It talks of an 'information revolution' that will make information more readily available to support patients' choices about their care, and to increase public accountability.
This focus on information provided for and by patients and the public is welcome. But is it enough? Will the 'information revolution' fill the current gaps in information and meet the needs of the new, redesigned NHS? Will it deliver the information that GPs will need in their new roles, and do current data flows align with the proposed architecture for the NHS?
Equity and Excellence: liberating the NHS builds on Lord Darzi's drive for measuring and reporting on the quality of services, defined as clinical effectiveness, safety and patient-reported experience, including a proposal to gather information on the performance of individual clinical teams – a welcome development, as more information is certainly needed on the quality of services. But current data flows are inadequate for these purposes, and the completeness, quality and use of national clinical audit data needs to be driven much more vigorously. As the quality accounts published recently show, trusts' participation in national clinical audits is patchy and even then, the data submitted is often incomplete. But clinical audit gets only a passing mention in the White Paper.
We also need better information on the quality of services provided by private providers. The previous government made a start on this, but there is a chasm between the range, depth and comparability of information available on services provided by NHS organisations and that available on their independent counterparts. With independent health care providers taking on a growing role in the NHS, and patient choice being set out as a driver of quality improvement, there is more need than ever for comparable information across all providers – NHS and private.
Information is vital for assessing the health needs of local populations, their access to care, the quality of services, and health outcomes. But the health White Paper doesn't address how existing information flows will be adapted to reflect the new architecture of the NHS.
GP consortia will need good information about their patients and their populations to inform commissioning and improvements in population health. Consortia will according to the White Paper need to have 'sufficient geographic focus' but this remains as yet undefined. GPs are expected to address public health, health inequalities and social care in partnership with local authorities, whose geographies (and therefore resident populations) are unlikely to correspond neatly with those of GP consortia.
Current NHS and health information systems mostly relate to existing, statutory geographical entities (eg, PCTs, local authorities, wards). A major transformation would be needed to reorientate information systems and data flows to deliver relevant data for the new GP consortia populations.
If GPs are to be accountable for £80 billion of public funds, the fitness of available data flows to support these tasks also needs urgent consideration. The potential misfit of information flows could also make it difficult for the NHS Commissioning Board to assess the performance of GP commissioning consortia. And how will outcomes be measured at GP consortia level?
Urgent consideration is needed of the implications of the White Paper for the information that the new NHS will need to conduct its day-to-day business competently, raise quality and improve health outcomes – and all this in an increasingly constrained fiscal environment.
We cannot wait to find out that the information foundations do not align with the castle they are designed to support. The proposed information strategy offers an opportunity to drive improvements in information on quality and outcomes, fill the gaps, and assess the fitness of information flows for supporting the new NHS. Will this opportunity be grasped?