Tony Collins's IT Projects Blog

Comment

Kevin Barron, the chairman of the House of Commons' Health Committee, gave a sympathetic hearing last week to Richard Granger, head of the NHS's £12.4bn National Programme for IT [NPfIT].

Barron's fireside friendliness towards Granger was a contrast to a hearing on 26 June 2006 when the House of Commons' Public Accounts Committee investigated the NPfIT.

Loyalist Labour MP Kevin Barron, who is chairing an inquiry of the House of Commons' Health Committee into aspects of the NHS's National Programme for IT [NPfIT], has warned that too much questioning may harm scientific Progress.

Barron set out his views at the first of a series of hearings of the Health Committee into aspects of the NPfIT. MPs including Barron asked some witnesses whether they were in favour of an independent review of the NPfIT.

Barron's own comments suggested he was not in favour of too much questioning of the NPfIT.

He said: "If you go back in years in medical history, into some of the things that doctors were doing at the time, which made major breakthroughs, people were sceptical about [these]. People were questioning even what their peer groups were doing in terms of whether it was the right thing to do."

The NHS Confederation, which represents more than 90% of statutory health service organisations, has expressed concerns to the House of Commons' Health Committee about aspects of the National Programme for IT [NPfIT] in the NHS.

In a paper to the committee, which is investigating aspects of the NPfIT, the NHS Confederation said that organisations continue to be "fully committed to the overall vision" of a Care Records Service" which aims to give 50 million people in England an electronic health record.

But it said that "delays in the delivery of key operational systems which feed the NHS Care Records Service, such as patient administration systems, are "causing real problems and costs within the service".

One highpoint of the first hearing of the Health Committee's inquiry into the National Programme for IT [NPfIT] on 26 April 2007 was an exchange between Martyn Thomas, who has called for an independent review of the scheme, and the committee chairman, Labour MP Kevin Barron.

Thomas made a good case for a review of the NPfIT and Barron appeared to remain sceptical throughout. Barron had not particularly welcomed his committee's deciding to hold an inquiry into the NPfIT.

Richard Granger, head of the NHS's National Programme for IT [NPfIT], when asked whether he supported the call for an independent review of the scheme, had made it clear that his door was open to critics whose comments were based on robust evidence.

But Martyn Thomas, visiting professor of software engineering at Oxford University's computing laboratory, emphasised the need for a review that was independent of the programme team

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing, Independent MP, Dr Richard Taylor, summed up the spoken evidence of the first group of witnesses, Richard Granger, Harry Cayton and Dr Gillian Braunold, as "bland platitudes".

These three witnesses had left the committee room after giving their evidence, without waiting to hear what the second group of witnesses - Martyn Thomas, Dr Paul Cundy and Andrew Hawker - had to say.

Speaking to Thomas, Cundy and Hawker, Dr Taylor, MP, said: "I am echoing David [David Amess, Tory MP on the committee]. It is so good to have you three after the bland platitudes we had from the first lot - absolutely refreshing. We were told user involvement was there from the beginning, and you said obviously it was not..."

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of the things that concerns me about the programme is that there is no definition of what is an acceptable level of security breach.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy was asked by David Amess MP: "Dr Cundy, is it a good thing that general practitioners will be offered a choice of suppliers for their electronic record system and does the decision to offer choice represent a change of direction by Connecting for Health and will it mean a less centralising approach to these issues?

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Dr Paul Cundy said: "I know from my system in my practice is that there are times when I, quite frankly, do not have an immediate clue as to what is going on with a patient, and we have 20 years' worth of patient electronic records.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Richard Granger said: "...I would say with the time overruns that one of the problems with this programme is there was no financial contingency.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said: "One of my concerns about the way the programme is going is that it is in danger of locking itself out of the advances that will be made in the availability of healthcare systems around the world.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing Martyn Thomas said:

"It seems to me that there are two issues that are being run together here. The overall objectives of the system seem to be trying to tackle two problems in parallel and those two issues are perhaps in conflict.

