In July and August, my NHS region was putting together a
communications plan on the NHS's technology programme.
Under the plan, every NHS trust had to inform every member of
staff about the National Programme for IT (NPfIT) and the huge
benefits that were just around the corner.
While we scratched our heads about how we could approach this
task, we witnessed one PR calamity after another.
First, the CSC datacentre failed and every NPfIT system in the
region was down for three days or more. Soon after this we read
about the meltdown of NPfIT supplier iSoft on the front page of The
Guardian.
Given this, we have been left wondering quite how to sell the
benefits of Connecting for Health - the agency that runs the NPfIT
- to our staff. And we are also struggling to understand how the
NPfIT can deliver our IT strategy aims.
A major worry is the mismatch between Connecting for Health's
delivery timetable and the timetable for NHS service reforms.
The latest roadmap informs us that the integrated clinical IT
systems desperately needed to implement these reforms will not be
delivered until 2009 or later.
The goal of enabling patients to wait no longer than 18 weeks
from GP referral to hospital treatment is one of the most
significant reforms in the history of the NHS.
But IT systems are needed to track every patient that has been
referred for treatment, and to know how long they have been
waiting. For the time being, trusts have been told they have to
develop their own interim solutions.
Under NHS financial reforms, hospitals are to be paid for
activity undertaken, rather than being paid under block
commissioning agreements, which was the prior arrangement.
But the time needed to effect improvements in information
services and IT to support this has been underestimated. Once
again, trusts have been left with no alternative but to develop
interim solutions.
So, over three years on from the inception of the NPfIT, what is
its status?
The delivery schedule for the NHS Care Records Service (CRS) has
slipped alarming. Realistically, the core components of the CRS -
integrated care pathways and electronic prescribing - will not be
available until 2010 at the earliest.
NHS trusts are losing confidence in the delivery roadmap and are
beginning to procure alternative solutions outside the Connecting
for Health umbrella.
NHS trusts that have implemented Connecting for Health systems
are struggling to cope with poor system performance and service
availability issues.
The NPfIT local service provider is working flat out to resolve
these issues. However, a great deal of damage has been done in
terms of deteriorating user confidence and satisfaction with
Connecting for Health systems.
The CSC datacentre outage was downplayed by Connecting for
Health as disappointing but not serious in its impact on patient
care. What cannot be underestimated from this, however, is the
impact this may have on future roll-out plans for the CRS.
NHS trusts will not implement electronic prescribing unless very
high levels of service availability can be guaranteed. Connecting
for Health may now have to insist that trusts produce contingency
plans for unplanned downtime in excess of 12 hours.
Unless a maximum of two hours of unplanned downtime can be
guaranteed, I envisage many NHS trusts opting out of the NPfIT.
Finally, the deteriorating financial positions in many NHS
trusts may end up having a significant impact on NPfIT
implementation plans. Connecting for Health is funding the purchase
and development of IT systems.
However, NHS trusts are responsible for implementation, and they
are already reporting large affordability gaps in their NPfIT
project plans.
The author of this article, who requested to remain
anonymous, works as an IT director in the NHS