NPfIT Specifications and Policies
From Nhs It Info
Output Based Specification (OBS) for Integrated Care Records Service (ICRS) (2002)
CfH
http://www.dh.gov.uk/assetRoot/04/05/50/49/04055049.pdf
"This document provides an introduction to the ICRS OBS. This OBS is being provided to longlisted bidders for the provision of ICRS solutions and certain other services as part of the procurements being undertaken by the NPFIT."
OBS2 For Integrated Care Records Service (ICRS) V2 PT1 (2003)
CfH
http://www.dh.gov.uk/assetRoot/04/07/16/30/04071630.pdf
(The above are the two public technical specifications that could be located for this service.)
The Clinical Development of the NHS Care Record Service (Version for Feedback) (July 2005)
CfH
http://www.connectingforhealth.nhs.uk/crdb/docs/scrrdocument.doc
"This report . . . sets out how the vision for a patient care record, compatible with the commissioned architecture and the NHS Care Record Guarantee, can be achieved. It describes an incremental approach that will build public and professional confidence, establish working practices and allow for the effective evolution of the whole NHS Care Record Service."
The Care Record Guarantee (May 2006)
CfH
http://www.connectingforhealth.nhs.uk/crdb/docs/crs_guarantee.pdf/download
"In the National Health Service in England, we aim to provide you with the highest quality of care. To do this, we must keep records about you, your health and the care we have provided to you or plan to provide to you. This guarantee is our commitment that we will use records about you in ways that respect your rights and promote your health and wellbeing."
Information governance in the Department of Health and the NHS
CfH
http://www.connectingforhealth.nhs.uk/crdb/docs/information_governance_review.pdf/download
"I define ‘information governance’ as: “the structures, policies and practice of the DH, the NHS and its suppliers to ensure the confidentiality and security of all records, and especially patient records, and to enable the ethical use of them for the benefit of individual patients and the public good”. Effective information governance is necessary to be sure that the new opportunities that the National Programme for IT promises will be effectively and safely realised and so that public confidence in the electronic NHS is secured. Whilst my review focuses on the areas specified in my remit, I undertook it with recognition of the wider context of information governance which includes both the Office of the Information Commissioner and other government departments and organisations. . . Although I am clear that the present arrangements will need to be improved to support an electronic NHS, I found no committee, group or individual not doing their best in the circumstances within which they were working. None of my comments or recommendations should be taken as criticism of individuals." [Harry Clayton, National Director for Patients and the Public; Chair, Care Record Development Board (2006)]
National Programme For Information Technology (15 Nov 2006)
South East Coast Strategic Health Authority
". . . Repositioning the NPfIT within the NHS - Whilst NHS Connecting for Health (CFH) has achieved a level of success as recognised by the NAO in its recent review, the increased tempo of delivery in the next 6-12 months requires a new approach if it is to ensure an effective and efficient implementation of the national programme. If implementations are to be realised at the pace and with the assurance that all parties desire, it is critical that the programme governance arrangements, structures and processes are optimised. In particular there is a need to devolve responsibilities and accountabilities around implementation from NHS Connecting for Health to Strategic Health Authorities (SHAs) as soon as possible. The fundamental aims of the planned devolvement are: To strengthen local governance and ownership, so that the SHAs and PCTs are enabled to drive the NPfIT in an appropriate direction that achieves the right balance between national imperatives and local needs; To ensure NPfIT supports the delivery of better quality and safer services for patients, and reinforce the value and benefits that can be derived from NPfIT; To build governance structures and processes that are fit for task; To improve clinical engagement in the programme. . ."
Southern SHAs to pilot greater local ownership of NPfIT (23 Nov 2006)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2288
"The three strategic health authorities in the south of England are piloting a new model of governance for the National Programme for IT that will shift responsibilities from NHS Connecting for Health at the centre to the local NHS. . . Barbara Hakin, chief executive of East Midlands SHA, told board members in her report to their November meeting this week that NHS chief executive David Nicholson wanted four things - to see a review of the technical architecture, to deal with current criticism, a review of NHS ownership and a review of whether the NHS is being too prescriptive in the programme, a piece of work which Pearse Butler, former chief executive of Cumbria and Lancashire SHA, has been asked to handle. . ."
