NHS IT staff look for guidance on £2.3bn scheme, so why the silence on key issues?
- Posted:
- 17:34 22 Jun 2004
- Topics:
- Databases | IT Workforce | IT Applications | Maintenance
Members of the influential National
Clinical Advisory Board want open debate on the national programme
but the minutes of their meetings remain unpublished
Mystery - or rather secrecy - surrounds the work of the National
Clinical Advisory Board, in which top medical professionals air
their views on the biggest IT project in the world, the £2.3bn
national programme for IT in the NHS.
Members of the board have approved sets of minutes for publication
but none have been published on the Department of Health's website,
except a one-page summary of the inaugural meeting in October 2003.
There have been four meetings since then.
The absence of the minutes raises the question of whether
publication has been blocked by the Department of Health because
the documents contain constructive criticisms of the
programme.
Richard Bacon, a member of the House of Commons Public Accounts
Committee, and Vince Cable, former chief economist of Shell
International and now Liberal Democrat shadow chancellor of the
exchequer, are both critical of the non-publication of the
minutes.
Cable said, "Good policy making is done in public so that everyone
can contribute their knowledge and skills, not least the doctors,
nurses and midwives who have to use NHS technology.
"Hiding information about spending millions of pounds of public
money is not only likely to lead to bad decisions, but fuels the
suspicion that the government has something to hide. If people
working in the NHS are not comfortable that this project is working
well, the government should encourage them to explain why, rather
than stifling dissent."
The advisory board is a key organisation in the national programme.
It was set up last September to give the Department of Health the
views of clinicians on the national programme. The board's members
are among the most respected in the medical profession. They
include senior figures from the royal colleges of radiology,
surgeons, physicians, anaesthetists, GPs, psychiatrists, nursing,
midwives, obstetricians and gynaecologists, paediatrics and
pathologists.
The then chairman Peter Hutton, who has since resigned, said last
year that the purpose of the board was to "listen to health staff
and shape the way the programme develops, in partnership with
technical experts".
Nothing is known of the specific discussions but, according to the
minutes of the inaugural meeting, it was due at its second meeting
to debate "communication with NHS staff and the public" and
"training and education". Many clinicians believe there has been
too little communication, and not enough money put aside for the
training of tens of thousands of doctors and nurses in using the
new systems, and to pay for locums while they attend courses.
A spokesman for the national programme hinted that the minutes of
the Clinical Advisory Board may not have been published because no
agreement over the wording had been reached among its
members.
"Minutes of meetings are published at www.doh.gov.uk/ipu/ programme
once they have been approved by members of the National Clinical
Advisory Board," he said.
However, Clinical Advisory Board member Peter Dawson, a professor
and registrar of the faculty of clinical radiology at the Royal
College of Radiologists, told Computer Weekly that he was unaware
of any disagreements over publishing the minutes. He said he had
seen sets of minutes which he had passed as satisfactory.
Meetings of the board members had been supportive of the national
programme and had also aired constructive criticisms. Dawson said,
"Of course, we have had occasional frank discussions but nothing
that anyone need be sensitive about."
Apart from the minutes of the inaugural meeting last October, the
minutes of meetings of another organisation whose formation was
announced at the same time as the clinical board, the Public
Advisory Board, have not been published on the Department of
Health's website.
The Public Advisory Board consists of individuals drawn from
patient, carer and citizen groups, including the Patients
Association, Consumers' Association, Help the Aged, Mind, Mencap
and the National Consumer Council. Like the Clinical Advisory
Board, it has had five meetings.
The failure to publish could simply be an oversight, or perhaps no
one had time to post the documents on the department's website. On
the other hand, there is little evidence that the department
welcomes constructive criticism about the national programme.
When the department became aware that a senior health service IT
employee had published a paper in October 2003 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.
With the paper withdrawn, a senior official at an agency of the
Department of Health wrote to Computer Weekly attacking the paper's
author.
Following criticism, the Department of Health published on its
website some key documents and regular updates on the national
programme. The updates make the most of the programme's anticipated
benefits of improving the care of patients, reducing bureaucracy
for doctors, increasing choice for patients, and stopping records
going missing.
But it does not give the other side of the story: the contractual
issues with the main supplier BT, surveys which show that
consultation with clinicians is inadequate, the concerns among
trusts and GPs about mounting costs, and disagreements over whether
GPs should allow patient records to be transferred to a national
database.
Trust IT executives and staff want specific, objective information
about how most trusts are progressing with their local plans for
implementing national systems.
Jean Roberts, lead for the policy task force of the British
Computer Society's Health Informatics Committee, which represents
many NHS IT specialists, said, "My personal feeling is that generic
information is not what is now required. We want to know what is
going on locally, when we are likely to see any benefits, and how
we can help. Web-based progress reports would be most
welcome."
A lack of openness has been a characteristic of several major
public sector IT projects in which the benefits have failed to
materialise, or have been delivered late and over budget. These
projects include the £337m air traffic control system at
Swanwick in Hampshire, which was five years late and cost more than
double the original fixed-price contract; and the Libra contract to
update magistrates courts' IT, which was supposed to cost
£184m but for which the latest estimate is £390m.
Next month the prime minister Tony Blair is expected to give a
speech which refers to the national programme. It is likely to be
reassuring and perhaps even uplifting - along the lines of the
information about the national programme that is published on the
Department of Health's website.
Granger challenges claims of secrecy
Richard Granger, head of IT in the NHS, insists that the national programme is being run in a spirit of openness. At a conference last month he said, "One of the things I find just repugnant frankly is this continuous charge of secrecy that is levelled by somebody because I do not know of any other public sector programme that has been as open as we have."
Granger was critical of some sections of the media, which was
seen as an attack on publications that have reported bad as well as
good news on the national programme. He said, "[It is] very
demoralising for staff to have one reality of a new system about to
be rolled out, that they can see, and then to read something which
suggests something else. People tend to quite concerned about
that."
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