The Public Accounts Committee has done us a service by
directing attention to the
poor progress being made on the central plank of the NHS's National
Programme for IT.
It has reminded us that most of the benefits of the scheme will
be obtained by creating detailed electronic care records at the
local level, and that it is the local
Care Records Service which, together with central overheads,
accounts for 82% of the NPfIT's total expenditure.
To their credit, the MPs on the committee have not allowed
themselves to be diverted by the high profile that has been created
for national services and the
digital x-ray programme.
The report makes grim reading. We are told that the first phase
of delivering local care records is already two years behind
schedule, with no firm completion date identified. This is despite
acute trusts needing to do no more than replace the existing
patient administration system with one from the NPfIT.
By February 2007 only 18 trusts out of 150 had done this. Or had
they? Well, no, actually. Not really. For in delving a little
deeper, it transpires that due to delays in software development,
no NPfIT patient administration systems are yet available in the
three clusters served by
iSoft, and in fact only old, pre-NPfIT systems have been
implemented.
But it gets worse. What of phases two and three, the addition of
NPfIT clinical functionality to patient administration systems,
which are "the key to the delivery of clinical benefits"?
We are told that their implementation may scarcely have begun by
the time the original local service provider contracts expire in
2014.
What do we make of Lord Hunt's statement that the Public
Accounts Committee's report is out-of-date? Alas, the situation
described above is only too up to the moment. The committee's
report is out of date only in that the latest problems, such as
those encountered by
Milton Keynes General Hospital, came too late to be
included.
Hunt really cannot claim that "we are on track to meet our broad
targets" when no firm dates exist for any acute trust to obtain
substantially more electronic patient record functionality than it
had when the NPfIT began five years ago.
By all means let him extol
successes in electronic prescriptions and digital x-rays, but
it is like praising a major house building programme for having
completed some garages and garden sheds even though the houses
themselves are still empty plots.
So what is to be done? The report makes two sensible
recommendations. It endorses the current move to make local chief
executives accountable for implementation of NPfIT, but with one
absolutely crucial proviso: that they are not merely given
responsibility, but also "authority and resources." In other words,
that budgetary responsibility and control of suppliers must also be
delegated. The report then recommends that additional suppliers of
core Care Records Service software are brought in to create an
element of local choice.
Something along these lines is surely the way forward. But
before we can start thinking in detail about cures, the patient
must acknowledge his illness.
It all reminds me of the atmosphere in 1996, when everyone knew
that however much it might tinker, the Conservative government was
doomed.
About the author
Alan Shackman is a contributor to a paper published in the
Public Accounts Committee's report on the NPfIT. He is an
independent consultant who has worked on electronic patient
record-connected matters for more than 15 years, directly for NHS
trusts. He was also an interim NPfIT programme director. He has
been involved in a number of Electronic Patient Record
procurements.
MPs dissect NHS IT plan's failings >>
Trust hits records trouble despite assurances to MPs
>>
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>>
Tony Collins' project
management blog >>
NHS Connecting for
Health website >>
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