The NHS, Standards, Security & Identity Management (26 Nov 2006)
Connecting for Health
http://www.oasis-open.org/events/adoptionforum2006/slides/ferrar.ppt
"Summary: Open standards an integral part of the National Programme for IT in the NHS. In fact, NPfIT not possible without open, accessible, interoperable and “implementable” standards. But products that implement same standards must also be compatible and efficient. Inefficient, incomplete or incompatible implementation are less than useful – in fact its expensive & dangerous. FINAL THOUGHT: What responsibility does the standards community take to ensure effective & efficient implementation?" [Presentation by Dr. Mark Ferrar, Director of Infrastructure, NHS Connecting for Health at the OASIS Adoption Forum]
Mythbusters
NHS Connecting for Health
http://www.connectingforhealth.nhs.uk/faq/mythbusters/
"Many common misconceptions exist about NHS Connecting for Health and the programmes and services it delivers. The aim of this section is to dispel these misconceptions and enable a clearer understanding of the work of the agency."
Report of the Ministerial Task Force on the Summary Care Record
NHS Connecting for Health
http://www.connectingforhealth.nhs.uk/publications/care_record_taskforce_doc.pdf
"In our report we acknowledge that there are differences of opinion and approach between GPs, secondary care doctors, nurses, and patients. These are based on differences of view about the practicality, ethics and value of creating a Summary Care Record. Nevertheless the Taskforce is united in believing that a national care record service is desirable for patients, clinicians and the Health Service and that the Summary Care Record, cautiously implemented, in line with our recommendations, will bring real benefits in safety, quality, efficiency and coordination of care. Our recommendations deal with several matters: implementation, patient access and consent, data quality, training for staff, equity and health inequalities, urgent care, the oversight of early adopter sites and their evaluation and public information."
General Practice IT Infrastructure Specification (2006)
NHS Connecting for Health
"It is intended that this document will be used by PCTs to: Develop an understanding of the direction of travel of GP IT systems within NHS CFH, and how they impact on the developments already in progress to the way that practices are supported within the PCT; Use this understanding to make strategic decisions about support arrangements for GP practices; Estimate the needs of individual practices for an effective supporting infrastructure, based on the overall need to deliver both clinical services and local business applications; Estimate the investment required to bring practices from their existing provision to the required standard. . ."
Guidance for the NHS About Accessing Patient Information in New and Different Ways and What This Means For Patient Confidentiality (22 Dec 2006)
NHS Connecting for Health
http://www.nhscarerecords.nhs.uk/nhs/docs/guidancefornhs.pdf
"This guidance is being made available to all NHS frontline staff (i.e. those directly involved with patient care) in England. It applies equally to existing electronic record systems and the developing NHS Care Records Service (NHS CRS). It explains:
- The implications of increased access to patient information by electronic means.
- What the introduction of the NHS CRS will involve.
- The impact that increasing electronic access to patient information will have on your job and patient care."
