Intended for healthcare professionals


The future of healthcare systems

BMJ 1997; 315 doi: (Published 11 October 1997) Cite this as: BMJ 1997;315:952

Many questions about reform of health sector remain unanswered

  1. Peter Bundred, Senior lecturer in primary carea,
  2. Lain Buchan, Research fellowb
  1. a University of Liverpool, Liverpool L69 3GB
  2. b Medical lnformatics Unit, University of Cambridge, Cambridge
  3. c Health Services Management Centre, University of Birmingham, Birmingham
  4. d School of Postgraduate Medicine, University of Bath, Bath BA2 7AY
  5. e Health Services Management Centre, Birmingham University, Birmingham B15 2RT
  6. f NHS Executive
  7. g East Norfolk Health Authority, Norfolk NR7 0HT
  8. h Wessex Institute for Health Research and Development, Winchester SO22 5DH

    Editor—The NHS has been in a state of exceptional change for almost 10 years, and these political changes in the structure of the service will continue if the contents of a recent executive letter from the NHS Executive are to be heeded.1 Richard Smith's editorial on the future of healthcare systems highlights the need to move the debate forward to a non-political phase, which must include the re-engineering of the whole health system.2 The move from industrial age medicine to information age health care described by Jennings et al is fundamental to this process.3 Information technology and health knowledge systems must be at the heart of these changes. Differentiation of highly specific clinical information from generalisable knowledge for healthcare workers will become more important. Systems will need to be produced to manage both human resources and appropriate developments in technology; changes should not be driven purely by technological fashion.

    Other issues in this re-engineering process include the changing roles of health professionals. Fundamental questions on interdisciplinary team working need to be asked. Nurse clinicians are now taking over a considerable volume of work from the doctors they are replacing. Who will be responsible for clinical care in this setting? Work traditionally carried out by doctors is increasingly being done by nurses; what role will doctors have in information age health care?

    New methods of clinical working are being introduced into the NHS. Evidence based medicine, integrated care pathways, and clinical protocols are beginning to have an impact on the quality of health care. …

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