Jeremy Hunt spoke exclusively with Victoria Vaughan, Management in Practice’s editor-in-chief about communication and technology in the ‘new NHS’
The new Secretary of State for Health is, even for a politician, something of a communications expert. Before politics Jeremy Hunt travelled to Tokyo to learn to speak Japanese and he worked at public relations company, Profile PR. In his former role as Secretary of State for Culture, Olympics, Media and Sport he oversaw the spread of high speed broadband. And, of course, there was that scandal over the News Corporation takeover bid for BSkyB, when it was alleged that secret communication channels had been established between Hunt, who was at that time the minister overseeing the deal, and one of Murdoch’s right-hand men (a charge he denied).
Perhaps it should not have come as a surprise, then, when he was named Andrew Lansley’s replacement in the September 2012 reshuffle. While Lansley had been the architect of the government’s current NHS reform programme, he regularly came under fire for not properly communicating the thinking behind the changes to healthcare professionals. What was needed was a smooth operator to take the heat out of the debate, while building a steady, stealthy PR campaign to win over the naysayers. On the former point, it seems, he has enjoyed some success. On the latter, there is clearly some way to go.
Hunt kicked off his charm offensive in November 2012 with the publication of the ‘NHS Mandate’. A two-year document effective from April 2013, in which the Secretary of State set out a series of objectives for NHS England, formerly the NHS Commissioning Board, it aims to be a way of removing the NHS from the daily machinations of Whitehall.
It says: “In a digital age, it is crucial that the NHS…operates…at the forefront of technology. [NHS England’s] objective is to achieve a significant increase in the use of technology to help people manage their health and care.” It goes on to say that the Government expects that by March 2015: everyone will be able to get online access to their own health records, order a repeat prescription and book a GP appointment online. In February, at a lecture delivered at think tank Policy Exchange he went further. “I want [the NHS] to become paperless by 2018. The most modern digital health service in the world.”
Speaking exclusively to Management in Practice, he explains why he would succeed where others had failed. “We cannot afford for it not to work. Connecting for Health was a disaster, but not a disaster for what it was trying to achieve,” he says. “It was a disaster because of the way it was implemented; it was implemented as a small number of national IT projects which became stratified, over-specified and over-specified again, so they became the NHS’s equivalent of building an aircraft carrier.
“We need to go about this from the bottom-up. There has been no controlling brain in Whitehall that has said, ‘Your iPhone must be able to talk to my BlackBerry and this is how it is going to happen.’ If they tried to do that, probably we would find that your iPhone did not talk to my BlackBerry, but actually they do talk to each other because people have just worked out common protocols and it happens. That is what we need to do with digital patient records.”
But what about the cost? The ‘paperless challenge’ is a tall order for practices, already under financial pressure. “Obviously, I hope that happens everywhere. But if it does not the cost will be to GPs, because it will save them a great deal of money and mean that they can invest more in patient care if some of the routine processes that they or their staff spend a lot of time doing are actually dealt with electronically.”
A report from PwC commissioned by the Department of Health, A review of the potential benefits from the better use of information and technology in Health and Social Care, found that it has the potential to save £4.4 billion. But in addition to the financial incentive the benefits for patients are obvious, with their medical records accessible to clinicians across the country if they are taken ill away from home or in an accident. For practices, being able to get rid of vast stores of Lloyd George envelopes could free up another consultation room, time could be saved on typing up information to share with colleagues.
However there are always drawbacks and one was highlighted by a pilot in a South London practice where staff found that patients with access to their records constantly wanted them amended, leading to a significant admin burden. Such problems will need to be ironed out. Another concern surrounding the security and confidentiality of online patient records. Something which may be addressed following Dame Fiona Caldicott’s review on Information Governance. It looked at the balance between sharing personal information and protecting individuals’ confidentiality in relation to improving health and social care. It has been delivered to Hunt and a response is expected this Spring.
Another key part of the of technology in the NHS is telehealth and part of this is the new signposting telephone service called ‘NHS 111’ which was set to replace NHS Direct in April. Lay people trained in special diagnostic software will answer calls and, where necessary, refer calls to a 111 clinician or another service. The role-out of NHS 111 has reportedly been delayed in 17 out of 47 regions (which affects 53% of England) and there have been problems with long call wait times and GP out-of-hours services having to take over.
Hunt is standing by the project. “The concept behind 111 is very important because we need to find alternatives to A&E for people that do not have to go into A&E. We have got one million more people going through A&E every year than we did two years ago.” He says the reason for this increase was the aging population but also “because GP surgeries are not open in the evenings and weekends and the standard of out of hours care is frankly not high enough.”
“We need to find alternatives and 111 is a way that we can do that, but we need to implement it at a pace that the system can manage and there will be many places where it happens faster and places where it happens slower.”
But Hunt also understands that while technology is important “it can never replace human interaction”. As was demonstrated by the announcement that the “Department of Health will become the first department where every civil servant will gain real and extensive experience of the frontline.”
That means ministers, too. “I have started doing some work experience. I am not divulging when or where because I do not want this to be a media fest. This is about me getting out and talking to people on the front line and I am happy to go out most weeks and do something on the front line. So far, I have found it incredibly useful.”
The Health Secretary has not been to any GP practices yet as part of this programme but it is only a matter of tine before some of you will be able to communicate your thoughts directly to him.