NHS CIO Christine Connelly announced the departure of the man
who is running the £12.7bn NHS National Programme for IT (NPfIT) in
an e-mail last week.
Martin Bellamy has been head of NHS Connecting for Health, on a
salary of at least £200,000 for less than a year.
He is joining the Cabinet Office to manage the
government's cloud computing strategy.
Connelly recognises in her e-mail that news of Bellamy's
departure - from a project which represents the government's
largest IT investment - "probably fuels" uncertainty.
But that is nothing new.
Last week the Department of Health published
31 Gateway Reviews on the NPfIT.
They show that the programme was not only uncertain, but
unfeasible from its launch in early 2002. While ministers were
publicly praising early progress on the NHS IT programme,
independent Gateway assessments of the scheme were raising doubts
about the integrity of its design and foundations.
It was - and is - a problem with many large and risky IT
projects and programmes in government. Once they have left Downing
Street's launch pad, there is no way of stopping them. Money is
committed, contracts are signed, and everyone involved has to try
to make it work.
Flawed from the outset
In 2002 nobody who valued their career could have gone back to
the then prime minister Tony Blair to say: "This NHS IT
modernisation is a good idea but perhaps we are not going about it
in the right way."
The Gateway reviews at that time show that the political
priority was to appoint about five service providers as quickly as
possible, rather than designing a system for patients. "We were
told categorically that the OBC [outline business case] was
specifically to gain approval for the procurement of the prime
service providers," one review noted.
And nobody really knew what they were doing. The first Gateway
review of the programme as a whole said in June 2002: "The people
on the programme display a 'head office' mindset, with 'great
thoughts' being developed at the centre and then disseminated. A
successful programme does not work like this."
It warned that only staff with frontline experience could ensure
that an application would actually work. But many of the 31 Gateway
reviews, from 2002 to 2007, said the programme lacked engagement
from staff. It is a criticism that sticks today.
Improvement
But things are starting to improve. The original plans of the
NPfIT - for a small number of nationally-integrated systems - have
disintegrated. The government spent £4bn for little in return. Some
hospitals that have pioneering NPfIT systems have lost track of
patients and left thousands of them without timely treatment.
So tainted is the NPfIT brand that officials at the Department
of Health now want to change the name of NHS Connecting for Health.
CfH is seen as too closely associated with the NHS IT programme. A
consultation on the future of CfH is underway.
The good news is that trusts are to be offered a choice of
centrally-funded systems, starting with trusts in the south of
England. They will be able to buy existing UK systems or the Cerner
Millennium system directly from Cerner, not through a local service
provider.
Choice may be extended to London and the rest of England too, if
the CSC Lorenzo software fails.
Connelly seems to be asserting herself, listening, and taking a
pragmatic view. She is still protective of the NPfIT, but perhaps
not overly so. Her e-mail to staff about Bellamy does not mention
the national programme. "Let's not forget the real appetite out in
the NHS for quality informatics," she says.
Inside the NHS, executives want Connelly and her team to choose
for the NHS only systems that are proven in the UK. That will make
a change from calamitous installations of IT that has been
successful in the US but has not been shown to work in the UK
without years of customisation.
The NPfIT may be dead or dying. But at least Connelly is
beginning to build some respect within the NHS for her informatics
plans. She says in her e-mail, "The ultimate outcome - creating the
best electronic healthcare systems and services in the world to
help save lives and improve the quality of care - is an ambition we
can all aspire to and share."
That is a message NHS IT professionals have heard many times
before from head office. Perhaps Connelly can make it happen this
time.
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