Matthew Swindells, the health service's departing chief
information officer, cracked a joke that went down well at
theHC2008
annual healthcare IT conference at
Harrogate this week.
He said that in 1989, as IT purchasing manager for a health
authority in the Thames region, he had bought a "Casemix" system
for Eastbourne Hospital - and this year the supplier is due to
deliver the finished product.
Many in the audience laughed or smiled because they knew he was
only half-joking. IT-related progress in the NHS moves so slowly
that the eye can barely perceive it.
The National Programme for IT [NPfIT] in the NHS was supposed
to change that.
Ministers wanted action, and quickly. Cynics would say that what
ministers wanted quickly was their comments in innumerable media
articles and broadcasts on how New Labour was using IT to modernise
the NHS.
As one executive working for the NHS and the Department of
Health put it, "Everything had to done at a speed of 100mph -it did
not seem so important where we were headed".
Officially, the Department of Health was saying that 21st
Century IT - the document which launched the NPfIT in 2002 - had to
be implemented as "rapidly as practicably possible".
In record time, Whitehall officials awarded £6.2bn worth of
contracts to suppliers Accenture, Fujitsu, CSC, BT and Atos Origin
to deliver a small number of standardised systems. The catchphrase
of the NPfIT became "ruthless standardisation".
Swindells last week described the euphoria that greeted the
announcement of the national programme. "You will remember the fit
of excitement at being able to drive things from Whitehall, the
world's largest train set."
Now, six years on from the announcement of a national programme,
some NHS staff and those working for the suppliers say significant
IT-related change has become slow and tentative, and at some trusts
has all but stopped. They depict the NPfIT as a behemoth that
nobody knows what to do with.
In some ways things are worse than they were before the NPfIT.
Hospitals were able to buy what they needed. Several trusts were
combining for consolidated purchases of electronic record systems,
which could have been mature products today - had they been allowed
to go ahead. They were cancelled because of the NPfIT.
Computer Weekly has recently reported on some of the trusts that
have put major IT plans on hold. Trusts receive money from
Whitehall for buying patient administration and other core systems
under the national programme. But if those systems do not arrive -
and patient record systems are running three years late - what are
trusts to do? If they bypass the NPfIT, and some of them are doing
just that, they have to fund major IT systems with hospital money
and risk becoming outsiders to the national programme.
Regular surveys by online researcher Medix have shown that
doctors have wanted the NPfIT from the start. The signs are they
still want it. IT executives in the NHS also want the programme.
But around the conference at Harrogate - a conference organised by
the British Computer Society - the feeling was that the NPfIT is
not working and may never work.
Swindells put it well in his speech, which opened the HC2008
conference. He said that
NHS Connecting for Health, which runs part of the NPfIT, has
been asked to "find the problems in what they were doing and start
to diagnose solutions". At 10 separate events 1,000 NHS staff gave
their views.
Swindells said, "The message that came back from those 1,000
staff was loud and clear: absolute support for the vision. There
was no sense out there that people said: 'I wish we were not doing
this, give us the money back and we will do something
different.'"
But, Swindells said, "There was considerable concern about
whether we were going to make it work and a real fear that they had
not got the training and the skills to take advantage of it when it
came into their organisations. We have taken that away."
Some in the NHS argue that there should be no national programme
in the sense of centrally controlled IT that is imposed on trusts.
That goes too for a national programme in a guise of a local one -
the so-called National-Local Programme for IT.
There should instead be a choice for trusts of IT systems that
should ideally, but not over ridingly, meet technical standards
that are set nationally.
Some independently minded NHS executives have long thought that
the NPfIT should cease to be an amorphous programme under which
integrated systems throughout the country deliver all that IT
should and could.
Better, they say, to have reliable electronic patient records
within local boundaries to replace paper records that frequently
are lost than a grand, risky, controversial scheme for national
records that exists only in ministerial statements of intent.
Yet ministers continue to hope that two main products - Cerner's
Millennium system and IBA Health's "Lorenzo" in the North will give
the NHS much of what it needs. But some see this strategy as a
single circular railway around England that drops people off a long
way from where they want to be.
How did the NHS end up like this, in such a mess? Some Whitehall
officials see this as a pointless question. They want to decide
where to go now. But others say it is important to learn from
history to avoid making the same mistakes again.