Is the NHS getting better or worse?

Editor—Smith's editorial on assessing quality of and in the English NHS underscored the essential role of good information at all levels.¹ It appeared on the same day that the Nuffield Trust launched a volume of essays on the importance of vision, value, and innovation in health information.²

However, the editorial perpetuated the frequent confusion between information and data and assumed that evidence would emerge by osmosis. The government, NHS, health professions, and commentators all continue to abuse the information sector in health—assuming that top-down direction on information technology and short term programmes will automatically yield the “right” answers to expedient questions.

But true investment in information, its development and use, and above all in trust in the data and authoritative analyses, get sidelined. At the same time, the leadership role of the NHS Information Authority is undermined and the field fragmented by the allocation of sections of activity to the central procurement function and to the Modernisation Agency, so no one body is empowered to lead the information function.

Other models exist but are ignored—for example, in Canada the Canadian Institute for Health Information is managed and funded jointly by the government and the provinces (www.cihi.ca). Detmer has recently called for a new authoritative independent UK body to guide health policy development, founded on the impartial gathering and analysis of evidence.³

An integrated commitment to a true health information function seems more robust than fragmented special agencies, but is politically unattractive. We may not be sure whether the NHS is getting better, as we lack the information. But we can be certain that the understanding of and commitment to health information are not improving as they should despite investment in technical systems, because of the lack of core commitment to an objective integrated approach.