It’s no mean feat that the National Information Board has secured more than £4bn of funding to transform data, technology and transparency over the next few years.
Also, importantly, but perhaps overlooked, is that by reporting directly to the Five Year Forward View programme board, the governance is in place to make sure this money is well spent and targeted at delivering new care models and not just used to develop new ways to do old things.
However, to date, the technology leadership has, in my opinion, been too inward focused, and needs to spend more time working out what needs to be delivered centrally, at the public purse’s expense, and where markets can be created or stimulated to let the private sector, at our R&D cost, do some of the heavy lifting.
Some work programmes are planned that can simply stop being done more than once and there are others that simply don’t need to be done at all by the public sector. The funding, whilst not insignificant, can’t and won’t enable us to do everything. There are three areas at least, where a little bit of letting go can make the money go even further.
The first, whilst perhaps geeky, might lead to significant cash release. Since the pause on care.data and the need to link data across health and care – crucial to the 5YFV, yet hard to achieve safely and legally – there has been a need to ‘scramble’ identifiable data but allow care professionals to know who the patients are.
For example, a local authority might identify that patients from a particular care home have usually high rates of unplanned admissions to hospital, and the GP would want to know exactly who these patients are to see if these were preventable.
There is a currently a “space race” to develop this solution, known as pseudonymisation at source, with the Health and Social Care Information Centre, certain Commissioning Support Units and a number of private sector suppliers all trying to develop solutions. As a taxpayer I would ask why, if the private sector is working on this problem, at their cost, two parts of government are also spending money.
Let’s let the private sector people compete and adopt the best solution. Also, most of them have a delivery timetable well ahead of the HSCIC’s. Added to these benefits, some of these private suppliers have said they will put their tool into open source one it’s proven and are not seeking income to provide it.
I’m sure if HSJ asked HSCIC to comment on this duplication, a reply would come back about special issues around privacy and governance. The HSCIC has a body, the confidential advisory group, to advise on whether these suppliers have got it right, plus help as well from the Information Commissioners Office. They, like a beaten presidential candidate, should withdraw from this race, and pressure should be put on CSUs to do the same.
Secondly, there is the plethora of data websites. There are certain pieces of data I can find published at least five times across the government estate, on NHS Choices, on My NHS, on the HSCIC indicator portal, in the NHS England data catalogue and on the CQC intelligent monitoring site
The government is now the monopoly supplier of transparency when it comes to health data
To make matters worse, I am only 99 per cent sure this is the same piece of data as these organisations have varying degrees of laxity when it comes to meta data so they are not all uniform. We’re also soon to get a sixth site with similar data measuring Carter review priorities.
I’m all for transparency, but surely some decluttering could take place here, streamlining strategy, and more importantly development cost. An unintended consequence of some of this activity means that with the exception of Which? Birth Choice pretty much every other publisher of health data has withdrawn from the market. The government is now the monopoly supplier of transparency when it comes to health data.
Upwards and sideways
Funding released from this website rationalisation could be spent on sustainable stimulating of this market through making more data available and helping patient groups and other interested parties to publish it.
Thirdly, there is the role of the commissioning support units themselves, who (not just in the example above) are competing with themselves, “upwards’ with HSCIC and “sideways” with the private sector to deliver (and sell), analytics, methodology development and access to data. Perhaps in this example, there should be some regulation to with HSCIC outsourcing or working with them rather than similar objectives being pursued by two different public sector-backed organisations.
There is no doubt that there are certain areas where central government needs to deliver: standards, interoperability, consistent use of the NHS number, infrastructure and a website such as My NHS are just some examples. But a little bit of house keeping, a little bit of bravery and little bit of trust in the mixed economy will ensure the £4bn is well spent.