Christine Connelly Q&A at eHI Live

8/8/2019 Christine Connelly Q&A at eHI Live

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Christine Connelly: transcript from EHI Live

The purpose of me being at EHI Live is to talk about the consultation that we've launched onthe information revolution. The consultation document outlines what it is we are trying to do,and through this consultation, we'd like to understand the best way that we should go about it.So we believe this audience is a great audience to give us feedback, and give us input.

To put this in context: the White PaperEquity and Excellence - Liberating the NHSwaslaunched in July, and in that White Paper there were some key themes. The first of which is toput patients at the heart of everything that we do. Now I heard somebody say earlier today, if Ihear one more person say that what we're going to do differently is put patient first, I'm goingto scream. And that's fair enough, however if for you this is an enduring theme then hear it asan enduring theme. If you look at it and you say, we keep saying it, but the question is whydoes it not feel that way if you're a patient? Then think of it that way. If for you this is acompletely new concept, then think of it that way. But the key thing is that everything that wedo inside the health service is about putting patients first - putting patients at the heart of

everything that we do. And from that achieving outcomes that are among the best in theworld.

The way we expect to do it is to empower clinicians to deliver those results, and we expect

the clinicians to work very closely with their patients. And I have never met a clinician whodoesn't believe he's working very closely with his patients already, where that clinician, he orshe, spends lots of time with their patients. However, sometimes the patients feel that theydon't have control of the situation. And if that's the case, we'd like to find a way to help thosepatients redress the balance.

So inside that White Paper we called for an information revolution. So why do we want that?Three mains reasons for an information revolution, the first to give patients control, and I'll talkabout that control later and what we mean by it. The second reason is in a system that isgoing to change the way we expect the health system to change, we will use information,technology, and process design to build the bridges across the different parts of the system,with lots of autonomous units. Then we will use that information flow to make sure thatinformation that patients and clinicians need moves around the system. The third reason foran information revolution we see it in every other walk of life: using information and

information technology to drive improvement and efficiency. We see people working on theirsupply chain optimisation, we see people simplifying their processes and then automatingthem, and it's time for us in Government to do the same.

Patient empowerment

So what will the impact be if we have more empowered patients? The first and mostsignificant is to actually see ownership of the health outcome. There's plenty of evidence thatshows when the patient and the clinician work far closer together then the patient feels morein control of their health, and actually their health outcome improves as a result.

The next thing about patient empowerment, we are committed to engage effectively withpatients, that means moving beyond surveys. We believe that we need surveys, we all talkabout patient reported outcome measures, for example, a very important part of the system,

but to move beyond those surveys into dialogue. When you look at other walks of life, thingsthat we might say are far less important to people than their health, then you can see asconsumers we engage with people who provide us with services and products, and weengage and tell them what we think of those services and products. And we do that in manydifferent ways, and we need to create that variety of opportunity for patients to enter intodialogue with the health service, with commissioners, and with providers. And that dialoguewill lead to changing the shape of services. From really small things, like giving feedback toan A&E department, about how they manage the queue, they might then say, that's a reallygood idea, we could do that differently. To big things where groups of patients come togetherand create a single voice that then shapes the services of the future. So actually we canimpact commissioners and providers.


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Empowered patients, we also believe that leads to informed choice. I'm sure that you willhave read in the White Paper about the commitment to choice, and seen the consultationthat's currently going on around choice. And for choice to be real, it needs to be informed. Weneed to each be able to go take a look at the options we have, understand those options,analyse them in a way that's important to us, not necessarily in the way that the institutionthinks we should look at it. And based on the information that we have, exercise our choice.The outcome of that, well obviously improved health outcomes, and improved satisfaction

with the service overall. If you feel you've had some say in how that service has beendelivered to you, you are more likely to be satisfied with the service that you receive.

Capturing data at the point of care

So a few things that I've picked out of the consultation document, and perhaps the things thatpeople might want to debate a little bit. Because I'm really interested in hearing what youthink about this, rather than just you hearing what I think about this. So the first thing that Ipicked is the idea of capturing data at the point of care. And the reason we picked this out isbecause to improve quality of data, to have quality information in the system, we have to havethe person who records it actually being responsible for that quality. And if they record it in themoment, then that will make a big difference. So one thing that we are seeking feedback on isthe ability of clinicians to capture data at the point of care.

At the moment we don't necessarily have systems that make it easy in every care setting tocapture that information during the care episode.

For us to deliver an information revolution we need to increase the amount of structured datathat we have in the system, so that we can actually go and mine that data, and draw insightfrom it. We can't just continue in some situations where we have reams and reams of text.There may be some technology over the horizon that says we can search and find anything,but given the limitations in the technology at the moment we really do need to push on havingmore structure in the data that we capture.

