Officially the NHS's national IT programme, the largest
civil IT scheme in the world, is a success.
In February, the health minister Liam Byrne - a former employee
of Andersen Consulting, now Accenture, one of the programme's main
IT suppliers - made a statement to the House of Commons on the
scheme.
He said that more than 1.5 million patients have benefited from
the national programme for IT (NPfIT) in the NHS. "Progress is
within budget, ahead of schedule in some areas and, in the context
of a 10-year programme, broadly on track in others."
But the glowing tenor of his statement conflicts with the facts.
Drafted by civil servants in the Department of Health, his
statement made no mention of delays of at least a year in the
delivery of core integrated software, or the hardships facing IT
staff in the NHS who are trying to sell the benefits of the
programme's systems to an increasingly sceptical medical
fraternity.
Nor did Byrne mention the fraught introduction in December 2005
of a Care Records Service - including an electronic patient record
- at the Nuffield Orthopaedic Centre in Oxford.
Nuffield was the first NHS trust in Southern England to go live
with the service, but its introduction led to patients having their
operations delayed, and some hospital records were lost. As a
result of problems with the new system, the trust issued an alert
to the National Patient Safety Agency.
The good news is that clinicians have generally welcomed the
objectives of the NPfIT. They especially want electronic medical
records to replace paper ones.
But surveys of doctors - by Mori and online researcher Medix -
also show that many clinicians lament what has happened since the
programme began in 2002. Some see the NPfIT as characterised by
secrecy, conflicting information over whether the NHS's technology
is moving forward or regressing, and uncertainties about the
potential costs, timetable for delivery of software and the
achievements so far.
The uncertainty is exemplified by the comments of the audit
committee of the Birmingham and the Black Country Strategic Health
Authority.
On 21 March 2006, the committee discussed the NPfIT at length
and concluded there had been considerable progress. Despite this,
the committee "remained concerned over the limited control on
slippage and additional cost, lack of clarity around the system,
what it was able to deliver" and "how [interim and legacy] systems
will migrate following reconfigurations of organisations".
Meanwhile, the share price of iSoft, one of the main software
suppliers to the NPfIT, has more than halved since it announced
lower than forecast profits from the NHS contract. Accenture, the
NPfIT's local service provider in two of the programme's five
regions, has announced a predicted write-off of £260m on the
contract.
BT, the local service provider for London, has been fined more
than once for poor performance. And US clinical software specialist
IDX has been dropped as the main software supplier for Southern
England, though it remains BT's main software subcontractor in
London.
These developments could be simply the settlement cracks that
beset otherwise sound new buildings. They are easily pasted over.
Or they could be early warning signs of a calamity. It would not be
the first time suppliers had signed contracts for integrated
systems that proved unworkable in practice.
When the London Ambulance Service sought to computerise the
sending of ambulances to emergencies in the 1990s, it set
specifications and a timetable that proved too ambitious, according
to an official report written after the project failed.
Some ambulance staff said the introduction of the system delayed
the dispatch of ambulances and caused unnecessary deaths.
Critics of the NPfIT's plans point out that the technology to
share medical records nationally on the scale proposed in England
remains unproven. And Nuffield hit serious problems after
installing only a basic system - not one that was fully integrated
and allowed the sharing of medical records with trusts across the
country.
This leaves unanswered the question of whether installing new
integrated national systems that are more advanced than Nuffield's
will cause serious disruption in NHS trusts, leading routinely to
surgical operations being delayed or cancelled, and medical records
being corrupted or lost.
This concern may be compounded by the recent comments of Kenneth
Robertson, clinical lead for information management and technology,
Scottish Executive Health Department. He told the Healthcare
Computing conference at Harrogate in March that IT suppliers are
not yet capable of delivering fully integrated health records.
"I do not think suppliers are yet in a position to meet our
needs in terms of our full vision of a single electronic health
record accessible wherever."
Yet the NPfIT is largely predicated on the notion that a single
electronic health record is accessible across England.
On the other hand, Connecting for Health, which is managing the
NPfIT, is deploying many new systems which are working well. Trust
IT executives report that these are "tactical" systems which mostly
pre-date the NPfIT and are not fully integrated. They do not, for
example, share electronic medical records nationally.
This raises questions about whether the total spending on the
NPfIT so far represents value for money. Byrne told the House of
Commons on 20 March 2006 that the total cost of the NPfIT from its
inception in 2002 to 31 January 2006 was £1.02bn.
It is against this mixed picture of progress in some areas
mingled with deep concerns over whether the programme's complexity
will cause it to fail that leading academics have called for an
independent audit.
Their open letter echoes a campaign begun by Computer Weekly a
year ago for an independent audit. This publication has argued that
an audit would complement an investigation of the programme by
spending watchdog the National Audit Office.
The NAO's report has been delayed by nearly a year. When it is
finally published, it will look at the progress of the programme
and whether it represents value for money, but it is unlikely to
answer the big question: will the NPfIT work?
A further limitation of the audit office's report is that it is
likely to be criticised as being out of date by the time it is
published. In comparison, independent technical auditors, if they
have the power and terms of reference to make far-reaching and
measurable recommendations, could see their findings making the
difference between success and failure.
An independent audit in 1999 by consultancy Arthur D Little of a
long-delayed air traffic control system destined for use at
Swanwick in Hampshire made many tough and specific recommendations
- including a suggested change in the culture of secrecy - which
arguably helped to prevent the project from turning into a complete
disaster.
National Air Traffic Services opposed the audits, which were
ordered by the government, and few will be surprised if Connecting
for Heath resists calls by academics for an independent audit of
the NPfIT.
But some managers at National Air Traffic Services, though they
disliked the idea of the audits, found them trenchant and
perceptive, which made the cost of the investigations seem trivial.
And one of the audits confirmed that, subject to recommendations
being acted on, the systems would eventually work.