Making IT Happen - The Slow Road to and IT Nirvana

For the last nine months, the Make IT happen campaign has been mirroring the concerns felt by health visitors and community nurses across the UK that they are losing out when the fruits of the IT revolution in the NHS are being distributed. It will, indeed, be a long road to the IT Nirvana.

The case being put forward by the Community Practitioners’ and Health Visitors’ Association (CPHVA) and the Community Psychiatric Nurses Association (CPNA), both organisations are part of amicus, the UK’s second largest trade union and if our members benefit by having computers, the right training and the access to the internet, so, ultimately, do patients and clients.

Our argument is that the government has provided the funds for IT, our members are keen to have it, but somewhere in the system, it is not happening to the extent that it needs to be.

To back up this assertion, the CPHVA conducted a survey of its members last summer, which revealed that:

  • Seven out of ten health visitors and school nurses would "significantly" improve their service to clients if they had full access to information technology i.e. a computer on their desk, access to the internet and the right training.

  • A staggering, four out of five community practitioners who do have computer access at work have to share with, on average, seven other colleagues.

  • 66 per cent of community practitioners don’t have access to the internet

  • 65 per cent don’t have use of email

  • Three out of ten don’t have access to any computer in their workplace.

These figures underline the case that the government’s £1 billion drive to ensure that all NHS clinical and support staff should have desk top access to basic email, browsing and directory services by March 2002 has not been implemented uniformly at local level. Community practitioners always appear to be last on the list.

The CPHVA is currently conducting a new survey of its local representatives to ascertain what progress is being made in the spring of 2002. We are not expecting over optimistic feedback from this exercise.

So where does the problem lie?

One area of concern is that middle managers in the NHS are thwarting the government’s determination to ensure that health visitors and community nurses enjoy the full benefits of the IT revolution in the health service.

While it may be unfair to say that this is happening deliberately, there is justice in the perception - and all too common reality - that community nurses are at the back of the queue when it comes to obtaining even a basic computer, a given in many other organisations.

Managers reading this might ask: ‘Who says that health visitors should be in the forefront of the IT revolution?, quickly followed up by the supplementary: ‘Where are the facts to back up this claim?

The answer to the first question is the government. And the second answer is that the Community Practitioners’ and Health Visitors’ Association has already revealed the depressing statistics regarding the lack of IT access.

The government’s view is unambiguous. As long ago as 1998, Prime Minister Tony Blair said: ‘The challenge for the NHS is to harness the information revolution and use it to benefit patients.’

In January 2001, health secretary, Alan Milburn said: ‘In the last two years we have made an additional £214 million available to support modernisation of NHS information systems.’ More money is available in the next three years.

The CPHVA believes the fact that health visitors and community nurses are not benefiting from the NHS’s IT revolution is now a major clinical governance issue, which must be addressed by clinical governance departments.

The problems are all encompassing and some of them are outlined below:

  • Health visitors and community nurses who often work in isolation cannot benefit from rapid communication by email

  • They cannot easily contribute clinical information to general practice patient records

  • They cannot utilise computer based patient information for profiling

  • They cannot set up computer based systems for managing their work and recording outcomes

  • They do not have rapid access to the National electronic Library for Health and research evidence

  • They can’t easily access much of the important information relevant to public health practice which is now largely web based

  • They cannot download information for patients

  • They have to rely on clerical support to type letters and reports

  • They cannot be accessed rapidly with safety alerts and other patient information, such as that interpreting media 'scare' stories

  • They cannot access professional email discussion groups which are proving an excellent source of national debate on important clinical issues and provide professional development and networking to those able to participate

  • They cannot contribute to email consultation on national initiatives. For example, all National Institute for Clinical Excellence consultations take place on email. Increasingly these are of interest to community nurses, but without a computer access will be denied to them. The outcomes could be medically biased as a result. If they are, this could affect later ownership by nurses.

As you can see, if clinical governance is to be given the seriousness that it is due, access to IT must be provided for health visitors and community nurses. They go hand in hand.

The CPHVA contributes to many national committees supporting development of the national information agenda. These include the Nursing Professions Information Group (NPIG), the National electronic Library for Health, branch library for Primary Care (NeLH-PC) and the Child Health Informatic’s Consortium (CHIC) as well as meeting regularly with representatives of the other nursing bodies and NHIA. It is therefore particularly frustrating that its membership is yet to reap the benefits of electronic developments in the workplace. In particular we expect the NeLH to prove an invaluable tool for supporting public health practice. Surveys have shown that most web access by our members takes place between 9 and 10 in the evening, at home.

Another reason for the lack of investment in community nursing could be the confusion of the term ‘primary care’ for ‘GP services’. Too often, money has been invested in GP practice IT systems, without regard to the information needs of community nurses. Now is the time to redress this imbalance.

We all have to work together – managers, doctors, nurses and PAMs – to make the NHS Plan and the individual healthcare plans for Scotland, Wales and Northern Ireland work for the benefit of patients.

Health visitors and community nurses need the IT tools to provide a first-class service to their clients.

The money is there, the government will is there – it is now time for NHS managers to make it happen big time for community nurses.

The CPHVA’s campaign is reaping success across the country. One good example is the North Durham Health Care Trust where community nurses were receiving 100 computers.

Should you wish to know about the CPHVA’s views, please contact: , Professional Officer, Research and Practice Development

Tel. 0771 2678281

, Professional Communications Officer

Tel: 020 7939 7043