Patient control of records

The next point is about giving patients control of their records. And we do mean control, I'veheard lots of people talk about this as giving patients access. The Secretary of State is

committed to giving patients control. That is a very big word from an information specialist,from a technologist, handing of control to somebody is a pretty big and difficult thing todeliver. So that is not an easy thing to say, and it's certainly not an easy thing for us all todeliver. And what do we mean when we say that? What we don't mean is to give patientsaccess to every computer system in the NHS. We don't expect to do that. What we don'tmean is allowing patients to withdraw all the data that clinicians have about them from theNHS, because clinicians need that data, they need to know what was there when they madetheir decisions, what did they base that on?

So at the moment our thinking around giving patients control of records is to allow a patient todownload from the system the information that we have, and then to put it wherever they wantto put it, and use it however they want to use it. Share it with whoever they want to share it.So we talk, for example, about the idea of people donating their data, and then others willdraw insight from that data if you do that. Also we can see a situation where people with

similar conditions may get together, share their data, and seek advice from somebody else,and that may be very liberating. Creating communities who could actually start to look at thatinformation and do different things. And for us to do that, and to do much of what's in theWhite Paper, we need to find a way to free the data that we have from the applications thatit's currently trapped in. We have lots and lots of data, we need to get it out of where it istoday and make it available, first of all to those patients, and also to other clinicians who canmake more use of it. All of that needs to be done with the privacy of the individual protected.So we are not looking to get to a place where suddenly patient data is just freely available for

anybody to come and have a look at.


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Transparency

And that kind of takes me to the next theme of transparency. I was lucky enough this morningto be in Tom Steinberg's session when he was talking about what they've done in My Society.And I thought about maybe I should change these slides, you know, having heard that.Because he said some really interesting things, and one thing that he said was that when theGovernment publishes data then other people come in and make use of it. We are intent on

publishing and not polishing. Now somebody challenged me on what do you mean by publishnot polish. We don't intend to be silly about it, we don't intend to take very small data sets andmake them available. We don't intend to get to a situation where the information is so purelydefined and structured and it's of no use to anybody. But we do need to get past this idea that

we collect up data and we wait for a year before anybody can have a look at it. If we go backto the idea of an empowered patient, somebody exercising choice, you need to understand,for example, how your local hospital is performing now, not a year ago, if you are about to gointo that hospital for some operation.

So we do expect to publish. We do expect to publish sometimes with a caveat, and thencome back later and revise. And one of the things about transparency is to allow us tocompare outcomes. Clinicians tell us they want to compare outcomes, they want to learn fromeach other. They would like to see how different patients respond to different kinds oftreatment, so if different teams are doing different things, they'd like to understand that.

Certainly patients would like to be able to compare outcomes, they'd like to understand thatinformation in a meaningful way, not just sets of statistics. They would need to understandthe kind of patients who went to see a particular clinician. Because if you are the world'sexpert in something, you may very well attract all the most difficult cases, so it's not just thecase that you see just the statistical outcomes.

And from creating all of this information, we believe then that we will find people in the marketto actually drive and improve the insight that we have. And that was what was interestingabout this morning's session, is that what we saw there was an example of whereGovernment data was available and that data was being used to add value for citizens inways that we hadn't expected. And that's a critical theme for us, we expect to reuse the datathat we've got, we expect to draw first of all from the electronic records that we have, not tohave people filling in more forms, and sending things in, and drawing up from those baserecords to them use and reuse that data.

And if we can create an environment, an environment where information is freely available, anenvironment where patients feel empowered, if we can create those conditions we believethat the market and patients themselves will develop compelling propositions that will makebest use of this data. That through the innovation that can happen locally, through theinnovation that can happen by seeing what people do in other sectors and bringing it overhere, through all of that rather than through some top down control, we'll actually create amuch more vibrant environment that will allow the health service to make more use of theinformation that we have, and drive on into spaces that at the moment we can't anticipate.

Questions

Mike Sinclair from the British Computer Society.

A question I wanted to ask the Minister this morning, which is really about the innovation anddriving improvement and efficiency. If all the changes that are happening at the moment arepushing stuff out into the service more, and the service recognises a lot of the messagesyou've made today, and the Minister made this morning. But we're in a situation where cutsare happening in a rather drastic level very fast across the NHS. You're talking to theconverted here, what can we do to get the message to people who made decisions in someplaces they're cutting, salami slicing, informatics budgets, when they could be using thosebudgets and those services to realise productivity and efficiencies in their own services.


