Computer Weekly agrees with several of the points made
by Richard Holway - for example, that health officials should be
applauded for trying to stop suppliers from ripping off the NHS and
taxpayers.
And there are other advantages of the National Programme for IT
(NPfIT). Hospitals that had cumbersome, unreliable and old
green-screen technology are having it replaced under the NPfIT.
A new broadband network has been installed, x-ray systems are
being rolled out - though this was happening before the advent of
the NPfIT - and there are some innovative uses of IT: for example
by the East of England Ambulance NHS Service Trust, whose
paramedics use handheld computers to beam information ahead to the
hospital.
But the main purpose of the £12.4bn spend on the NPfIT is not to
show how well suppliers can be managed, or to put new technology
into ambulances, whatever the undoubted benefits. A key objective
of the programme was to deliver an electronic health record for 50
million people, accessible by any authorised user across
England.
At a meeting last week of health IT experts, the audience was
asked whether the chief objective of the NPfIT should still be the
delivery of a national electronic health record. No hands went up.
Some thought it better to work towards a less ambitious scheme, to
deliver a reliable and easily accessible local electronic medical
record rather than a national care records system which may not
materialise.
This brings to the fore one of the main concerns about the
NPfIT: that nobody has any real idea whether it will meet its
original objectives, or whether some of those objectives are now
obsolete.
An independent review could ascertain whether the NPfIT will
deliver what the NHS needs. But Caroline Flint, minister for public
health, has rejected the call by 23 leading academics for an
independent review in part because she says there have already been
many internal assessments of the NPfIT.
She has refused to publish all of the reports, which raises
suspicions that much is being hidden - or worse, that there is much
to hide possibly the fact that the programme as originally
configured by the government in early 2002 was fundamentally
flawed.
We learned last week that the Rural Payments Agency had sailed
through a series of red lights set by "gateway" reviewers appointed
by the Office of Government Commerce. The project was a disaster.
How could it happen? The National Audit Office explained at a
briefing that nobody at the time had dared ask, "Is what we are
doing, and how we are doing it, a good idea?"
That is where the media has an important role: reflecting the
views and concerns of those in the IT industry and medical
professions whose voices the arch-enthusiasts would rather drown
out.
We do not want the NPfIT to end up like the rural payments
project, which ultimately caused widespread distress. Yet the NPfIT
is projected to cost about 40 times that of the rural payments
scheme, and it is immeasurably more complex. And it affects
lives.
Richard Holway refers to the pain that inevitably accompanies
big projects. So far the pain that has accompanied the NPfIT has
included cancelled operations, people turning up for consultations
and not being expected because health staff have been unable to
access lists of appointments, and systems at 80 trusts failing
simultaneously - a misadventure that could not have happened before
the national programme.
So we do not agree that the media should be criticised for
criticising. We think it crucial on any big IT-related programme
that those involved should tell it like it is. Because if they do
not, they accentuate the need for the media to do so.
It is true that the media has made much of the departure of
Accenture from the NPfIT. But the ease with which the supplier can
be replaced is not the main issue. The question is, why did it
leave? Does it know something the other suppliers and health
officials would rather not?
We are also concerned at suggestions that the NPfIT is Richard
Granger. Without Granger's impressive drive and conviction the
programme is more likely to disintegrate but the programme was
conceived many months before he joined, on the flawed basis it
would cost £5bn and take less than three years. The NPfIT is a
programme involving ministers, officials and thousands of NHS sites
and people. It does not belong to one man.
If the NPfIT delivers what the health service needs, which may
conflict with what ministers originally set as its objectives, it
is likely to save lives. But the point was made at last week's
meeting of health IT experts that if it goes wrong it could cost
lives.
So any argument that dismisses the potential for causing harm by
arguing that "any large programme is painful to implement" is
dangerously simplistic. We should not experiment with peoples'
lives on the basis that some good will eventually come from the
pain.
We hope the billions spent on the NPfIT will eventually improve
the care and treatment of millions of patients. This is more likely
to happen if the media remains independently-minded, well-informed
and free to say what needs to be said about the NPfIT.
If it simply writes up Whitehall's speeches and press releases,
and publishes selective quotations from NHS people, as some
officials would like, the IT industry and the health service will
be robbed of its independent voice, and the programme will continue
to suffer from a lack of openly expressed dissent.
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NHS IT project is force for good and worth the pain...
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NHS IT watch