Secret papers reveal Blair's rushed NPfIT plans

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Summary of article

- Tony Blair tried repeatedly to shorten the time to make health records available online, which would have made them available to patients shortly before the 2005 general election

- Original timetable for NHS National Programme for IT [NPfIT] is revealed in Downing Street papers released to Computer Weekly under the Freedom of Information Act, after our three-year campaign for their disclosure

- Downing Street meeting in February 2002 gave birth to the UK government's biggest IT investment, but no minutes were taken

Article

Tony Blair repeatedly sought to shorten the time period projected for an IT-based modernisation of the NHS - which if achieved could have allowed patients to access their health records online in time for a general election in 2005, Computer Weekly has learned. 

Papers obtained by Computer Weekly under the Freedom of Information Act show that the Department of Health drastically underestimated the time it would take to make electronic records available to doctors and patients.

In a paper presented to an NHS meeting at Downing Street, which was chaired by Tony Blair, the Department of Health gave undertakings of what the NHS would be like in 2002/3, 2003/4 and finally 2004/5, if the right investments were made.

The paper promised that an IT-based modernisation would provide “seamless” care across organisational boundaries wherever patients are by 2004/5 – less than half the time now allotted to the scheme.

It said that by 2004/5, as a patient:


- I can receive telecare at home, so I can leave hospital sooner

- I can access my own electronic records

- I know that if I have an emergency away from home that a summary of my health record will be available

- I can book appointments where and when it is convenient for me (and get reminders)

And as a doctor, by 2004/5, the paper said:

- EPRs [electronic patient records] will enable me to have clinical data online as well as reporting of results

- I can prescribe drugs more safely at less cost by using computer support

- As a junior doctor I save 30 minutes a day in chasing results and getting ready for ward rounds.

- I will be able to use patient summaries from their electronic health record eg for emergency care

- I will know that clinical terms in use are clearly defined and support analyses in practice

As a health professional, by 2004/5, the paper promised:

- I can really work as part of a multiprofessional team, and across organisational boundaries, providing seamless care to a patient wherever I see them

- I can begin to use some video-based materials from the NHS U [university].

The Downing Street meeting on 18 February 2002 was attended by several Cabinet ministers, the Cabinet Secretary, representatives of IT suppliers including Microsoft UK, No. 10 policy advisers and health experts.

Blair made it clear at the meeting that he regarded even the 2004/5 timetable as extending over too long a period. He asked repeatedly for it to be brought forward. It was likely at that time that there would be a general election in 2005.

Blair told the meeting at Downing Street that taking the programme faster than currently planned would help underpin the reform agenda and provide visible evidence of NHS modernisation to patients and the public. Those at the meeting argued for the NHS IT scheme, as did Blair, but he alone wanted an acceleration of the programme.

But the timetable in the Department of Health paper has proved hopelessly optimistic. Today, access by patients and doctors to national summary care records are only at a trial stage. And contracts for the delivery and implementation of new national systems run until 2013 – eight years beyond the 2004/5 period mentioned in the Department of Health’s paper to Blair.

The Department of Health awarded most of the local service provider contracts in record time under the NHS’s National Programme for IT in 2003, but some suppliers complained they were being given too little time to consider their proposals.

One important part of the NHS IT programme - a national summary electronic health record - is now running three years behind the original timetable, in part because the idea is proving more complicated than first thought to put into practice.

The Downing Street papers raise questions about whether the timetable for the national programme was geared towards a general election in 2005 rather than the practicalities and complexities of the scheme – and whether the Department of Health put politics before realities in promising the NPfIT in under three years.

Paul Cundy, GP IT spokesman for the British Medical Association, said it appeared that the Department of Health had been “wildly even delusionally-optimistic about the timetable for the NPfIT in order to secure funding”.

Vince Cable, Liberal Democrat Deputy Leader, said the Downing Street papers showed that the launch of the NPfIT and the political endorsement given to it by the meeting chaired by Blair was in the context of “amateurism, extreme naivety and a lack of consideration of the practicalities”.

Martyn Thomas, professor of software engineering at Oxford University and one of 23 academics who has called for an independent review of the NPfIT, said of the Downing Street papers:

"The Department of Health briefing to the Prime Minister was misleading. It implied that the department had overcome its difficulties in delivering IT systems throughout the NHS and that all that was now needed was increased funding and more central control over IT spending. Its timescales for delivering improved services were hopelessly optimistic, but no-one in the seminar was recorded as having challenged them (presumably because the purpose of the seminar was to win the PM's agreement to the funding, not to critically review the strategy).

"In my opinion, no competent IT director would have recommended substantial investment on the basis of the DH paper, and no competent chief executive would have approved such investment without a robust, independent review of the strategy and plans."

For three years solicitors for the Cabinet Office had opposed our request for the Downing Street papers in part because “disclosure of the information may disrupt the proper consideration of NHS IT projects in coming years” and “information as to the format of the meeting demonstrates the way in which the policy relating to NHS IT was developed and approached".

In fact the papers reveal the informal way an IT-based modernisation of the NHS was discussed. There were no minutes of the Downing Street meeting – only a letter from one official to another which reported some of what was said – and no discussion of the risks of failure, or what would happen in hospitals if poorly-planned implementations disrupted the care and treatment of patients. There was no independent appraisal of the scheme.

The Department of Health’s briefing paper to Blair gave undertakings about making use in the IT programme of the NHS Modernisation Agency and the NHS University – both of which have since been dissolved.

The Cabinet Office papers released the papers on 11 February 2008 – the day the Information Tribunal was due to meet to consider a ruling on whether they should be disclosed.

Links:

More than £4bn spent on NPfIT by April 2008

Who was at Downing Street meeting

Why we campaigned for release of Downing Street NPfIT papers

Forthcoming release of Downing St papers on the NPfIT

Secrets of Blair briefing on NPfIT to be surrendered

Downing Street NPfIT papers to be released

Cabinet Office - investing public money in secrecy

Information Commissioner orders disclosure of NPfIT papers

Freedom of Information blog

NHS Spending Billions on Centrally Stored Patient Records But, German Doctors Say "No Way!"

NPfIT in trouble?

Blair had 10-minite briefing on the NPfIT

2 Comments

  • Well done to CW for finally extracting this information, which confirms only too well what we have known from the outset: the initiative was positioned as an IT project, rather than the Information Systems initiative that was really required.

    A clearer cut example of putting the cart before the horse could not be given.

    Sadly this happens far too often with Government initiatives. Technology is seen to be the answer, when systems (including technology) are really required.

  • This information is no surprise. Health IT has long been dominated by non medical decisionmakers overflowing with false assumption, underestimations and an irrational exuberance about IT that creates mayhem.

    The IT world fuels the irrational exuberance, with its 1940's IBM punch card/plug panel tabulation-machine, magic-bullet culture. Medicine is just a bit more complex than the rigid accounting systems accomodated by that card punch-tabulating culture.

    See my web site on health IT difficulties here.

    In previous years I've seen many "hits" on the website above from the nhs.uk domian. I wonder if anyone of importance was reading and comprehending the material there, a site in existence since the late 1990's.

    Also see my webcast on the Government Health IT site (U.S.) entitled "The Problem with EMR's". I discuss the irrational exuberance phenomenon here.

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