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Christine

I think that kind of takes me back to the three reasons why we need an information revolution,and you're highlighting the third of those reasons, which is about driving efficiency andchange either very locally or across a particular health community.I think it's incumbent on allof us to actually build compelling propositions and be bold enough to take them in and talkabout them. And I don't mean by that exaggerate the benefit, because we don't need to

exaggerate the benefit. I think that if you look at other sectors when the sector is in adownturn, when people have found themselves needing to be more efficient, when they foundthemselves needing to save dramatic amounts of money, they turn to information andtechnology to help them achieve those targets. Because what they want to do is to first of all

simplify the way work gets done and then automate the way work gets done.

And I think that we need to be going forward and saying, here's an idea, and certainly throughthe QIPP programmes that I've seen, and I've seen the QIPP programmes in SHA, and wehave a national stream for QIPP around technology. And those QIPP programmes are prettycompelling and we've got quite a lot support for them. So I would just encourage everybody toengage in those programmes of work and to link the things that we are coming up with to thethings that the service is using overall as the levers to the change.

Question

Why has the information revolution consultation paper not mentioned once open source?When we mirror that with the Government action plan on open source, and it talks about openstandards, open data, and open source software. And if you look at the information revolutionconsultation paper, there's a lot of talk about open data, and open standards, obviously, butopen source is not mentioned. Is this another decade of opportunities missed for theDepartment of Health.

Christine

So first of all the consultation document is incredible light on anything to do with technology,

other than to say that technology is an important way that we'll deliver this. So it waspurposely not set out to be a technology document. If you want to have a conversation aboutopen source, and you're interested in my opinion on that, I can give you that, but the reason

that we didn't put it there was we didn't put lots of technology things in that document at all.And we wanted to position this as saying that the goal is an information revolution, and thetechnology is a means to deliver that information revolution, rather than the goal istechnology, and information is just what we put on the bus, you know. So that was what wewere trying to say by talking about this as an information revolution. We would like to see lotsof different ways of delivering this information revolution and we'd like to create the conditionsthat allow people to go out and explore that without being overly prescriptive. We talk aboutstandards because we believe that we will need to create a minimum number of standards tomake this proposition work, because without it we won't be able to join the dots. But we'retrying not to replace one mandated structure with another mandated structure for the future.

Mary Hawkin [GP]

This is really a heart felt plea. We've got information revolution consultation, which I welcome.

We can all agree with most of the high level propositions, but if we're then going to get aninformation strategy after this consultation has finished, then consultation on that informationstrategy, we're going to be hitting April 1

st2013 with rather an information gap. And as a

member of the GP Consortium I need to know preferable sooner how big my Consortium isgoing to be, what functions it's going to follow, how it's going to manage its technology.Because remember, we're all totally dependent on the IT we've got now, and being an EMISuser, my patients could have access to their records tomorrow. A lot of this work has beendone. But getting the joined up information structure to get interoperability between primarycare, secondary care, community, and the data flows that we are going to need for

commissioning, and knowing where the resources are going to come from, and where theresponsibilities are going to be, is something that if we don't get it in time to plan realistically


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for April 1st

2013, we're going to be really in a mess. I'm concerned about the lack of anyinfrastructure information.

Christine

Our plan is that we are in consultation at the minute, and we would expect to take the outputsof that consultation and then publish an information strategy. At the moment there's no

expectation that we will go through two rounds of consultation. So if the consultation closes inthe middle of January, obviously depending on what that consultation delivers for us, wewould hope then to be publishing our information strategy a couple of months beyond that.And we are trying very hard through the process of consultation to take feedback as we gothrough, and feed that into the guys who are looking at how do actually put this into aninformation strategy document.

One of the things that we are doing as part of this process is working very closely withBarbara Hakin on the development of the National Commissioning Board and the GPConsortia. So Barbara has established a Board as a subset of the NHS Management Boardto help her drive that, and I'm a member of that Board. So we do see this very much as aniterative process where the what's possible may come from us, and what's required will comeout of the work that's going on around the GP Consortia design, the Commissioning Boarddesign, and then obviously Ian Dalton and the work that he's doing with the providers. There's

a similar structure for that.

So inside the Department we have been set a very challenging timetable in the White Paper,and nobody would deny that. It's a very large change to deliver in the time that we have, butthat means then we all have to work closely together to make sure that we design anddevelop achievable plans for that. So it's very important to us that we use this consultationperiod in as broad and rich a way as possible to get the input that we would like to have toinfluence that strategy document, because we would expect to publish it straight away well,as soon as we can.

