The future focus for IT in the NHS will be less about installing information systems and more about delivering information services, writes Dr Gwyn Thomas

The past few months have been a watershed for NHS Information and Communication Technology (ICT) - beginning with the Wanless Report on NHS funding, which recommended sustained corporate investment for NHS ICT, continuing with increased investment announced in the 2002 Budget and concluding with a shift in emphasis in the way ICT is to be implemented across the NHS.

In future the focus will be less about installing information systems and much more about delivering information services which support patients and clinicians to make decisions. This is the fundamental proposition set out by the Department of Health in the document, Delivering 21st Century ICT - Supporting the NHS, which describes how we will support the aim of the NHS Plan - which is to provide improved patient care. It is not a brand new information strategy but a change in direction that defines a national ICT implementation programme that is based on corporate delivery. The NHS is committed to taking a whole-system approach. This begins with integrating the delivery of more bandwidth for the NHS network and providing national services for electronic care records, electronic bookings and electronic prescriptions.

The work that the NHS Information Authority has already been doing to develop more cohesive relationships with national and local NHS organisations and to form strategic partnerships with industry and other NHS bodies will form a sound platform for the future. We are working closely with industry to introduce a new way of ICT procurement, based around strategic partnerships. We believe this will increase the speed of delivery and implementation.

The new approach to procurement will involve a small number of Prime Service Providers (PSPs) who will sub-contract and manage specialist services, provided by a wide range of small and large IT suppliers. Central guidance will ensure compliance to standards with audit, service delivery and performance playing crucial roles in the definition of contracts. The current programme of industry forums managed by the Information Authority will continue and will encourage PSPs to invest in development of the suppliers. It is also likely that we will set up exemplar sites to establish feasibilities and to create development resources related to national services for use by product providers.

Development of the new procurement strategy is of particular importance for the development of the "Integrated Clinical Records Service" (ICRS), which will involve a continuously expanding portfolio of services to meet the generation, access and development of records. An outline description of the standards and specifications for the ICRS has recently been published for consultation (see www.doh.gov.uk/nhsexipu). During the past few months the Information Authority has carried out some preliminary work in this area through its Health Record Infrastructure Programme (HRI), which will provide new services based on web technology.

HRI will link together existing computer systems, holding patient information. Details will be retrieved to form a virtual record of the NHS care and treatment each patient receives. The new service will integrate locally held data and keep the amount of information held nationally on central databases to a minimum.

It's easy to think of NHS information and communication technology as the equipment, wires and computers that sit on people's desks. But it is much wider than that. NHS ICT is shorthand for wide-ranging organisational and cultural change, which will support all health service professionals and make possible better patient care. It is the critical enabler for the fundamental changes that the NHS is seeking to introduce and its success will depend on how well we support and help frontline NHS staff to use ICT to change working practices that improve patient care. In an important first step, later this year, all NHS staff will have free access to training in basic ICT skills. Regardless of a person's job within the NHS, they will be able to take part in training leading towards the European Computer Driving Licence award. Another example of the benefits of staff training has been demonstrated by our Primary Care Information Services (PRIMIS) programme. PRIMIS is helping primary care organisations to improve patient care through the effective use of their clinical computer systems. It offers guidance, training and support, analysis of data quality and feedback to help GPs and primary care providers understand how they can use data to improve services and has been very well received by clinical staff.

Technology solutions are essential to support the modernisation process, but only if they are implemented with a strategic education and training programme. If we can use information and technology effectively to support clinical priorities and care we can make real progress towards delivering NHS services that are more responsive to the people who use them. In other words, easier access, increased choice, shorter waiting times, higher clinical standards - all of which contribute to better patient care and experience.

While the Information Authority is mainly responsible for information, communication and technology solutions for the NHS, it is vital that we actively seek partnerships with patients and citizens so that their views can shape service development. Working closely with NHS Direct we have established a Patients' Reference Group, which will provide a pool of people to take part in consultations, surveys and focus groups and test out products and services.

The starting point for the new ICT programme begins in April 2003. In the meantime the NHS Information Authority is working with other partners to develop the details of the National Programme. However we already provide many essential operational services, such as the NHS network, the NHS Strategic Tracing Service, systems to support GP payments and preventative screening programmes, clinical information and clinical terminology services and it is important that we maintain the quality of those national services during this period of significant organisational change in the NHS.

Current improvements in these services includes setting up a new national email and directory service, that will provide every member of staff within the NHS with their own, personal email address, based on their name. For example, john.smith@nhs.net. Staff at a number of early adopter sites will begin using a trial version of the new service from September, leading to national implementation of the service starting in 2003.

Personally I have been heartened by the sea change in attitude towards the use of ICT within the NHS, and pleased that many of the components of our existing work feature strongly in the new programme and reflect the four key aims of the NHS Information Authority:

The NHS is about to embark on an ambitious programme to change the way in which ICT is implemented and we all have to recognise the scale and complexity of the task. It is one of the largest single ICT programmes in the world and will deliver a major piece of public services infrastructure that will become as important to people in the future as roads and railways are now.

Case study one:

The Blood Stocks Management Scheme

The Blood Stocks Management Scheme (BSMS) was launched on April 2nd 2001. The Scheme is a partnership venture between the National Blood Service (NBS) and participating hospitals. It has been established to promote better practice in the management of blood stocks throughout the NHS. Registration is voluntary for hospitals, all NBS centres were registered from implementation. Two hundred hospitals were registered by July 31 2002, accounting for 75 per cent of red cell issues.

The scheme is unique and leading edge and utilises a web based data management system that facilitates communication of both data inputs and feedback reports to participants. The innovative use of the data management system was recognised in the 2002 Health Care Effectiveness awards (in conjunction with the British Journal of Healthcare Computing and Information Management) , in which it was "highly commended" by the judges.

Each hospital submits daily non-reserved red cell stock levels and monthly red cell wastage to the BSMS data management system using the web - or a paper based reporting system if web access is not available on site. NBS information is automatically fed in through the NBS IT system.

Data extraction facilities allow "real time" data analysis and feedback through a variety of graphical displays. This powerful tool has encouraged hospitals and the NBS to make changes to their practice, leading to more effective management of a valuable resource.The BSMS has its own website that includes an online user guide, online registration and a discussion forum as well as access to the secure data management area.

Judith Chapman, Scheme Manager

www.bloodstocks.co.uk