Modernise IT in the health service - but do not discourage full and open discussion

Tony Collins

Tuesday 29 July 2003 05:26

Computer Weekly responds to criticism of our reporting of More Radical Steps - a BCS/Assist health IT conference - from three specialists in their fields

Three leading specialists in their fields have sent strongly-worded letters by e-mail that complain about Computer Weekly's coverage (15 July issue) of a health IT conference at the NEC in Birmingham on 1 July.

The three criticised our coverage of the More Radical Steps conference, a "think-tank" organised by the British Computer Society's Health Informatics Committee and the Association of ICT Professionals in Health and Social Care (Assist).

One of the complainants was Marlene Winfield, head of patient and citizen relations at the NHS Information Authority, part of the Department of Health. The second was from David Young who also works for the Department of Health, as a clinical adviser. The third was from Glyn Hayes, chairman of the BCS' Health Informatics Committee, who is a GP and a senior IT professional. All correspondents are among the most respected people in their fields.

As we prepared to publish the three letters, the Department of Health decided to post them on its website. The department published them twice: on the websites of the NHS Information Policy Unit and the NHS Information Authority.

Such a decision by a government department to publish a series of independent letters to a magazine, before that magazine has had an opportunity to publish them, is unprecedented.

The purpose of the conference in Birmingham was to gather the opinions of delegates on a £2.3bn national programme for IT in the health service. Richard Granger, director-general of NHS IT, had asked the BCS and Assist to give their views on the national programme and particularly on aspects of an all-important sequence of documents called the Output Based Specification (OBS). Comprising about 600 pages, the OBS provided a specification for companies that were bidding for contracts under the NHS' national programme for IT.

In the interests of open debate and in recognition of the importance of the topics discussed at the conference, Computer Weekly has published the three letters in full on pages 18 and 19. We have also published other letters in which the writers support our coverage.

The arrival of the critical letters disappointed us for five reasons:

They impugned the motives, professionalism and ethics of Computer Weekly, and one of its senior writers. They were defamatory of the magazine and the reporter. Computer Weekly made not a single factual mistake, incorrect inference or misunderstanding in any of the articles mentioned by Winfield, Young or Hayes.
The website of the Department of Health gave Computer Weekly no opportunity to comment before the letters were published.
Two of the letters criticised us for a statement we did not make.
One of the letters, from Young, said it was a "gross breach of confidence to report the meeting [of BCS/Assist] at all".

It is not our policy to breach confidences, journalistic or otherwise. Nor did we in this case. Young said it was a private meeting. This is incorrect. Computer Weekly had been invited by the BCS to cover the event; the reporter's presence was announced at a workshop; he wore prominently a badge with the name of the magazine on it and although he was not put under any restrictions, he elected to apply them anyway: nobody was named in the articles, except two people who were asked and consented to be named.

l Focusing on criticism of the critics rather than attacking the issues they raised could discourage the open debate in which our readers are entitled to participate.

Our chief concern is the last point that the letters do little to advance the debate about the challenges that face the national programme for IT. We are particularly concerned about the loud rumble of unexpressed criticism of important facets of the national programme for IT and the almost total absence of openly expressed criticism.

Nobody wants the programme to fail, particularly as the extra £2.3bn being spent on NHS IT over three years presents a unique opportunity to improve the care of patients. For our part we have launched a campaign to encourage frank and open discussion of the risks in order to help ensure the programme delivers genuine benefits.

We also strongly support the principle of electronic medical records, the official term for which is Integrated Care Records Service - a concept that lies at the heart of the national programme for IT. NHS patients need to know when they go to hospital that doctors have not lost their records.

But the plan is for a complex national system, driven from the centre by the Department of Health, rather than a network of compatible local systems that meet national standards and have the buy-in of clinicians because they are the product of initiatives in hospitals and GP surgeries.

There are huge benefits in having a national system. But the risks of failure are also huge. A string of far simpler national IT programmes has failed in the past. Despite this the Department of Health is rushing ahead at top speed. Contracts for national ICRS systems will be awarded within months in the face of a plethora of concerns, risks and uncertainties.

Since the risks and benefits are so great, the airing of dissent, and particularly dissent that leads to serious problems being recognised for the damage they could inflict on the national programme, is vital to the success of the national programme for IT.

Yet there is a body of evidence that the department is obsessed with secrecy. And it appears to welcome the support of anyone who would keep all dissent underground.

It is particularly disappointing, then, that three eminent individuals who want to see ICRS implemented successfully have attacked us for being, in effect, a means of expression for dissenting views.

Two weeks ago, in a front page article on the Birmingham conference, Computer Weekly highlighted evidence from Canada that new electronic records had led to doctors seeing 30% fewer patients. This was because doctors spent too much time dealing with issues related to the systems. There is a prediction among UK experts that the same will happen here.

This disclosure in our article is not pursued, denied or even mentioned in any of the three letters.

Prospective suppliers do not speak out about the national IT programme because they fear being removed from shortlists for huge NHS IT contracts if they do. IT professionals cannot speak out without harming their careers.

Yet MPs found that one of the reasons for the failure of Wessex Regional Health Authority's Regional Information Systems Plan - which was a mini version of the national programme for IT - was too much unnecessary secrecy, and a dearth of whistleblowers.

We see our role as a positive one: the more we encourage the industry to talk openly and honestly about the risks that are most likely to deny success to the national programme, the harder it will be for the programme's evangelists to naively downplay serious problems as "manageable".

But if we are attacked for the fact that we criticise, not for any mistakes we have made, and the Department of Health treats all of its detractors within the NHS in the same way, what hope is there for the national IT programme?