A System For Health

VitAL Magazine looks further into the body of the Health Service to find what will make it tick in the future!

You hear it increasingly said these days that IT is no longer a function that works for the organisation but is more often a vital organ of the organisation. What organisation that didn’t have IT in the blood would attempt to make all of its information plus any information that is relevant to its work available to all of its own people and any other users who wish to know? You might as well burn a stick and write the information on a dry cave wall in the hope that passers by might see it.

But what then if that information happened to form one of the largest bodies of knowledge in the world; and was renewing at such a rate that there were 30,000 regular journals dedicated to the latest news plus countless academic papers and the notes of practitioners in the sector, all to be made available in real time? What, also, if your subject was one of the most popular topics ever and your core audience numbered 700,000 while your wider audience numbered nearly sixty million in your home country alone? What if people relied on the knowledge you provided for life and death decisions, not the kind of life and death decisions that fabricate ersatz pressure in a TV Reality show but the kinds of decision which, if wrong, could really end with somebody’s death?

Its easy for journalists, from the comfort of our chairs to create some good ‘shock horror’ copy about the National Health Service and its eye watering IT budget but when one starts to consider the scale of that undertaking and, therefore the scale of everything it does, you begin to realise the awesome challenges that poses for its own Service Managers and the potential value that everybody might gain if it can get it right.

In a previous issue of VitAL, we interviewed Ian McKinnell, Head of Development at the National Library for Health while this article focuses on Sir Muir Gray, Director of the NHS National Knowledge Service. The government is probably the single largest user if IT in the country and the NHS is probably the most extensive user of IT within the public sector; plus, with the much publicised cost of new systems, readers may well be interested to know what is being planned and achieved. We asked the VitAL questions.

VitAL:  What is the NHS National Knowledge Service?

Sir Muir Gray: Our purpose is to first discover what clinicians, patients and managers need then having established what that is, we set out to find it, procure it and deliver its at the point of need. The knowledge service is structured as a network of knowledge providers such as Nice [National Institute for Clinical Excellence] and the Department of Health. Once a piece of knowledge has been is procured, it is placed in the National Library for Health from where users can access it through either a search engine or by email notification [for those who have registered their interest in particular areas]. Essentially the National knowledge Service is a knowledge supply chain.

V: How does the Service fit in to the health service and what does it mean for the ordinary patient?

SMG: We supply our product to the health service wherever it is needed: it’s rather like being an electricity provider but we are delivering knowledge. [In the previous interview we learned the various ways in which clinicians and academics can access knowledge in the health sector] but will also serve patients; and patients can get their knowledge through NHS Choices. Picker Europe surveys of patient experience has shown that patients value knowledge and want more knowledge to help them make decisions related to their own health or procedures that they may be facing.

The fact is that the application of knowledge has a far bigger impact on the quality of health and combating disease than any new drugs or technology.

V: What are the ongoing issues and challenges that the Service faces?

SMG: Because of its considerable size and complexity, infrastructure is a major problem for the NHS and in particular for the distribution of knowledge within the service. There is a major issue in getting knowledge from the source to the point of use and that is being tackled by Connecting for Health, to be found at www.connectingforhealth.nhs.uk . People want more information and knowledge and it is our job to get it to them.

V: What issues, challenges and opportunities has the Service faced as part of the current change climate in the NHS and in particular what have been the IT issues etc?

SMG: The way the IT is going [within all of the other changes] is both a challenge and an opportunity. We are dependent on Web 2.0 and really, on that side of our operation, things can only get easier with the progress of time and change. The enormous opportunity for us is that people always want knowledge and especially in an area such as health which impinges so personally on them. IT makes it possible for us to deliver to our users what they want, when they want it and in a form that suits what they are doing.

V: Who are currently the largest users of the NHS National Knowledge Service and will that change as a result of the current development programme?

SMG: Currently our largest users are General Practitioners, Nurses and Doctors in training. They all use the service for checking clinical evidence and I think that that will remain the case for the foreseeable future.

V: What are the future plans for the Service?

SMG: We want to extend the service on two levels really. In the first case we want to extend the number of people who can access what we’re doing at the moment or whatever new services we are able to offer. Beyond that we want to extend the scope of the service, that is to say the type of services and the type of knowledge that we are able to offer.

V: Are there any other issues concerning this NHS National Knowledge Service and the IT developments that need to be recorded?

SMG: I think that most of those were covered during your interview last time with Ian McKinnell.

In this most recent interview as well as in our last meeting with Ian McKinnell, we have seen a very ambitious vision for what IT can do in terms of making more knowledge more widely available by more means.

Even the most cursory glance at the website NHS Connecting for Health will reveal a facility of considerable ambition. With no less than 27 first level facilities or capabilities, each one of which is simply a portal through which the user can drill further down into the service’s knowledge base, this website alone is already beginning to attain ‘BBC’ dimensions. Just going into the NHS Care Records Service reveals two further knowledge paths for Patients and NHS Staff. Beyond that, patients can access a further level in which more than a dozen alternative information routes become available.

And beyond this technical ambition of leading each user to the appropriate knowledge source for the task they wish to complete today, there lies the overarching ambition of connecting everybody who wants to use it to every piece of health related knowledge that they could conceivably want to use. In any sphere of human activity that would be a daunting undertaking: in the health sector where such massive amounts of knowledge published daily, where progress renders so much information out of date so quickly and where peoples thirst and knowledge is driven by the very human desire to maintain our physical condition at the best possible level, the undertaking is Herculean.

It is to be hoped that as the National Health Library and Knowledge Service both overcome the enormous challenges against which they have set themselves, they will also generate and publish the kind of useful information that every organisation out there will find valuable but which it might find prohibitively expensive to generate for itself.

In our two interviews with the service we have learned of its ambitions and of its current thinking as to how those ambitions might be achieved. Of course all of that will change and evolve as the programmes progress and so we hope that at some stage in the future we will be able to return to this subject and learn what further insights and methodologies have been developed to facilitate what must be one of the most ambitious programmes of its type ever.

Meanwhile our thanks to both Ian McKinnell for the previous interview and to Sir Muir Gray for this current interview and for revealing to us some of the work that is going on to put IT into our Health Service.