Health ministerLord Darziopens his interim review
of the NHS - a report that is likely to have significant
ramifications for the NHS's IT investment programme - by saying he
is a doctor, not a politician.
But in his comments about the
National Programme for IT (NPfIT) in the NHS, Darzi knows he
needs to be the quintessential politician. He is a consultant in
the field of robot-assisted, minimally invasive surgery, and when
mentioning the NPfIT in his interim report he manoeuvres delicately
over the thin skins of ministers and officials who do not want to
read any criticism of the scheme.
In highlighting the success of the
Picture Archiving and Communications System (Pacs) in his
report, Darzi's praise was in line with the marketing strategy of
NHS Connecting for Health, which runs part of the NPfIT.
A confidential briefing paper by Connecting for Health to the
prime minister on the progress of the NPfIT said in February 2007
that there was a plan to launch a "proactive campaign", based upon
the success of Pacs.
Success story
It is true that Pacs is the big success of the NPfIT. It
replaces costly x-ray film, which is easily lost, with stored
digital images that can be interpreted by doctors on or off site.
It is a highly successful medical technology that may result in
patients needing fewer x-rays.
But Pacs was not part of the original core objectives of the
NPfIT, which were to supply a national electronic patient record,
electronic prescriptions, electronic booking of hospital
appointments, and a national broadband infrastructure.
Pacs was parachuted into the programme in 2004. In a letter to
senior responsible owners and regional implementation directors of
the NPfIT on 15 September 2004, Margaret Edwards, director of
access at the Department of Health, said, "I am writing to confirm
the decision of the National Programme board to make Pacs a core
service within the National Programme for IT
"The decision to make this a core service means that, with
immediate effect, trusts should not therefore enter into, or
continue with their own procurements for Pacs, but plan for
deployment of the system as contracted for their cluster via the
National Programme. I would be grateful if this could be
communicated to strategic health authorities and trust chief
executives as a matter of urgency, as we are aware that a number of
trusts are currently involved in negotiations."
To the tactful Darzi, in his interim report the success of Pacs
and the NPfIT were analogous. He also praised the linking of
hospitals and GPs to a common secure network - the N3 broadband
infrastructure supplied by BT. Local upgrades of the N3 broadband
capacity can be expensive, and on its own the network brings few
clinical benefits, but the bandwidth is an important advance on
what the NHS had before, so it is a success of the NPfIT.
Clinical benefits
Darzi's report said, "The national infrastructure established by
the NPfIT has connected every hospital and GP surgery to a common
secure network. Clinicians should benefit from the implementation
of digital access to x-rays and scans - Pacs. But I believe more
work is now needed to ensure that the Connecting for Health
programme delivers real clinical benefits, and I will be
considering in the second stage of my review how best to achieve
this."
It is welcome news. But IT directors in the NHS are entitled to
ask why it is only after five years - the NPfIT was launched in
2002 - and after more than £2bn has been spent centrally on the
scheme, that a professor is undertaking a review to ensure that the
national programme delivers clinical benefits.
Separately, the Department of Health has ordered an internal
review of the NPfIT to establish "will this work?" There is no
indication that it will be published.
It is difficult to avoid the conclusion that these are political
compromises, half-done replacements for a high-level published
review of the NPfIT.
This is, of course, a £12bn scheme, the world's largest civil
IT-based change programme. Those funding it, those whom it should
benefit, those working on it, and those who should be working with
it, deserve more than the passing reference to a review of clinical
benefits on page 50 of Darzi's 54-page report.
One reason for the absence of an unrestricted, independent
published review is that the NPfIT has become politicised. It has
become a test of the ability of government to manage
mega-projects.
This could explain why ministers and some Whitehall officials
want NPfIT's realities locked in a dark room. They fear the full
facts emerging into the sunlight and being judged harshly by a
cruel world.
So the NHS and those funding it are denied the truth, the
programme limps along without clearly understood and realistic
objectives, and the government claims all is well.