The Department of Health has reacted with only limited
enthusiasm to a call by more than 20 top academics in
computer-related sciences for an independent audit of the technical
feasibility of the NHS national programme for IT
(NPfIT).
In response to an open letter (Computer Weekly, 11 April), the
department said, "The national programme for IT is under constant
review, scrutiny and audit by parliament and government bodies. We
remain confident that the technical architecture is appropriate and
will enable benefits to be delivered for patients, whilst ensuring
value for money to the taxpayer."
The professors wrote their unprecedented letter in part because
they were concerned both about the technical feasibility of the
NPfIT and the lack of transparency surrounding the project.
"Concrete objective information about NPfIT's progress is not
available to external observers. Reliable sources within NPfIT have
raised concerns about the technology itself," the letter said.
An investigation into the project by public spending watchdog
the National Audit Office has been delayed by nearly a year. "The
report is not expected to address major technical issues. As
computer scientists, engineers and informaticians, we question the
wisdom of continuing with the NPfIT without an independent
assessment of its technical viability," the open letter said.
Although there is still widespread support for the aims of the
NPfIT, it has failed to win the hearts and minds of the clinicians
and NHS staff that will eventually use the systems, according to
John Bourn, head of the National Audit Office.
The complexity of the project, delays, changes in leadership and
policy issues that in part led to the professors' call for a
technical audit have been tracked by Computer Weekly over the past
four years.
February 2002
The national IT plan is agreed at a seminar at Downing Street,
chaired by the prime minister Tony Blair. A civil servant at the
seminar, John Pattison, reveals that Blair has been told the
programme will last less than three years.
Later, without any explanation to parliament, the plan becomes a
10-year scheme.
There has been no public consultation over the project, or
discussion by parliament of the funding. In 2005, Computer Weekly
asks for details of the 2002 Downing Street seminar under the
Freedom of Information Act, and the request is refused.
July 2002
NHS managers react to the national IT plan. They say they want
change but see risks in centralising IT.
Computer Weekly reports that the "main problem the government
faces is how to implement a strategy so dependent on central
control across an organisation as complex and devolved as the
NHS".
September 2002
IT industry body Intellect in an article welcomes the NHS plan
but Laurence Harrison, healthcare programme manager at Intellect
warns that "the devil is in the detail". The same article questions
whether the NHS and suppliers have the ability to deliver such a
complex programme. It says, "The health service's history of
implementing large, high-risk systems quickly is not good."
November 2002
A Gateway review of the business case for a national care
records service - including an integrated system for sharing
electronic health records on 50 million people - finds significant
problems. The independent assessment by the Office of Government
Commerce raises concern about resourcing and whether it will be
possible to manage and deliver such a large undertaking on time.
The concerns turned out to be justified.
December 2002
The NPfIT tells suppliers they can be removed from shortlists
for contracts and excluded from doing business with the NHS for 10
years if they publicly question the project.
The warning is given at Avonmouth House, a conference centre in
South London, on 3 December 2002, when suppliers meet to hear
details of the national programme. One of the supplier's delegates
records what is said for his company's internal minutes.
The Department of Health tells Computer Weekly it had "no
intention of blacklisting suppliers" and that the warning should be
understood in the context of the NPfIT wanting to hear criticism
directly and not through the media. IT directors tell Computer
Weekly of a climate of fear over speaking out about the NPfIT.
June 2003
The NPfIT is criticised by some potential bidders when the
Department of Health asks them to design some of the world's
biggest and most complex systems in only five weeks.
On 23 May bidders say they are presented with a 500-page
"output-based specification" document, which is described as a
"work in progress" and not a final specification. They are to
submit proposals of unprecedented scale and complexity by midday on
30 June.
A spokesman for the NPfIT dismisses supplier concerns about the
procurement process. He says, "All bidders were made aware of the
procurement timescale from the outset in order to be fully prepared
for a process that is as rapid as good practice allows."
July 2003
The Department of Health takes the extraordinary step of posting
on its website three letters that are critical of Computer Weekly's
coverage of a health IT conference at the NEC in Birmingham. Two of
the letters are from the department's officials and are addressed
to Computer Weekly.
This publication had reported comments about the NPfIT, some
positive and some critical of the programme, which were made at a
conference organised by the British Computer Society's Health
Informatics forum and Assist, the Association for ICT Professionals
in Health and Social Care.
October 2003
The NPfIT says that the contract for booking systems had been
part of the NPfIT's "ground-breaking schedule" - only 190 days had
elapsed between advertising the contract and awarding it. This is
unprecedented for such a system, it says, adding that the
specifications had been "well-defined", and the degree of clinician
involvement in the process had been high.
October 2003
An independent report into the NPfIT lists the successes of the
programme but also raises some profound concerns. It is published
on an official NHS website, the National Electronic Library for
Health, but is withdrawn after Computer Weekly quotes its
criticisms to the NPfIT.