Question

And just a point of clarification, if this is the information strategy which is now being consultedon, does the NHS then have a technology strategy? Is that still the National Programme for

IT remains the technology strategy?

Christine

In terms of what we've said about the National Programme is that we expect if you were tocharacterise it, we expect to move from the world we've been in which is about replacing allthe systems we had with single sets of systems, to a world of connecting up multiple systems

in different places. Now what we can do in terms of evolving from where we are to wherewe're going, is different depending on the geography that you're in, because it's differentdepending on the commercial arrangements that we've got, and we're trying to be aspragmatic as possible to move that forward.

Question

Margaret Cousins [Teleradiology]

I'm also working on the implementation of the EPR at Rotherham NHS Foundation Trust. I'mnot asking a question or anything to do with my current job. I worked in the North West as a

programme manager and delivered there's some fantastic work being done up there to dowith speech recognition, digital dictation, genuine, genuine, money saving to the trusts,genuine patient care improvement. The trouble that I had, and I'm asking you to do somethingabout this, is procurement. The little companies that I knew could do the job for me weren't inthe club to be procured. I had to go through all sorts of jiggery pockery to get some fantasticteams in to do the job. All around this hall there, are some incredible companies that are


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going to deliver the innovation that we need in the NHS. I'm just asking you to help them todo it.

Christine

I'd love to say, here's the answer to that, but a couple of reasons to be cheerful. First of all itseems very strange that in the world we live in, which is about rapid change, and technology

cycles of being nine, 12, 18 months, to be in a procurement cycle that lasts longer than that,you know, that just doesn't quite fit, does it?

Now the reason to be cheerful is that all the way up to the Prime Minister, he has recognisedthat, and he made a speech last week I think he said about East London and making usebuilding a technology centre, linking up technology companies to the Olympic legacy. And inthat that he would look at procurement on how we can then bring in innovative, small andmedium sized organisations to deliver services for Government. So there's certainly anappetite to look at it, so lots of people have noticed it.

In our own space, one of the reasons why we feel so positively about the interoperabilitytoolkit is to say that if we can create the conditions that mean people need to surface theirother end of that connection. So particularly data, if we created a world where every providerorganisation in the NHS had to surface their data in a particular way then it would allow lots of

new entrants to come in and say therefore, if I am using the other end of that connector, I canpick it up and I don't need your permission, big company, to build an interface. So the reasonfor the ITK is to get us beyond that, and we're very happy to see big companies and smallcompanies participating in that, because there is advantage for both. If you're a very largeorganisation, given the scale of the product you're bringing to market, you find it hard to bringin every innovative idea really quickly, and so your customer base can get really frustrated.So if you can then say, well, we'll bring you in this much, a core of what you're doing in thistrust, and you can easily get all these other pieces from these places, then that creates amuch more compelling proposition and delivers benefit faster.

So in terms of the challenge about procurement, it's understood. I'm not sure exactly howwe're going to deal with it, but it's on my list. And it's on David Cameron's list, so that's a goodlist to be on, I think, probably better than mine. And the things that we've done over the lastyear or so on the ITK is a start on how we could make it possible if we're able to procure from

those small companies, for them to come in and make a difference quite quickly.

So the point Margaret just made was, please make ITK international standards. I think if youlook at the consultation document, we are committed to building on international standardswhere they are, and absolutely committed to that. However we don't want to wait foreverything until only those standards have been adopted, and one of the things that we'vedone with the ITK as an incentive to people to have them come work with us, is to say, ifyou're in a space, and your space we don't currently have, that standard established, if you'rewilling to be the first mover, then we'll work with you to make what you're doing the standardthat we use. And then hopefully you would see an advantage of migrating to the internationalstandard as it became available. And we would do that as long as what the supplier is doingis not overly proprietary. You know, obviously if you've built something weird and wonderfulthat's great, but it would be very hard for everybody else to adopt, then that would make itdifficult for us. But we wanted to incentivise people to be the first mover in the space, we

didn't want to sit in the Department and make a list of, so what should we develop for ITK first.And tried to do it in a more collaborative way.

Tim Benson

Are you going to do anything about the mish mash of different standards organisations thatwe are living with in the NHS, and allow the NHS information area?

Christine

So what would you suggest, Tim?


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Tim

Well I think the sort of way that the Canadian's have organised it where they have effectivelya non-Governmental organisation, the Canadian Infoway Standards Collaborative, wherethey've combined everything in that as a genuine consensus organisation, bringing in all theappropriate stakeholders and people of interest into that, rather than having lots of differentorganisations including the Government developing them, it seems to be a way that might

is a pattern that has been admired in many parts of the world, if not copied.

