Table 1

Assessing the framework against the Hayes principles2 (page references are to the framework2)

Patient-centred principles
The patient must be at the centre of all information systems.ExcellentThe framework is strongly patient centric and its theme is ‘personalised care’ for patients and citizens.
The provision of patient-level operational data should form the foundation – avoid the dataset mentality.GoodThe objective (page 32) is ‘collecting all the information required to support direct clinical care and the analytic needs of health and care, once and once only at the point of care’, but datasets are needed until that is feasible.
Store health data as close to the patient as possible.Less relevantThis principle set out how trust was key in sharing data. The closer physically data are held to the patient, the greater the willingness to share. Maybe less relevant in the age of the ‘cloud’.
Enable the patient to take a more active role with their health data within a trusted doctor–patient relationship.ExcellentThe self-management aim is fundamental to the framework.
Subsidiarity principles
Standardise centrally – patients must be able to benefit from interoperability.GoodAdopts the forward view idea of ‘central standards, with explicit and extensive permissions to unleash local energy and enterprise’ (page 13).
Provide a standard procurement package and an approved process that ensures safety standards and provision of interoperable systems.GoodThe framework leaves procurement to local decisions: ‘we will be tight on standards and definitions, and clear on expectations regarding interoperability, but we will support local decision-making on systems, programmes, interfaces and applications…[local health and care communities will] decide upon and procure their own solutions, provided they meet nationally specified technical and professional standards’ (page 17).
Authorise a range of local suppliers so that health providers can select the system best meeting local needs.GoodProposes ‘local buying consortia’ and raises the possibility of replacing GPSoC with direct funding to allow greater freedom of choice of supplier (page 52).
Allow local migration from legacy systems, as and when improved functionality for patients is available.GoodThis is implicit in the previous point.
Strategic principles
Evaluate health IT systems in terms of measureable benefits to patients.WeakThe concept of evaluation is acknowledged but insufficiently developed, as argued above.
Strategic planning of systems should reflect strategic goals for the health of patients/the population.GoodIn the context of transparency, the framework says it will take account of work by the Department of Health, NHS England, Public Health England and the Local Government Association to ‘develop and align the outcomes frameworks for the NHS, public health and social care’ (page 38).