Health informatics must be made accountable

In the run-up to the 1974 NHS reorganisation, while Edward Heath was prime minister, the Department of Health and Social Security chose to classify computer staff and costs as administrative and clerical. The obvious alternative was professional and technical, which covered medical laboratory staff.

‘The decision to classify computer staff as admin and clerical led to degradation of status and technical prowess’

This strategic decision, deplored by many at the time, can be seen in retrospect to have been the first of a chain of events that undermined the development of health informatics in the English NHS.

Internationally, in the late 1960s governments established experimental computer programmes, mainly in teaching hospitals, and during the mid 1970s the English programmes were state of the art.

With the exception of England, these projects ran their course and the units were converted to university health informatics departments that still flourish today.

In England, the units were gifted to those who ran the regional payroll systems. Since then health informatics units in English hospitals have reported to finance chiefs and lost their edge.

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Lack of provision

A major consequence of being classified as an admin and clerical function was that little or no provision was made for undergraduate and continuing education.

A search of the UCAS website reveals just one undergraduate course matching health informatics or similar phrases. This course is Medical Sciences (Environment and Human Health), which sounds more like public health than health informatics.

Five universities in England run postgraduate master of science courses in health Informatics. In contrast, 57 universities run undergraduate courses in microbiology.

The National Information Board has a workstream, supporting care professionals to make best use of data and technology, which recognises that health and social care staff need knowledge and skills to use information, data and technology appropriate to their role.

It plans to deliver a roadmap for a faculty for health informatics for clinical practitioners and a Federation for Informatics Professionals for non-clinicians. 

Having two bodies risks perpetuating the clinical-clerical schism. What matters are knowledge, capabilities and accountability - not initial training.

‘Having two bodies risks perpetuating the clinical-clerical schism’

Historically, the UK has lacked a single independent body for health informatics professionals. Of the 32 countries in the European Federation for Medical Informatics, every country apart from the UK is represented by a specialist medical or health informatics organisation. The UK is represented by the Chartered Institute for IT.

However, only one or two of the 34 people on its council have any background in health informatics. A similar pattern is found in trade associations. TechUK is the leading UK trade association for health informatics, although none of the members of its health and social care council sits on its governing body. 

Lack of independence proved important in the past, although we should be looking forward not backwards. On two occasions health informatics groups saw an existential need to lobby against ill considered government initiatives, but were vetoed by their governing bodies from making their views public.

The first situation followed the 1992 election, which John Major won unexpectedly. The government was stung by the claim made by the Labour opposition that management costs (admin and clerical functions) had doubled in the previous five years.

An easy target

The easiest targets to cut were health informatics projects - they closed down four important national initiatives and sold off 14 regional computer centres without ringfencing their budgets.

In addition, they required that all capital expenditure on IT systems over £5,000 be accompanied by a full business plan, tested for private finance, and approved by both the DH and the Treasury.

Expenditure fell predictably but the health informatics industry was decimated.

The second situation was at the start of the National Programme for IT launched in 2002.

‘The time is overdue for health informatics to become professionally accountable’

This was flawed in the hubris of Tony Blair’s initial conception of the scheme at 10 Downing Street, and by the programme leadership’s failure to take advice from those with greater experience in healthcare computing.

Contract transition and exit costs continue to accrue in 2015. The market has yet to recover.

It is difficult to imagine that these things would have happened like this if the Department of Health and Social Security had had the wisdom to treat health informatics as a profession 40 years ago.

The decision to classify it as admin and clerical led to degradation of status and technical prowess, failure to provide education, training and professional development. It paved the way for the calamities of the 1990s and 2000s. 

The time is long overdue for health informatics (along with non-clinical hospital managers) to become professionally accountable to an appropriate regulatory body on par with the clinical professions.

Tim Benson FBCS is co-founder of R-Outcomes and author of Principles of Heath Interoperability HL7 and SNOMED