The
National Programme for IT in the NHS was launched with the best
of intentions - to use technology to help doctors, nurses and other
health professionals make better decisions in the interests of
patients.
The NPfIT is also aimed at helping patients make better
decisions in their own interests.
But good intentions have taken some hospitals on the road to
hell.
Conservative MP David Davis - the former shadow secretary - says
that there are too few in government who understand IT enough to
realise that it doesn't have magical properties.
This could explain why, when New Labour launched the NPfIT in
2002 ministers and their enthusiastic advisers - particularly
potential suppliers - delighted in the potential rewards and
consigned the risks to a list on an A4 page in documents about
policy, objectives and methodologies.
It is the materialising risks which now dominate the programme.
Patients at hospitals have had their care and treatment disrupted,
cancelled or deferred as a result of installations of the NPfIT
Care Records Service at hospitals such as Nuffield Orthopaedic
Centre, Barnet and Chase Farm, Weston, Barts and the Royal
Free.
Now another risk is coming to the fore - that of trusts buying
their hospital systems outside of the NPfIT. This raises questions
about the point of a national programme for IT.
The Department of Health has given suppliers billions of pounds
worth of contracts, largely to install systems at trusts. But if
trusts do not buy their main systems from the NPfIT suppliers is
there much point in colossal national contracts?
This is a political problem: if the national programme was badly
cracked at the outset, and there is every sign of this, that is a
matter for politicians.
It is more than a political problem, however: health officials
are now threatening to penalise some hospital boards, particularly
semi-autonomous foundation trusts, if they buy outside the
NPfIT.
This could have a bizarre effect: trusts paying millions of
pounds in penalties so they can forfeit the right to have "free"
systems under the NPfIT.
The NPfIT contracts have guarantees to the programme's local
service providers CSC and BT. The idea is that these companies use
their money to build systems which comply with Whitehall's
output-based specifications in return the Department of Health
guarantees to the suppliers a minimum amount of annual business.
This guarantee puts the onus on trusts to buy their patient
administration and central clinical systems from CSC or BT.
But when foundation trusts bypass CSC or BT, the Department of
Health is left with a liability to the supplier for
"non-deployment" compensation. Some health officials want to pass
this liability to trusts which buy their main hospital IT outside
the NPfIT.
This is why health officials have threatened Rotherham NHS
Foundation Trust with charging its board for the Lorenzo system
from CSC when trust has decided to go to open tender and install
alternative technologies.
The threat was revealed by Brian James, chief executive of the
Rotherham trust, in an interview with Computer Weekly.
If the threat were carried out, it would mean that Rotherham
installed one hospital e-records system and paid for two. The
supplier CSC would be paid in effect for not deploying Lorenzo at
Rotherham and the taxpayer would pay for nothing which would
benefit patients or the NHS.
We understand that threats of penalties for non-deployment have
been made against various NHS trusts but have not been pressed
home, as far as we know. It may happen. Last year John Yates, a
lawyer with Beechcroft, said in an article that there was tension
between the Department of Health and trusts over "non-deployment"
charges for trusts opting out of the NPfIT.
He said: "This is becoming a bone of contention between trusts
and the department.The department's legal right to penalise Trusts
buying outside NPfIT is unclear, but anecdotal evidence suggests
that the department is using its political and financial muscle to
force trusts to follow NPfIT, and so perhaps Monitor [the regulator
of foundation trusts] needs to look into this urgently."
The Labour government was dismissive of, and even oblivious to,
the seriousness of the risks when it launched the massive NHS IT
programme. From its outset the programme was defective in its
one-size-fits-all approach. But the materialising serious risks
should remain a problem for ministers and perhaps even for voters
at the next general election. The programme's defects should not
continue to haunt NHS trusts - or taxpayers.
Read more on the IT Projects Blog >>