Kelsey departs as England’s e-health project faces further criticism

The departure of Tim Kelsey looks like more bad news for England’s plans to introduce electronic records for all National Health Service patients.

Kelsey has been leading the initiative since 2013 as NHS England’s national director for patients and information, but the ambitious project has been beset by problems and setbacks.

The plan to extract anonymised data from patients attending GP surgeries and hospitals could help make England a world leader in electronic patient records, and allow patients to reap the benefits with less error-prone and more joined up care. However the project has been looking shaky ever since patient and doctors’ groups claimed last year it could breach confidentiality rules.

Despite all these problems, the UK government wants to press ahead with a phased introduction of the system. Shortly before Kelsey announced his departure late last week, health secretary Jeremy Hunt pledged that patients would have access to their primary care records online by 2016, with all hospital records available by 2018.

However the government has also acknowledged that it must ensure adequate safeguards to protect patient privacy. The assertion that data could be traced back to patients and was not truly anonymous resulted in a six-month hold on the pilot phase of the programme, and prompted an ongoing investigation into its opt-out provisions by Dame Fiona Caldicott, the UK’s National Data Guardian.

The data collection pilots resumed earlier this year – at a much small scale than originally intended – but were hampered by more than 700,000 people opting out of the scheme. The project was paused once again in June when it was deemed to be failing and “unachievable” by the government’s Major Projects Authority (MPA).

It concluded there are “major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable.”

The MPA gave a red light – its lowest rating – and identified a number of issues that needed to be addressed, including the appointment of a “full-time, senior responsible owner”, and Kelsey’s exit is only likely to exacerbate that issue.

Other deficiencies identified by the MPA included a need to “reconstitute the programme board with a clear role and responsibilities; approve explicit go/no go criteria; agree and clarify finances; assign owners to key risks; and recruit key personnel.”

Adding to the pressure on the scheme, a report by researchers at the University of Cambridge published in the journal Technology Science concluded last month that “faces multiple challenges due to its mismanagement and miscommunications, inadequate protections for patient anonymity, and conflicts with doctors.”

Kelsey is leaving NHS England after three years to take a job in the private sector in Australia, joining digital and mobile specialist Telstra Health as its commercial director.

“It has been an enormous privilege to work with such talented and committed colleagues at NHS England and across the wider health and care service,” he said in a statement.

“Together we have made the case for a digitally-enabled NHS in which patients are encouraged to participate.”

It is not yet clear whether Kelsey’s departure will add further delays to the launch of the scheme, but a more piecemeal approach to its introduction next year looks likely, given the scale, complexity and sensitivity of the project.

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