The paper says that too little attention has been paid to
cultural, organisational and change management issues, and there
has been insufficient clinician involvement in the building of the
specification for a care records service - which includes a system
for exchanging medical records electronically. The paper also says
there is a lack of clarity over how much money will be available
locally to implement national systems.
December 2003
A book on the NPfIT, written by four leading healthcare IT
specialists, including Bud Abbott, a founding father of NHS
computing, strongly supports the principles that underpin the
programme but warns, "The level of complexity, the barriers to
overcome and the means to achieve change are not agreed and are
generally underestimated."
March 2004
At an NHS conference in London, to which journalists were not
invited, the health minister John Hutton and Christopher Bland,
chairman of BT, who was knighted for his NHS work in 1993, speak of
the NPfIT's risks and potential benefits.
Bland, whose company has won the biggest contracts in its
history to implement key parts of the programme, says BT is excited
by the challenge but "somewhat frightened by the enormity and
complexity of it".
Winning more than £2bn in NPfIT contracts, Bland says BT feels
"slightly like a dog chasing a car. What do we do if we catch it?
Well, we've caught it".
May 2004
Richard Granger, director of NHS IT, challenges press assertions
that the national programme is being run under a cloak of secrecy.
He says, "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."
June 2004
Granger acknowledges that the NHS has severe shortages of
high-level IT skills. A shortage of talented people is causing
"big, big problems", he says.
Despite the difficulties, Granger remains confident about the
future. He says that no major programme has achieved as much as the
NPfIT in its first two full financial years.
September 2004
Aidan Halligan announces his intention to leave the NHS. He had
inherited the senior responsible owner role from John Pattison, who
retired.
October 2004
Computer Weekly reveals that the NPfIT could cost a minimum of
£18.6bn - at least three times more than the announced figure -
with a large part of the bill falling locally, on NHS trusts.
In a written statement to Computer Weekly, the NPfIT says that
the business case for the programme estimates the total cost to be
three to five times that of the procurement costs - the procurement
costs being £6.2bn.
"It is generally accepted in the IT industry that implementation
costs are some three to five times the cost of procurements. That
is reflected in the business case that was made for the national
programme," says the spokesman, who maintains that the initiative
will "undoubtedly deliver benefits and savings beyond its
costs".
January 2005
A Computer Weekly reporter is barred from attending a press
conference on the NPfIT chaired by the then health minister John
Hutton at Richmond House, headquarters of the Department of Health.
More than a dozen journalists from national newspapers and
magazines pass through a security gate to enter the press
conference. But when Computer Weekly's reporter approaches, a
Department of Health press officer stands in front of the gate,
barring entry. The barring denies an opportunity to Computer Weekly
to ask the health minister about the NPfIT.
March 2005
Computer Weekly calls for an independent audit of the NPfIT.
Editor Hooman Bassirian says, "A forward-looking review would
complement a study on the project's value for money by public
spending watchdog the National Audit Office." The campaign is
backed by MPs.
A spokesman for the NPfIT says, "We should like to place on
record that we do not think it is appropriate for a commercial
media organisation to be calling for an independent review of the
national programme when that is rightly the role of the National
Audit Office, which reports to parliament."
October 2005
The House of Commons Public Accounts Committee learns that
Richard Granger has never had full responsibility for the
engagement of the wider community of clinicians. This means that
the NPfIT has never had one person in charge consistently for
persuading doctors and nurses to support the programme.
November 2005
In a leaked e-mail, Richard Granger criticises a senior official
at the Department of Health over Choose and Book, a part of the
NPfIT which aims to allow patients and doctors to book hospital
appointments online.
Granger says, "Unfortunately, your consistently late requests
will not enable us to rescue the missed opportunities and targets."
Richard Bacon, an MP on the House of Commons Public Accounts
Committee, says the leaked e-mails could indicate that "the blame
game has started in earnest".
March 2005
In a memo, the NPfIT asks NHS trusts to refuse applications
under the Freedom of Information Act for details of contracts
signed under the programme.
Lawyer Dai Davis of Nabarro Nathanson criticises the blanket
nature of the NPfIT's advice to trusts. But a spokesman for the
NPfIT says the memo was quite clearly marked as guidance. "It did
not purport to be instruction or direction and was never intended
as such," says a spokesman for the NPfIT.
March 2006
Accenture, the main supplier of NPfIT systems to two of the five
"cluster" areas in England, reports a 67% drop in profits after
accounting for expected losses from its work on the national
programme.
It blames delays in part on its UK partner in the NHS project,
iSoft.
Connecting for Health is critical of the wording of Accenture's
statement on its predicted losses on the NHS contracts.
April 2006
Leading academics across the UK send an open letter to the House
of Commons Health Committee which echoes Computer Weekly's call for
an independent audit of the NPfIT.
The NHS announces that Ian Carruthers, acting chief executive of
the NHS, is to take on the role of senior responsible officer for
the NPfIT.
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