A force for revolution

20 December 2012

Tim Kelsey has some big ambitions to transform the NHS but his vision is still lacking buy-in from some clinicians. Does the NHS Commissioning Board have what it takes to break down resistance? Matthew D'Arcy reports from Public Service Events' Digital by Default conference

Tim Kelsey wants to bring about a "data revolution" in the health service – something he feels strongly everyone in the service needs to embrace. To some he is a visionary, but is his vision realistic?

The man who was appointed as the national director for patients and information at the NHS Commissioning Board during the summer has already shown his ambition is more about improving care and saving lives than it is about advancing digital technologies.

Kelsey, formerly the government's transparency tsar, wants to hold the NHS up to the same light, so that doctors' performance data for improving patient outcomes is highly visible and innovators can use NHS information.

But despite now having eliminated many of the turf wars by taking on the responsibilities of chief technology officer, chief information officer and marketing director all in the one job, he is still not without opposition.

"We are running out of time," Kelsey told the Digital by Default event. Having recently survived a conference of hundreds of clinicians, he wakes every day to start work feeling "engulfed and slightly panicked".

"It was quite the pinstriped brigade. I started to talk about transparency, participation, and I could see the audience dividing."

He spoke to them about the importance of data, openness and outcomes – "all the things that really matter". He thought he was winning after the first upbeat question. "And then I got the question from the guy at the back in his pinstriped suit."

The public health doctor didn't mince his words. "Mr Kelsey, you are a visionary," he said. "And I think your vision is total nonsense." A ripple of applause followed.

Kelsey wants to create a data-rich environment in the NHS, one that entrepreneurs can use to develop digital platforms that will "truly revolutionise things".

"This is really not about technology, this is absolutely about culture and change and explaining to people why this is not just some new fangled thing that cool guys in the East End take seriously. This is something that will fundamentally improve the sustainability of our public services. This is about making the case for change," Kelsey told the Digital by Default conference sponsored by KANA.

He aims to create a new "social movement" in the NHS with open data at the forefront of clinical practice. The NHS should be "putting the patient voice in the middle of everything and making it the defining characteristic of the future of our system".

Central to this will be a requirement for every primary care clinician to provide a standardised set of data that can be used to assess the quality of their service. "At the moment about 2,000 people each year die because they are prescribed antipsychotic drugs when they have dementia," he said. "Generally speaking that is regarded as bad practice, bordering on severe negligence. At the moment we can't tell which GPs are doing that."

There was no meaningful data on mental health, children's services or on primary care. "You name it, it's not available, but it does largely exist," he explained. "We need to get that data, liberate it and stick it in the hands of people who will make value with it."

He recalled the ordeal of his mother, a GP, when she became a whistleblower on a "tragedy" in which a consultant had been "stuffing mammograms down the back of his radiator", ignoring referrals from GPs. Kelsey recalls inquiry findings that at least 11 women and perhaps as many as 50 had their lives shortened as a result.  "Data transparency at one level at least is about life and death."

A paperless NHS is part of his vision – a term he keeps getting "ticked off" for. "Of course I am not going to deliver a fully paperless NHS by spring 2015, but I am going to deliver paperless referrals in the NHS by 2015 so that we no longer have GP letters flying around, arriving late," he told delegates. "These are not just inconveniences, they are in some cases real threats to patient safety. People get forgotten."

The NHS will now have its ebooking system relaunched in a major undertaking that is set to "transform the way in which customers, patients, engage with the service".

He no longer wants patient records kept in "tatty folders". Thousands of manila envelopes in hospitals that can be lost at any time can be "truly catastrophic". "So let's end treasury tags and rubber bands and let's start dealing with a data based digital health service."

How can he make this happen? Some clinicians may still feel threatened by his "nonsense", but Kelsey is operating in a new health landscape. The NHS Commissioning Board has "real power", he says. It distributes the government's £100bn healthcare spend, and it will do so on the basis of outcomes.

"A service that can't tell us whether or not it is providing a certain standard of quality for patients theoretically won't get any money," he said. "These are very meaningful powers which are now consolidated for the first time in a way they haven't been before."

This distribution of money from the centre is the means by which he intends to enforce big changes and fulfil his vision.

This article first appeared in Public Servant magazine