Tuesday, June 17, 2008

CfH Conference - The Information Revolution

Today I attended the annual Connecting for Health Conference for Nurses, Midwives & Healthcare Practitioners entitled "Culture Change in Professional Practice - The Information Revolution".

This years event was held at Central Hall, Westminster and was less busy and exciting than the first event I attended a couple of years ago, with less than 200 booking for the event & quite a few of them not attending (and quite a few leaving early).

Although I arrived a little late because of delays (again) on First Late Western Trains, I caught most of the welcome and introduction by Barbara Stuttle and Susan Osborne, Connecting for Health's National Clinical Leads for Nurses. They gave some standard messages about the integration of systems and current drivers in the NHS with a particular focus on providing "connected care in the community" based on risk and demographic change.

The first keynote speaker was Dame Christine Beasley, the Chief Nursing Officer at the Department of Health. She highlighted the complexity of care and listed the "achievements" of Connecting for Health - a list of figures obviously provided by one of her staff and which didn't stand up to too much scrutiny. She mentioned her visit yesterday when she had seen the "Mobile Clinical Assistant", which is basically a robust laptop which can be disinfected, in practice (see Intel , Motion Computing etc.) She highlighted safety issues, particularly related drugs and polypharmacy, and emphasised the importance of HealthSpace (which is unavailable as I write this). A final mention was made that a National Director for Nursing is to be appointed in Connecting for Health and within her organisation chart this role was seen as being fairly high level - with the "Clinical Leads" reporting to them. It will be interesting to see who is appointed to this role - and whether they make a difference in terms of engagement with the professions and to the culture of CfH.

The coffee break was followed by three "knowledge sessions". The first of these was by Gill Stollen (?sp) talking about Lorenzo development. She started from a historical perspective related to paper records - and asked for nurses to tell them what the Lorenzo releases should do. Several speakers during the day repeated this request for nurses to get involved and help to specify what the systems, which are under development, should help nurses in their practice. The thought which came to my mind was that CfH should have involved clinicians when the original specifications were drawn up five years ago & maybe they would be further along with implementation (and have more NHS staff "on board") than they have at present.

The second knowledge session was about clinical assisstive technology (which I would call telehealth) led by George MacGinnis (Assistive Technology Programme Manager, NHS Connecting for Health), who was wearing his falls monitor! This session also included Helen Rollins a community matron in Swindon. She described a program which has put blood pressure, pulse oximetry etc monitors, and scales into the homes of patients with COPD connecting to a monitoring centre. Staff at the centreare able to detect changes in patients conditions enabling intervention where needed. The examples of success, which she described, have led to further developments, with blood sugar and other monitors being connected to the system via a variety of peripherals. She also touched on the interface between health and social care - including who should be funding this work.

The next presentation was by Mike McAtominey about the new Essential IT Skills programme which has replaced the ECDL as basic IT skills training provision in the NHS and NHS Health which teaches staff about Information Governance. He did say that this was being made available to students in Universities on NHS related courses and I will have to follow this information up. I picked up a copy of the training materials, which have been developed by University Hospitals of Morecambe Bay NHS Trust, in the exhibition and will be taking a look at them when I get some time.

During the morning delegates had been encouraged to write questions on slips of paper for a panel session which convened after lunch. The panel included: Susan Osborne (National Clinical Lead for Nurses), Michael Thick (Chief Clinical Officer for Connecting for Health), Ian Cowles (Group Director NHS CRS Implementation), Marlene Winfield (National Patient Lead NHS Connecting for Health), Julie Tindale (National Clinical Lead for Midwifery) and Yvonne Pettigrew (National Clinical Lead for Allied Health Professions) with the questions being selected and put by Barbara Stuttle. The questions put to the panel touched on a variety of topics, but a cynic might suggest they had been selected to enable the panel to give their "set pieces". A question about Local Ownership and clinical engagement brought nice phrases about SHA clinical leads been "brought on board"; partnership working with social services about assisstive technology brought platitudes about shared budgets and a question about system failures and downtime - brought claims about the national spine being available 99.99% of the time.

There were various other questions but what really annoyed me about this session wasn't the fact that none of my SIX (awkward) questions was put, but that when statements were made by the panel no follow up questions or comments were allowed from the floor. Two particular statements which I wanted to respond to were a statement that everyone had the right to opt out of having a summary care record - which I believe is untrue as you have to have a record (otherwise your GP and others in the NHS will not be able to treat you) but that you can refuse consent for it to be shared - and even this is limited. One of my questions that wasn't asked was about the evaluation report on the Summary Care Record early adopter sites and its recommendation that England move to the approach being taken in Scotland and Wales to "consent to view". The other statement which I felt needed further exploration was that Connecting for Health is paying for 90% of implementation costs - if you talk to local trusts etc you get a different story where, even if they use the software products being provided by Connecting for Health, the hardware and training costs are the ones they are having difficulty in meeting.

Barbara did say to me privately that the answers to questions that were put and those that weren't will be put on the Connecting for Health web site (if & when I find them I will add a link) - and asked me to email her my concerns about the answers given - I will sent her the URL for this blog post and offer the opportunity to post a comment in response & see what response I get. The controlled format of this session and refusal to take questions or comments doesn't bode well for the new culture of openness I thought we might see after the departure of Richard Granger as Director General. It might also be a response to last weeks vote by GPs at the BMA’s annual Local Medical Committees conference expressing no confidence in the government’s ability to store electronic patient records safely, and backing calls to support patients who wish to opt-out of the Summary Care Record (SCR), and a motion calling for a halt on any further development of plans to develop Care Records Service plans.

The following speakers, to a dwindling audience, included Keith Ward from the University of Huddersfield who talked about his Nursing Documentation Project which included an examination of 10,000 nursing records and nine months of observation. He described the use of an intuitive humanist model which conflicted with the "medical" information processing model, which he saw as underpinning the development of software systems within Connecting for Health. He suggested that "algorithm approaches" are deskilling nurses and how requests for data recording, which was not relevant to nursing care amounted to "cumulative unreasonableness".

Kathy Sienko from Cerner talked about the importance of preparing the professional workforce for the digital environment and some of the vital issues which need to be addressed before systems go live.

The final speaker was Simon Eccles (National Clinical Director, Secondary Care, NHS Connecting for Health) who urged everyone to get involved and gave a first look at their new DVD which is supposed to persuade everyone of the benefits of Connecting for Health. The short versions we were shown (with lift music) will not, in my humble opinion, achieve this, but I will reserve judgement until I've had more time to review it more fully.

The conference closed with more exhortations from various of the clinical leads for everyone to get on board.

Although it was a nice opportunity to meet up with some old colleagues I left the conference feeling disheartened, and unless they are likely to change significantly I will not be attending one of these again.

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  • Thanks for your report on this, Rod (which I am multitasking reading from the conference I am at here in South Africa). What you report is hardly surprising, and shows a worrying lack of progress in engaging with the wider community.
    It is no surprise that they did not want to tackle any of your 'awkward' questions. I am not going to hold my breath on expecting to get the answers posted on CfH website or as a comment to your post.

    By Blogger Peter, at 8:27 am  

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