The public and private faces of the national programme are
in conflict - and the public face is winning. The side that
perceives an enormous gamble remains suppressed.
As one national newspaper put it, Richard Granger, the national
programme for IT chief, "made clear that he would enforce the
standard confidentiality rules governing procurement with such
vigour that chief executives are terrified to discuss the programme
in public".
"This has stopped suppliers trying to influence the procurement
process by grandstanding about their wares. But it has stifled
debate and made it hard for NHS staff and outsiders to assess its
merits."
What public criticism of the national programme that does exist is
dismissed by the Department of Health. Last year, after Computer
Weekly published articles which included criticisms of the
programme, the department replied by publishing ferocious
criticisms of the magazine on a government website.
And when the department became aware that a senior health service
employee had published a paper about the national programme on an
official NHS website, it was suddenly withdrawn without her
consent. The paper was largely positive about the aims of the
national programme but contained some detailed criticisms.
The department has an ability to make different critics appear as
if they all belong to one category: Luddites. Those who publicly
criticise facets of the programme are depicted as people who wish
to see the whole programme fail.
But everyone in the NHS, even the programme's critics, supports its
objectives. If it succeeds it could save lives: the new systems
should reduce clinical mistakes by delivering accurate information
quickly to doctors and nurses, at the point of care. It could mean
no more missing and inaccurate health records.
The programme's critics take issue, however, with the apparent
haste to sign huge contracts before new working practices are
agreed with doctors, before there is certainty the programme can be
afforded, and before anyone knows that the mass of clinicians will
use the new systems.
Audit reports show that a project to introduce uniform systems in
the Wessex health region ended disastrously in 1992 after contracts
were signed in haste. Eventually money for the project ran out when
end-users in district authorities, which had not participated
adequately in the procurement, refused to continue to fund it.
Questions about what lessons from Wessex and other IT disasters
should be applied to the national programme are not being aired in
public by NHS professionals.
Despite their concerns, many IT specialists in the health service
would prefer to ally themselves with the public face of the
national programme: they feel inspired under Granger's leadership,
recognise that the national programme is an opportunity that comes
once in a lifetime, and will do their best to help it succeed.
They also, privately, share the reservations expressed by Bland: a
fear of the programme's enormity and complexity, and not knowing
whether it is a worthwhile risk or the world's biggest IT gamble.
Some also worry that all the talk about the "NHS's vision" masks
the fact that the programme may be too ambitious to work properly.
If the programme is a gamble, do taxpayers and patients support the
idea of billions of pounds being risked on national IT systems that
are imposed by the centre on a befuddled NHS? As with so many
questions about the national programme, no one knows the answer.