Thread by @DavidHancock6

1/17 Been reflecting on the Joining up care for people, places and populations White Paper published 8th Feb 2022. The announcement on “Managed Convergence” of #EPRs last week has made me go over it again and it raises more questions for me on the Transformation Agenda - a 🧵

2/17 The White Paper’s intentions are laudable, who could disagree with what it is seeking to achieve? However the Digital and Data Section is extremely ambitious. Is it achievable and is it really focussing on the right things to deliver? assets.publishing.service.gov.uk/government/upl…

3/17 Each ICS will have a single health and social care record for each citizen by 2024. This relies on digitisation of existing 1/3 to 1/2 (70 - 100) of Trusts who have inadequate digitisation by end of 2023 and digitisation of all of #socialcare by end of 2024

4/17 This needs to be done at a time of unprecedented demand with the backlog where people waiting longer than 12 months is not planned to be eliminated until March 2025
england.nhs.uk/coronavirus/wp…

5/17 Where Patient flow is at its most sclerotic for yea6s. For example A&E wait times are all going in the wrong direction and are at their worst for at least 15 years
nuffieldtrust.org.uk/resource/a-e-w…

6/17 and there are huge issues with delayed discharges from hospital. In early January 2022 there were nearly 12,400 patients fit to be discharged who could not be as there was nowhere suitable to discharge them to.
bmj.com/content/376/bm…

7/17 We have a system running extremely hot already. There's a huge workforce shortage - c100,000 vacancies in the NHS and c122,000 in Social Care. Does the system really have the capacity to do Digital Transformation at the same time as all this? commonslibrary.parliament.uk/the-health-and…

8/17 Is the Gvt going for great headlines today and hoping everyone forgets about its commitments? In 2013 the Gvt said the NHS should be paperless by 2018 & for digital information to be fully available across NHS and social care. Sound familiar?.
gov.uk/government/new…

9/17 the #NPfIT programme started in 2002 was due to be complete by 2010 and finally scrapped in 2015. Are these ambitions REALLY achievable and if it is isn’t, what good is there setting these objectives for the service? Are we learning from our history?

10/17 Furthermore, in the Digital and Data section there is a very worrying detail that shows the Gvt still does not understand how to successfully land “Digital” and how it still works very top-down. This perhaps reflects the Gvt wanting to direct how the extra money is spent

11/17 Mandating standards on how information is collected & stored is top-down enforcement. Focusing on collecting data will lead to clinician/care giver burnout as John Halamka said at @DHSummerSchool in 2019

https://twitter.com/jhalamka/status/1083493304573022208?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1083493304573022208%7Ctwgr%5E%7Ctwcon%5Es1_c10&ref_url=https%3A%2F%2Fpublish.twitter.com%2F%3Fquery%3Dhttps3A2F2Ftwitter.com2Fjhalamka2Fstatus2F1083493304573022208widget%3DTweet

12/17 Standards on how data is stored in a common way across the entire system will mean applications having to be rewritten from the ground up and will halt innovation for the next 5-10 years. This is exactly what happened in #NPfIT – hasn’t anybody learned?

13/17 What this paper should say is “we will mandate standards on how data is provided and consumed between applications and the APIs they must support. We will expect systems across and between Health and Social Care to get data from source and not by rekeying data”

14/17 Anybody remember the Policy paper The future of healthcare: our vision for digital, data and technology in health and care - Published 17 October 2018. One of the best things produced as a vision but sadly not executed on. gov.uk/government/pub…

15/17 Is this paper written by people who do not understand the difference between standards for collecting and storing data and #interoperability standards? If so that is very worrying.

16/17 This White Paper with its over ambitious targets and it focus on collecting and storing data plus the announcement on managed convergence makes me fear that those writing policy have not learned the lessons of IT in Health and Social Care over the last 20 years.

17/17 I hope this strikes a chord. Want to discuss and also understand how #interoperability of #EPRs is so important and how #interoperability solutions can solve these issues, come to stand B14 at @DHRewired @InterSystemsUKI