Additional systems catalogue plans 'near completion' (1 Mar 2007)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2515
Plans for a catalogue of 'additional systems suppliers' covering a wide range of specialist clinical systems are in the final stages of being drawn up by Connecting for Health (CfH), the agency responsible for delivering the £12.4bn NHS National Programme for IT. E-Health Insider understands that the supplier catalogue plans being drawn up may cover all major departmental systems and clinical specialities, together with areas such as A+E, maternity and theatres. Services such as acute data migration and infrastructure are also thought to be covered. . . The plan would appear to be for local service providers (LSPs) Fujitsu, BT and Computer Sciences Corporation to continue to provide base patient administrations systems into which into which "best of breed" specialist clinical and departmental systems meeting clearly defined interoperability standards would then be plugged. This would be a significant departure from the strategy of single standardised systems that has previously been pursued by CfH. . . The introduction of a supplier catalogue, comprising best of breed solutions, to meet the areas not being met by LSPs is understood to be one of the key recommendations likely to be contained in the report being drafted up by the House of Commons Public Accounts Committee. Potentially, the ASCC supplier catalogue could offer a lifeline to specialist clinical suppliers. Most were effectively excluded from the NPfIT programme three years ago when CfH chose to award contracts predicated on four local service providers delivering integrated care record systems meeting most of the requirements of the major clinical communities. Plans for a catalogue of additional suppliers were first announced by Richard Granger six months ago, in which the original intent appeared to be to have additional capacity or options on call should contracted suppliers be unable to deliver. . . This 'spares' approach now appears to have evolved into a full blown interoperability strategy. EHI understands that the need for the new approach has only been accepted by CfH's leadership reluctantly. "Yes, it's been heavy weather. It's come through gritted teeth," one anonymous insider said, who indicated that the move had been dictated by the Department of Health. They added: "CfH has discovered it has disgruntled customers. It has to become more relevant." However, they also pointed out that a catalogue approach did not mean a free-for-all as in most specialist clinical areas there was one dominant supplier and a challenger. The pressure for a new approach has built due the limited success LSPs have had first in delivering PAS systems on a 'cookie cutter approach' - delivering standardised systems one after another. Even more striking has been the failure of LSPs and their software partners to develop and then deliver promised specialist departmental and clinical systems or equivalent functionality through their CRS solutions. As a result many NHS trusts - including independent foundation trusts - have grown increasingly impatient waiting for promised new and replacement clinical systems such as maternity, theatres, cardiology, oncology. In areas such as maternity some have begun to vote with their feet. An anonymous senior supplier told EHI: "The reason they are doing it is simple, there are huge gaps in the current catalogue of services offered by LSPs." In addition to struggling to meet the original CRS objectives the programme is coming under increased pressure to deliver systems that support policy priorities such as 18-week wait targets or integration between health and social care, and delivering care outside hospitals. One senior industry figure told EHI. "This looks to have been triggered by the GPSoC OJEU," which he said had effectively sounded the death knell for the single CRS solution approach that had been pursued by CfH. . ."
Working Group report on the 'Secondary Uses of Patient Information' (10 Aug 2007)
CfH
http://www.connectingforhealth.nhs.uk/crdb/secusesreport.pdf
"A considerable amount of information is collected during the provision of care and treatment, some of it specific to the patient being treated some of it not. The primary purpose of this information is to support and improve individual patient care and much of it is held under professional and legal obligations of confidentiality. However, this information, often in conjunction with other administrative health records, such as existing Cancer Registries, is of value for many other purposes to support healthcare and providing appropriate steps are taken to meet confidentiality obligations, whether through consent, anonymisation or legal authorisation, this information can legitimately be used to support these other purposes (called 'secondary uses'). . . the expectation is that data for secondary uses should be provided in unidentifiable (aggregated or anonymised) form except where specific justification can be made and approvals provided. To implement this, it will be necessary to ensure that the data is appropriately managed and made available to users. . . Many current secondary users of health information are not accustomed to being restricted to anonymised or even pseudonymised information, particularly in the case of secondary uses by people who are also primary users with routine access to unanonymised data. It is important to ensure that valid business functions are able to continue and that users for secondary purposes are supported in understanding and observing the appropriate safeguards. . . One of the reasons previously given by users for access to identifiable data is to enable linkage between different datasets and to overcome some of the difficulties of poor quality and incomplete data. The Secondary Uses Service should enable both issues to be addressed through the use of the NHS Number as a consistent identifier for data collection, and through stringent validation checks on the data being loaded. . . Whilst consent can be assumed for healthcare purposes where a patient has been effectively informed about what may occur, it would be wrong to assume consent for secondary purposes. Additional efforts to gain consent are required for these purposes. . . Where the data used is in identifiable format and generally felt to be personally more sensitive, recorded informed consent with positive 'opt-in' is more likely to be appropriate than a communications exercise and a negative 'opt-out' consent model. Where a patient has asked that their information not be disclosed in an identifiable form then there must be mechanisms in place to ensure these wishes are implemented."