Christine

Sure. So a couple of things about standards and what's written in the White Paper. First of allin terms of health, we expect, and the White Paper is quite clear on it, that the NationalCommissioning Board will set the standards for health. How the National CommissioningBoard chooses to do that, then you know I would expect to advise them and then see whatthey decide to do. Now we would like to make that based on international standards. I met,just last week, with representatives from the US, to talk about how we could work togethermore on the basis that if the US and the UK, or even the US and Europe, both want to dosomething in the same way then actually suppliers find it easier to deal with us if we can, orwe can get our requirements clear.

So certainly there is a desire for us to work across lots of boundaries and simplify what we'redoing. And by us creating a point in the system where we're clear on who gets to say what thestandards are, that creates the opportunity for us to design a system of standard setting forthe NHS. Obviously in the public health system, and there'll be a White Paper later on thepublic health system, the need for us to join up between the NHS, the public health system,and social care, means that although the National Commissioning Board is setting standardsfor the health system, we also need to work back into the Department of Health so that we getthat broad range sorted out. So I'm not sure exactly how that'll come out, but I appreciate yourview on how we can go about it.

Colin Jervis

I'm not expecting a detailed answer, just a question on outcomes really. Now the newGovernment's made a big thing out of measuring outcomes which after 20 years of having my

head almost bitten off suggesting that you know that's what we should be working to is quitepleasant to my ears, because I think most of the operating standards we've had so far haveconcentrated on process and structure, and less on outcomes. But can you tell us a bit moreabout how these outcomes are going to be developed because I imagine my head was bittenoff for good reasons.

Christine

So the Government absolutely is committed to measuring on outcomes rather than onprocess targets. And you see that not just in health but in other parts of Government. I think,you know, Bruce Keogh is working on the outcomes framework to say, so what are theoutcomes that we would publish, what are the outcomes that we would expect people todevelop in different parts of the organisation. So I think actually I'm not sure if theconsultation document on outcomes has completed, I think it has, hasn't it? The consultation

is complete, and so we're waiting now to hear from Bruce and his team on how we will thentake that forward. But they've already done quite a lot of work through the National QualityBoard inside the NHS on designing outcomes, and trying to get to a place that says, how dowe create these in a way that doesn't create a massive burden on the system, which bringsus back to the point of drawing the information out of the records that we have, rather thanintroducing lots of intermediate layers of data. The work that will happen next year onconsulting on data returns, and what we still need, and what we don't need for the future, willalso be part of that exercise.


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Question

So in terms of the consultation, how many responses have you had so far? Do you have anysort of sense of that?

Christine

Actually, I've got no idea how many we've had, but what the consultation team tell me is thatyou don't get response very early in the process, that actually getting a thought throughresponse is what you're looking for, and not just a knee jerk response. So you need to givepeople time to properly consider the material that's there, and then you need to support theconsultation as it goes through. So if people are running events, if they want somebody fromthe Department to come along and help, and support that, then obviously we're offering to dothat. And there's a number of different groups who have offered time for us to do that, andwe're very grateful or it. So I can't tell you exactly how many responses have come in. I cansay that in the consultation to the White Paper we had a great many responses about theinformation revolution as it was outlined there, and that was encouraging that we actuallyhave tapped into something that people are interested in.

Question

The consultation covers a lot of ground, and some of it would appear to be specifically writtenas questions for patients. Do you think sharing of information, availability of records, and thiscontext is a good idea. But this particular audience of NHS, IT professionals, clinicians andsuppliers are there particular areas of the consultation that you're hoping to get well, you'rehoping that you're going to get a lot of responses?

Christine

So I would hope that this particular audience will give us a lot of advice on how to do it. Youknow, so coming in and saying, you know, you want to set standards. It would be helpful ifyou set standards through a single body, it would be helpful if you looked at the Canadianexample, you know? So the way that Tim put that kind of gives us the sort of response that

then allows us to consider that, and actually to write a document in the information strategythat's richer around the how will we do this, and what kind of timing makes sense?

I get lots of feedback from people when they talk about the National Programme for IT, thatsay, we don't again want some big top down exercise, we want you to get out the way. Okay,great. Then the next thing that we hear is, if Government doesn't do this they cant deliver. Sowhat we're trying to find is what is the space that we need Government to occupy that allowsus to create the conditions that means that we'll then end up in a world where each of you canfeel that you can be more innovative and be freer to deliver in the space that you currently

occupy today. So actually getting some advice on that balance would be really helpful.

