Integrated Patient Care and the NHS

From time to time we will look at healthcare IT environments from around the world to see how different countries approach healthcare technology challenges. Below is the first in a series of guest posts on the English NHS from contributor Colin Jervis.

Integrated patient care has been a goal for at least a decade. Twenty years ago, when I worked for the NHS as an employee leading a large ICT programme, I remember trying to catalyse co-operation between an acute trust and social care to help the early discharge of “bed blockers.”

My efforts came to nothing – as did attempts to give a local GP access to the patient administration system I had implemented – though that was probably owing to the slowness

of modem access rather than any organisational mismatch.

Now the NHS struggles to become more efficient at the unprecedented rate of 4-5 percent a year. Even greater economies are forced on local authorities, which manage social care, with savings of 20 percent or more being common. This fiscal pressure has warmed the glacial pace at which the integration of NHS and social care has progressed.

Economic pressures are only one factor in the quest for efficiency. Patients with long-term conditions live in a triangle between social, primary and secondary care -participants in a game of pass-the-patient from which they escape through the front door of an Emergency Department to an expensive stay in an acute hospital bed. Until now there has been no clear lead for these patients’ care – though there are now plans to make their GP accountable.

Nonetheless, the greater incidence of long-term conditions will increase demand for healthcare that it is unlikely to be met without radical change to its processes, structure and technology.

It is not clear to me that healthcare has accepted this. I have the impression the NHS thinks that it can continue with business as usual until a deus ex machina saves it.

Accordingly, the NHS turns to information and communications technology (ICT) probably because it is the last black box in town. But there is little evidence in healthcare (and elsewhere) that on its own ICT creates economies. What is needed is ICT combined with new models of care delivery -  something beyond a remix of business-as-usual.

Combining NHS, social and even third sector care, creates new challenges. These organisations have different cultures and funding models, and different approaches to the security and confidentiality of patient and client data.

The NHS has the secure N3 network and a stringent set of rules and guidelines for sharing and managing information. These are regularly self-assessed using the NHS information governance toolkit.

Is this system perfect? Definitely not. In recent years there have been many instances of patient information having been lost on storage such as computer hard drives. In addition, if you really want to know who is suffering from what in your neighborhood, sit next to your GP’s reception desk and listen in.

Local Authorities have access to GSi - a government data network with similar levels of security to N3.

Nonetheless, as usual, technology is only part of the challenge. The way it is used by staff is of equal, if not more, importance. Users can break even the most perfect system.

Nor are healthcare data restricted to traditional organisations. Search engines probably know more about your lifestyle and preferences than your doctor, and Google says that searches relating to health are the second largest category. In addition, many of us now wear computing that records our activity, what we eat, our blood pressure. All of this data is stored and probably presents a far more comprehensive picture of us than our traditional medical record.

As security and confidentiality move beyond the walls of institutions, the debate about patient data takes on a new aspect and leads to questions about risks and benefits.

What questions do you have?

Colin Jervis is an independent healthcare consultant. His book ‘Stop Saving the NHS and Start Reinventing It’ is available now. His website is, and he also posts on Twitter: @colin_jervis.