Exploiting the information revolution: call for independent evaluation of the latest English national experiment

Background - The English National Health Service (NHS) has a long history of national experiments with information technology; some successful, others less so. The NHS England Five Year Forward View aspires to ‘Exploit the information revolution’ through the transformational work of the National Information Board (NIB). NIB has published a ‘Framework for Action’ that promotes citizen empowerment, information availability, transparency, public trust, innovation, informatics skills and societal value.

Issue - The framework sets out many laudable and common sense ambitions, but is light on evidence to support its aspirations, or plans for its evaluation. Considerable resource was invested in evaluation studies in the later stages of the National Programme for IT in England, but the analyses do not seem to have been included. Most of the cited evidence is from an unpublished report by management consultants rather than independent peer-reviewed work.

Recommendation - National experiments of this importance should be evidence based and properly evaluated so that each iteration of ‘information revolution’ produces an evidence base to inform subsequent generations of care provision models and technology innovation. Evaluation should be planned from the very start rather than added in as an afterthought. Like any good business plan there should be defined critical success factors for health and social care, and a declaration of how they might be measured. Unintended consequences should be qualitatively explored. Evaluation should also consider critical-interpretive social perspectives to understand the human factors in technology deployment and should seek a theoretically informed insight into the mechanisms of change.

Conclusions - The NHS Five Year Forward View and the NIB framework set out challenging ambitions based on transformative use of information technology and collaborative partnerships with commissioners and providers. The framework stands up very well against the Hayes principles, but the learning opportunities associated with this programme should not be missed.