And if I could sneak in a third thing: one of the big challenges for us is about the capacity inthe informatics workforce inside the health service. And I think about the capacity inside thehealth service and the whole capacity in the market. That is an issue for us as we look atramping up the informatics needs of the NHS, we need to have an able, educated, capableworkforce to take that on and drive it through. And I'd really like to hear from you on what we

can do to help make that happen. You know, how do we encourage it, how do we bring morepeople into our market, how do we bring more people into our ranks, how do we do that? AndI think that this audience particularly would be well place to guide us on that in a way thatperhaps other groups couldn't.

William Lumb [GP and clinical lead, Informatics NHS Cumbria]

How are we going to resolve the issues of the commercial negotiations around some of theLSP contracts and the deliveries, and interoperability? Because the two don't sit very easily,and one of my big struggles is achieving interoperability with an LSP provider.


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Christine

I think you're right that it's not easy to evolve forward from where we are to where we want toget to. I think that the LSP providers really want to find a way to deliver well into ourenvironment. Their motivation is to do a great job and deliver good outcomes. What is clear isthat they can't deliver everything, and so we are working hard with them to say, so what is thescope of the LSP contract going to be? And how do we then create the hooks that allow

others to come in around the sides of that. And we've seen some good examples recently inthe sort of pilots that were done around the ITK, we've seen some really good examples ofwhere the LSP providers have made available information in their core systems that othersthen have linked to and made use of.

I think that we need to find a way to rebase where we are in the environment that we're in,rather than this mindset that said, everything about LSPs is bad, we've got to get ourselves toa place that says, what is the good stuff that we've got, how do we leverage that more, makemore use of that, and then work with that to go further, and bring other people in to do that.And from the things that I've seen with the LSP suppliers when I've talked to their chiefexecutives, they're up for that, and they're asking us the question, how do you want to do it? Iknow that there is a lot of history and I know a lot of that history is negative, but I think it isimportant for us to say, we've got an opportunity here to take an asset that we've got,leverage it more, and do the best that we can with it.

Steve Mathieson, Smart Healthcare.

We've heard earlier today from both Rotherham and Kingston, who've sort of taking oppositeapproaches on new systems. Are you expecting hospital trusts to follow Rotherham in pickingtheir own system, Kingston in taking the LSP system, or are both equally valid now?

Christine

What I would really hope for is that trusts will choose the systems that we have alreadycontractually committed to, that would be the best outcome. However, the key thing is that we

are committed to an environment where trusts have choice. So in London, the KingstonHospital chose to go ahead with Cerner and in the contract that we have signed with BT andthe revised contract, we are clear on the trusts who are going to go ahead in that

environment. And those trusts, their systems, will be delivered through the structures thatexist under the National Programme. And everybody who's working on that is optimistic andpositive about the way things are currently going.

We're currently going through a process with CSC and NME to work out exactly what we willdo moving forward with that contract, and much of that is tied into the Lorenzo Release 1.9implementations that we have at the moment. In the South we've agreed that we're movingforward with the ASCC, so we are expecting a number of particularly community trusts whohave recently put their hands up and said, we want to go that route, to come in and work withus, and purchase their systems in that way. The trusts that don't want to do that won't beforced to do that, if they think there is something better out there and that product isn'tcurrently available on the ASCC framework, then our expectation is that they will go and findthat. You know, so and the question that will come back to me is, how come that productwasn't on that framework? So we then have to refresh and revise our framework so that that

can happen. So I wouldn't say that it's I expect everybody to go one way or the other, butwhat I do look for is that the trust is committed to upping the quality of the information systemsthat they currently run, because until we get better systems in place, we won't deliver thebenefits for patients that we believe that information and technology can deliver.

Paul Malcolm, Simple.

One of the things you said earlier on was around empowering patients, and letting the patienthave control of their medical records. So the extrapolation of that mean that we'll declassifythe confidentiality of medical records, such that I can then take or hold my medical records

offshore or in fact anywhere I choose to?


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Christine

There's two separate things there, first of all in terms of the records that we hold, we don'tintend to drop down the classification of those records. So where the health service is holdingthose records, the privacy that we have guaranteed around the records will be maintained. Myexpectation is that if I take a copy of my record, if I get that, I can decide where I want it to gothen. It's up to me to assess the opportunities that are on offer, and decide if that is secure

enough for me or not.

