Northern Ireland’s health service has been substantially reformed in the last two years, under the direction first of Peter Hain and his team of direct rule ministers, and now by the devolved health minister, Ulster Unionist Michael McGimpsey. The common driving factor has been to streamline a wastefully bureaucratic system and allocate more resources to front line services.
The structure of services in Northern Ireland is significantly different from that in Great Britain: social services, public health and the fire service are responsibilities of the Department of Health, Social Services and Public Safety (DHSSPS) rather than local government. Until last year, there were 19 health trusts but now there are just six.
The next stage of reform in April will be the replacement of four health and social services boards by a single Health and Social Services Authority; 15 local health and social care groups become seven local care groups; and four health and social services councils merge into a Patient and Client Council.
Other quangos will merge into four new agencies, one of which – the Business Services Organisation for back office operations – is under review.
Overall responsibility for health IT lies with the Directorate of Information Systems within the DHSSPS. Until recently the department ran a distributed server infrastructure, using 105 servers. This has now been replaced by an IBM system using two data servers. The centralised data warehouse is used by DHSSPS to monitor individual trusts’ performance outcomes, such as in the reduction of waiting lists, and is intended as the basis for an integrated electronic patient record system.
A limited electronic patient record system was installed last year in Northern Ireland’s hospitals, with BT contracted to deploy the Sapphire Theatre software produced by Newgate Technology. The system was designed to provide theatre staff with immediate access to information on patients and to improve the administration and management of operations and theatres.
Although it has not yet committed itself, the Northern Ireland health service has also given itself the option of adopting a patient management system jointly procured with Scotland. The Scottish government published the tender early last year.
In 2003, Steria won a 10 year contract worth £26.7m to provide the linkage between the health and social care trusts and agencies, including the 350 general practices. Its Health and Care Number system now shares patient information across all health bodies.
The contract required Steria to update the email, internet and electronic inter-system services for all surgeries. Steria had responsibility for all aspects of design, build and managed services, which runs through the IBM hardware platform and uses iSoft software.
iSoft’s software recognises all patients using their Northern Ireland health care number, with a central index that cross-references and confirms identities. All the province’s hospitals use iSoft’s Clinicom patient administration system, which is also the basis for the sharing of electronic imaging.
A contract was awarded in October last year to Sectra to provide the technology for managing radiology information, picture archiving and sending RIS/PACS images across Northern Ireland. The 10 year contract was valued at £30m.
US corporation Partners HealthCare was awarded another technology contract last year to improve healthcare management practices. It covers remote monitoring of patients, reflecting the devolved government’s ambition of telemonitoring 5,000 patients by 2011. The contract is also tied into the creation of the European Centre for Connected Health, which is intended to bring together public and private sector health and bioscience professionals and boost the telehealthcare sector in Northern Ireland.
Dr Jimmy Courtney, of the British Medical Association, says that despite the investments, there remains a heavy reliance in the hospital trusts on old legacy systems. “A clinician will often have to look-up a record from a legacy system and have to log onto five or six different systems,” he says.
Nor, he says, are patient records effectively integrated. “If the patient is from a different trust, you may not be able to access the patient details,” says Dr Courtney. “The patient administration has been around for 15 years or so. It does need to be replaced, but there is nothing around to replace it. There is a lack of compatibility between systems. You can’t access information from other trusts at present.”
Dr Courtney adds: “It is still work in progress on the amalgamations [of trusts] from last year on IT systems.”