The new CEO of the NHS, Simon Stevens, has also recently been appointed.  He is perceived as an ‘outsider’ and this is a clear signal to the NHS that large-scale change is required.

Commissioning Support Units (CSU’s) are to be ‘externalised’ by 2016.  The IT industry could play a major role in this large-scale outsourcing activity.

Caldicott 2 emphasises the sharing of patient data1.


Whilst the UK economy is growing relatively strongly, there is a public sector lag.  This means that the recession will continue, or increase, as far as public services are concerned for several years yet.  The only game in town at the moment for NHS Trusts is saving money, i.e. cash-releasing activities that address the bottom line.  Upwards of 30 NHS Trusts are, or very close to being, bankrupt.  This means they will require ‘bailing out’ from central government within 12-18 months.  Mergers will increase, as will sharing services.


The ‘Winter A+E crisis’ is a good example of the vulnerability of the NHS to systemic shocks.  Hospitals desperately need to keep patients away in order to avoid breaching waiting time targets.  At the same time, they lose money if they treat fewer patients.  This ‘catch 22’ situation could be addressed by changing the financial model to reward new pathways of care and reduction in re-admissions, etc.  Such ‘care co-ordination’ is a major theme of  global healthcare strategy, but isn’t mature in the UK context yet.

There is still a need to combine financial, administrative and clinical information across organisations.  This could represent at ‘big data’ opportunity for the IT industry.


Business intelligence is woeful in the NHS.  HSCIC has produced a tool to help Trusts recognise where they are on the journey to a ‘paperless’ NHS’, called the Clinical Digital Maturity Index (CDMI)2.  This will be the metric used to assess progress.  Interoperability is essential, and the IT industry must ensure integration, for example, via the Medical Information Gateway (MIG), as well as meeting all ITK standards, etc.

Simplistically, clinicians must be able to view the patient’s record across organisational and technical boundaries.


How can the IT industry help beleaguered Trusts manage their burdensome regulatory compliance?  Many Foundation Trusts are close to breaching their licenses to operate.  The Keogh Review3 has indentified a dozen or so Trusts requiring ‘special measures’.  How will IT solutions and services help?


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.  Telehealth could help, but there is little appetite amongst doctors.

Outsourcing: IT departments in hospitals are often low-status and variable quality.  There is the opportunity for the provision of high-quality, reliable, modern IT facilities, especially in ‘cloud computing’ environment.  The ‘cloud’ could probably host all the NHS’s IT requirements!


  1. Caldicott review: information governance in the health and care system
  2. CDMI
  3. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report

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