So there are number of people who look at the security levels that we hold in the NHS, andsay it's too high, and they think that it's unnecessary. Well that's fine if they want to take theirrecords and put it somewhere that's less secure. We won't, you know once we've given it toyou, it's your record and you're in control of it, it's up to you. And what I then expect is thatorganisations will show up and say, here's a great tool to manage your health record, let ushelp you do that, and here's how you can keep extracting information from the system aboutyou. And we would love to work with organisations who want to do that. And then we wouldalso expect third party organisations who look at collections of information to then offer valueadding services to patients. So we'll use the example often of Cancer UK: what would happenif every patient who had cancer gave their record to Cancer UK, what insight would CancerUK draw from that? What would happen if every person who had diabetes put theirinformation in the same place and allowed others from particular nominated places to go to,

what would come out of that?

I think the point I took out of the session I attended this morning on My Society was you don'tknow what's going to come out of it, so you have to make the step and make the informationavailable, and then that will happen. So the answer to both parts of your question is, yes,we're going to keep information standards the way they are for the data that we have, whichmeans at the moment we store that information in England, and for information that thepatient takes for themselves they can then decide to offshore it by themselves if they want todo that. There'll be nothing to stop them.

Roz Fode from BCS Health Exec

Why do you want patients to download their records when they will immediately become outof date, when the systems already there for them to have access direct to their GP records

without attempting to keep other databases synchronised?

Christine

So the piece for us there are systems available to allow people to access their records.And if the Secretary of State had asked me to come up with a mechanism to allow people toaccess their records, then we might then have said, okay, so how can we give people readaccess to stuff that's in there and what would we do about it? But he didn't ask me to do that.He asked me to give patients control of their record, and one of the challenges that you'verightly pointed out is that when you take your record into your system, how are you going tokeep it up to date, and we would like to hear from people on how much of that howinstantaneous does that update need to be. Is it that we would expect if you've taken acopy of your record every time something happens we would send you that update, is it thatwe would wait for you to say, do you know what, I would like to now I know I've now done

something, so can you please give me the record, I was at Kingston Hospital last week. Canyou now give me the piece of my record form Kingston Hospital, I'd like to have that. And is itboth things. Is it that different patients would want to do different things? And I really,honestly, don't know what patients would want, and that's part of the consultation. And Isuppose there's a possibility that when patients look at the proposition and say, have patientcontrol of records, they might come back to us and say, I don't want control of my records, allI want is access. I don't know.

But what we believe at the moment is that patients would like control, they'd like to take their

records and put it somewhere else. They'd like to give access to that record to third parties,sometimes just to their carer, just to their carer, sometimes to other organisations who might


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be able to advise them. And we'd like to understand in this consultation just what it is and howcomplex that needs to be in terms of delivering it. So I don't know yet how we'll do that, andit'll depend on what comes back from the consultation. And there's a great many people in myteam who keep looking at it and saying, Christine, you can't possibly mean that? Surely wecan just mean this? Well, maybe it'll mean that, maybe it'll mean this. And we want to do isfind out, and then to build out plans based on the feedback that we get.

Question

Is there a future for HealthSpace?

Christine

Yes. It's that easy. What I can tell you about HealthSpace is that the project has been throughall of the work that we had to do around the IT moratorium and Government, and the project'sbeen through all of that, and come out of it positively. So we're now jut kind of back nowinto now that we have the authority to continue, exactly how do we structure that and whatdo we do.

Peter Goodaire, South Birmingham

I would be interested to know whether you see the current reconfiguration, or proposedreconfiguration of the NHS as a real risk to delivery of the innovation revolution? What I havein mind here is obviously the Consortiums, the GP Consortiums, are beginning to formulate,and it will take some time before that beds in. So how do we gain traction for delivery of theinformation revolution in this rapidly changing environment?

Christine

I wouldn't say that the reconfiguration of the NHS is a risk to the information revolution. Iwould say that there is a risk that if we don't deliver the information revolution that we won'tenable the reconfiguration of the system, because it's very clear that we're moving forwardwith the reconfiguration of the system. And it won't be held up because we drag our feet. Sowe do have to get that timeline clear on that's going to happen in PCTs and SHAs, GP

Consortia, the National Commissioning Board, working out how we deliver the information

needs of that structure and how we do that over time. And it might be a case that we deliver instages to actually reflect the development of that whole new organisation system. As youwould in any business reorganisation, if you were doing a big merger acquisition, disposal,whatever it is, you would have to work to the timetable that the organisation had regardless ofjust how challenging that is. And I don't want to underplay what's going on in health at theminute is a very big change. And it is a change for all of us who work in the system, andeverybody who supplies to the system. I think that the changes are laid out in the White

Paper, and we are committed to delivering on that White Paper.

