SHOULD THE NATIONAL HEALTH SERVICE HAVE AN INFORMATION STRATEGY?
| DOI | http://doi.org/10.1111/j.1467-9299.1994.tb00998.x |
| Author | JUSTIN KEEN |
| Published date | 01 March 1994 |
| Date | 01 March 1994 |
SHOULD THE NATIONAL HEALTH SERVICE
HAVE
AN INFORMATION STRATEGY?
JUSTIN KEEN
The National Health Service
(NHS)
Review committed the
NHS
to the development
of
sophisticated information management processes and
to
the creation
of
a
massive
information technology infrastructure, and the success
of
the new arrangements depends
critically upon progress in these two areas. Yet the
NHS
has a modest track record in
both, which the period since the review has served only to highlight. The article examines
the political environment
in
which information is exchanged and technology imple-
mented,
in
order to explain the current state
of
play and the likely pace and direction
of future developments. In particular it focuses upon the role
of
the
NHS
Management
Executive
in
influencing these developments, and argues that success will depend on the
extent to which national information policies encourage collaboration between key
groups
of
managers and professionals and support the implementation
of
contracts for
health services.
INTRODUCTION
Information, once
a
marginal policy issue in the National Health Service
(NHS),
is
now
centre stage. The success of the provider market and other aspects of
the new arrangements depend on good information; and in practice this means
that success also depends on implementing and using information and communi-
cation technologies
(Ins).
The
NHS
has only a modest track record in this area,
and the turbulent backdrop of the reforms means that the way forward is difficult
to predict. It would therefore seem important for the
NHS
Management Executive
(ME)
to develop an information strategy, and indeed it has done just that, having
published its Information Management and Technology
(IM&T)
Strategy at the
end
of
1992.
But
in
a
service with increasingly autonomous players, how
successfully can
a
centrally driven strategy influence events on the ground?
The article examines the political issues likely to influence the success of the
strategy, principally through effects on hospitals.
As
elsewhere in the public
sector, the relationship between the centre and periphery
of
the
NHS
has been
Justin Keen is
a
Research Fellow in the Health Economics Research Group, Brunel University.
Public Administration
Vol.
72
Spring 1994 (33-53)
0
Basil Blackwell
Ltd.
1994,
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34
JUSTIN KEEN
analysed from a management perspective
(Ham
1992; Klein
1989);
but much
less attention has been paid to information policy. It is argued here that
NHS
information policy can usefully be analysed by examining the extent to which
it supports or undermines the development
of
collaboration and quasi-markets.
The first part
of
the article outlines some
of
the principal characteristics
of
the post-review
NHS
and
of
the
IM&T
Strategy. The second part examines key
information
-
and information system
-
related activities at different levels of
the
NHS
and
comments on some of the opportunities and tensions arising with
the new arrangements. The final part discusses the role
of
the centre in the
changed environment of the
NHS.
THE
NHS
REVIEW
AND
INFORMATION FLOWS
The
NHS
Review (Secretaries
of
State 1989a) and the reform
of
community care
(Secretaries
of
State 1989b) currently dominate the
NHS
policy agenda. The most
striking element of the review was the proposal
of
a quasi-market for health
services, with purchaser and provider functions formally split, which was
officially introduced on
1
April 1991 (figure
I).
Most hospitals and community
units are now
NHS
tmsts, with new freedoms to govern their own affairs, and
some larger general practices have become fundholders and purchase a limited
range
of
services. There have also been changes in hierarchical arrangements,
most obviously in the creation
of
regional outposts of the
NHSME
and the
proposed merger (followed by abolition in 1997)
of
regional health authorities.
FIGURE
1
NHS
hierarchy
in
1993.
Department
of
Health
I
NHS
Management Executive
Regional Outposts
....................
Commissioning Agencies
1
Non-fundholding
GPS
Fundholding
GPS
NHS
Trusts
________________________________________-
--
-
Hierarchical relationships
- - -
=
Contractural relationships
0
Lsil
Blackwell
Ltd.
1994.
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