With the general interest in the media and elsewhere in
how the world's largest civilian IT programme came about, Computer
Weekly is republishing the minutes of a meeting at Downing Street
in February 2002 which sparked theNHS's £12.7bn National Programme for
IT.
The minutes show that the then Prime Minister Tony Blair was in
a rush to have the national technology programme for the NHS
completed, perhaps in time for a 2005 general election.
The Downing Street minutes were obtained by Computer Weekly
three years after we requested them. The meeting was chaired by
Tony Blair and led to the announcement in June 2002 of
"Delivering 21st Century IT Support for the NHS", a strategy
for an IT-based modernisation of the NHS.
Among those attending the meeting was the head of Microsoft in
the UK, along with other suppliers and consultants. A year earlier
Bill Gates had met Tony Blair where a modernisation of the NHS was
discussed.
The minutes were reported internally in a letter by Simon
Stevens, then an official at Downing Street, to Sammy Sinclair, who
was then an official at the Department of Health. The letter was
written on 26 February 2002, eight days after the Downing Street
NHS IT meeting.
This is the letter:
From the senior policy adviser, 26 February
2002
Dear Sammy,
PRIME MINISTER'S SEMINAR ON NHS INFORMATION SYSTEMS
The Prime Minister held a seminar on NHS information systems
with your Secretary of State, the Chief Secretary, Lord MacDonald,
Lord Hunt, Sir Richard Wilson, Nigel Crisp, and Sir John Pattison
on 18 February 2002. Paul Corrigan, Andrew Pinder, Peter Gershon,
Neil Holloway, Kevin Dean, John Hall, Ian Walker, Ed Richards,
Dominic Hardy, William Perrin, Wendy Thomson, Michael Barber and I
were also present.
Your Secretary of State opened by saying that IT was one of the
key mechanisms for supporting NHS reform. The NHS was starting from
a low base because over several decades there had been instances of
high-profile project failures, and because of an historic lack of
investment. The NHS spent between 1.5% and 2% of its budget on IT,
compared with 6% in the US.
Continuing, Lord Hunt [now a minister in the Ministry of
Justice] said that the vision for IT in the NHS was that it should
underpin the reform programme and provide fast and convenient
access to services, through booked appointments, electronic
prescribing and electronic health records. Historically NHS IT had
been dogged by too little managerial capacity and clinical
ownership, but there was a real sense now that people were prepared
to back IT developments. The key was to use stronger central
direction to accelerate the pace of change and make more use of
partnerships with the private sector.
Sir John Pattison [then lead Director for the NHS IT programme]
said that the starting point for the IT programme in the NHS was
the relationship between the patient and the clinician - from GP
consultation through diagnosis and prescribing support, to booking
a consultant appointment and supporting the care pathway through
treatment in hospital. The priority now was to accelerate the
development of broadband connectivity and focus on the main areas
outlined by Lord Hunt [booked appointments, e-prescribing and
e-records]. In terms of delivery the NHS Modernisation Agency
[since disbanded] was working with clinicians to help change
working practices and drive compliance with standards.
The Prime Minister said that in his view good IT was a
pre-requisite for a modern NHS. At the moment, it did not have the
information systems which would enable it to deliver first-class
health services. The main issues to be tackled were how to ensure
the NHS had the right systems how these systems were implemented
locally by managers and clinicians and how we increased the pace of
development.
Neil Holloway (then Microsoft UK chief executive] said that the
private sector was increasingly focusing on defining adherence to
core standards in areas such as data exchange. The NHS should adopt
this approach. This avoided the need to specify that every part of
the health service had the same system, but would ensure that they
could communicate with each other.
Kevin Dean [Cisco] agreed that there was now a range of
technologies which supported this approach, but they relied on
ruthless central direction to ensure that everyone complied with
standards.
Your Secretary of State of State added that, in the past, money
allocated for IT had not been used for IT projects. The only way to
ensure that this happened was to ring-fence it and insist that it
was spent by the NHS against a set of national standards.
The Prime Minister said that it was clear that this needed a
strong central focus within the department and that now was a good
time to make progress because Primary Care Trusts would shortly be
taking up their full responsibilities.
Nigel Crisp [then NHS chief executive] said that the NHS was now
receptive to a central approach in this field and that funds should
be earmarked centrally.
Andrew Pinder [Cabinet Office e-envoy] said that it was
important to define a set of standards as quickly as possible as
this would be the key building block for further developments.
Electronic health records were another key component, but the
Department of Health had to decide which of the pilot schemes it
wanted to back to make quick progress. Increasing broadband
capacity was equally vital, not least because this would enable
electronic health records to be moved around the system.
Sir John Pattison agreed with these points and added that NHS
staff would be receptive to changes in the way IT was delivered,
even if working practices took some time to adapt.
The Prime Minister asked whether the programme could be
accelerated. In the past, there had been uncertainties about the
benefits and reliability of different technologies but these were
now much clearer. Taking forward the programme faster than
currently planned would help underpin the reform agenda and also
provide visible evidence of NHS modernisation to patients and the
public.
Peter Gershon [then head of the Office of Government Commerce]
responded by reporting that the Office of Government Commerce was
taking forward work to compress the time needed to procure systems.
There was scope to reduce the time between project conception and
the awarding of the contact if those involved had a clear idea what
they wanted. The department needed to monitor private sector
interest in the NHS IT programme to ensure it could meet
demand.
The chief secretary asked whether the new NHS systems would be
compatible with those used by Social Services to ensure efficient
data transfer at the interface between the two sectors.
Sir John Pattison said that the department was currently
exploring how medical records would be transferred, perhaps using a
unique NHS identifying number, although this was not the only
solution.
The Prime Minister asked about work in progress across
government in this area and asked Sir Richard Wilson [cabinet
secretary and head of the home civil service] for a paper outlining
latest developments, including the possibility of a single
identifier for individuals.
Summing up, the Prime Minister said that it was clear that good
IT had a major role to play in helping secure fast and responsive
NHS services. It was an area which had seen significant
underinvestment in the past but one which would undoubtedly benefit
from greater investment in the future. There would be further
discussions in the context of the Spending Review. He agreed with
the priority areas of work outlined by Sir John Pattison, but asked
the Department of Health to look again at its implementation
programme and accelerate it where possible. Greater central
direction of the programme would help provide momentum and ensure
that NHS organisations complied with standards. He would be
grateful for a further paper on progress and options for faster
implementation in due course.
I am copying this letter to the private secretaries to the chief
secretary to the Treasury, Lord MacDonald, Lord Hunt and Sir
Richard Wilson.
Yours sincerely,
Simon Stevens
Department of Health
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