Now obviously all of that is subject to what happens in terms of putting the Bill throughParliament. But we are behaving as if that is the way things are going to be, and are buildingour implementation plans to deliver in those timescales. And we will need everybody workingtogether to make that happen. Which is one of the reasons why when Mary asked about sowe're consulting now on the information revolution then we will publish the information

strategy, we're going to consult again. And saying, no, actually as we lay out our plan, we'redoing the consultation now, we need that to be as rich as possible, because then we need topublish the information strategy and move on into the implementation, and how theimplementation mirrors the implementation of that rest of the system.

So the goal is to deliver what's in the White Paper, and the information revolution supportsthat and the critical thing about what's in the White Paper is around delivering improvedoutcomes and doing that with patients at the centre of the system.


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Zac Pandora, Herefordshire NHS and Herefordshire Council

Can I ask a question about NHSmail. Is that likely to be a cloud-based offering across allpublic sector, or is it going to be restricted to the NHS? And also associated with that, do weknow whether it's going to be continue to be funded kind of free at the point of use for theNHS beyond its current contract?

Christine

On the second part of your question, we don't know that yet. What we have is a set ofservices that were designed as part of the National Programme.We've got a number ofcontracts that go with that. And then the new design of the system, how we are going to runsystems like NHSmail, assuming we choose to continue with it, then we have to work thatthrough, and who's going on what, I don't know the answer to that yet.

On the first part of your question - do we see NHSmail being a cloud-based system, and dowe see it kind of going across the rest of Government? It's quite interesting becausewhen you read about clouds, you talk about public and private clouds, and NHSmail, if youlook at the scale of it on its own. If you just think about it as a third party provided servicesthat you basically go through the Internet and connect to. In terms of that being a privatecloud, it would be one of the largest private clouds around. So in terms of a secure private

environment, by any other label, what you have is already a cloud. So that is how I seeNHSmail as it is today.

In terms of would we look to go across Government? Certainly email systems would be acandidate for us looking across government at public services either for us to participate in,you know, so if there is a secure email system developed for all Government departmentsand local government and everybody else, then if that delivered for us a better unit cost thanthe unit cost we've got today, why wouldn't we go into that?

In terms of our system becoming that for everybody else, if we have the most efficient system,and others across Government wanted to share in that, why wouldn't we do that?

So certainly in terms of the things that have happened through the Cabinet Office in thesummer, taking a look at things like network connectivity, email services, the sorts of services

that you would see as more of a commodity, if the specification for those things is similar thenwhy wouldn't Government departments share it? So certainly people are talking about that,exactly how it will turn out, I don't know.

Joe Waller, BT.

You've talked about control of the patient record, and you've talked about it specifically inrelation to being able to download the record, and hold it, and then decide where it can go to.

But I think what the patients often think about when they think of control of their record inaddition to that, is actually the ability to know who sees and who uses, and who changes theirrecords, because once you've downloaded it, you've still left a record elsewhere, and there'sstill records all over the system. And I think it's really that aspect of control which is perhapseven more important to the patients. Do you have any plans to kind of provide that kind ofinformation about use and access to patient records, perhaps through HealthSpace or

something like this?

Christine

Certainly the information is on the system in terms of who has looked at your record. So ifwhen we're talking if through this consultation process what comes back is what we want tosee is not just kind of, yes, my last blood test, but we want to actually see who's been lookingat it, there's no reason why we couldn't extract that and pass it on. There's no reason why interms of the possibility to alert people if somebody goes and looks at their record, that'spossible. But as I keep talking I know the technical guys behind me are going, oh my God, Iwish she'd shut up.


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But, I think in terms of what patients really want, it's going to be very interesting for us to findout, but if I think about myself, I want to do more than just see information, I want to transactmy business online. So if I can go and look at my record in the GP system, why can't I look atthe appointment system and book a slot, you know? Why can't I see the results of my testand then virtually have a conversation with some expert on line. Why do I have to wait untilI'm referred to go to a particular clinic, you know? I think that for me personally, which isdefinitely not Government policy, but for me personally I think that we are at a point in time

where citizens today no longer thing it's enough to just get access to information and to see it.They want to actually use that information to do something, and to do something differently.And we heard the Minister talk about that today, it's not enough that you can just, for

example, go on and read book reviews, you want to order a book and have it send to you. It'snot enough that you can compare prices of flights. You want to book a flight, get yourboarding pass and have that boarding pass that's on your phone, get you through security.And I don't know why we would think that in health we are going to be immune to thoseneeds, because there's a whole generation of people who are growing up wondering whythey can't just do it for themselves. And we have to find a way to deliver that.

Documents

Christine Connelly Q&A at eHI Live