"On the one hand, there is the question of putting in good IT to support the clinicians supporting the patients, and I think everybody in the NHS is entirely behind that. Where IT can improve healthcare, it is sensible to deploy it once you are in a position to be able to be able to roll it out without disturbing things too much.

There is also the issue of transforming the way that the Health Service operates and the way that the Health Service is managed and the need for information to be available in order to be able to change the management structures.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the first Health Committee hearing MP Jim Dowd asked Richard Granger: "When you say it [the NPfIT] has got more functionality than originally envisaged, is that because the original estimates were just wrong?"

Richard Granger replied: "I do not know of a large-scale IT enabled transformation programme in a complex organisation that from its starting point to its mid point has a direct correlation.

"I think it would be a fantasy to imagine. I know people write fantasies, but in the real world it would be ridiculous to imagine that halfway through a ten-year programme you would only be doing the same things as you set out five years ago.

This is one of a series on this blog of some of more memorable comments made by witnesses and MPs at an inquiry into the National Programme for IT [NPfIT] by the Health Committee of the House of Commons.

The witnesses at the first hearing on 26 April 2007 were:

- Richard Granger, Director General of IT for the NHS and head of the NPfIT
- Harry Cayton, National Director for Patients and the Public, Department of Health
- Dr Gillian Braunold, a GP and National Clinical Lead for GPs, Connecting for Health.
- Martyn Thomas, visiting Professor of Software Engineering, University of Oxford,
- Dr Paul Cundy, Chair, General Practitioners' Joint IT Committee
- Andrew Hawker, NHS Patient

A list of who is on the committee is at the end of this article.

At the Health Committee hearing the chairman Kevin Barron asked Martyn Thomas why he was calling for an independent review of the NPfIT. Barron's view appeared to be that the facts independent reviewers would discover would already be known to the project team. So why have an independent review? In reply Thomas gave a sound summary of the benefits of an independent review over one commissioned internally.

Barron asked: "Do you think that people who are involved in the National IT Programme at the moment are aware and conscious of those facts, whether reviews have been published or not in terms of that? Do you think they are not capable of knowing that as something in their daily business, as it were? The programme is not without its problems. Are these people who are developing it not capable of being able to do that?"

Thomas replied: "I have reviewed a lot of large technical programmes over the years, and I want to stress, I am not asking to review this one personally, I am not for a second bidding for that job, but my experience of carrying out those reviews is that people get blinded by the fact that they are too close to the project and they get compromised by the fact that they cannot stand back and admit errors.

Statement from Connecting for Health, which runs the NHS's National Programme for IT, on Computer Weekly's article on duplicate patient records in Greater Manchester.

Download file

Connecting for Health, which runs the NHS's £12.4bn National Programme for IT, has responded to some our questions. These are its replies.

A team of people is working to stop medical information going missing after a software upgrade under the NHS's IT Programme led to hundreds of unwanted, incorrect and duplicate patient records being created every day.

The problem involves NHS sites in Greater Manchester and raises questions about how well some systems are being tested before going live as part the £12.4bn National Programme for IT [NPfIT].

Internal documents show that the duplicate patient records are incorrect. They have been created on the assumption that patients do not already have a record - even if they do. If these duplicates are left in place it could lead to clinicians seeing patients without access to important medical history.

To stop this happening, patent records have to merged with the duplicates quickly. If a backlog of unmerged records builds, hospital record libraries could send to clinics, days in advance of an appointment, the wrong patient file based on the duplicate record - which could be that of an entirely new patient.

Hundreds of unnecessary and incorrect patient records have been created daily as hospital appointments were booked on the National Programme for IT's Choose and Book system when linked to iSoft's iPM system.

It has come to light after an Maintenance Release 1 upgrade of iPM system over the weekend of 21/22 April 2007.

The problem means that when appointments are made on some Choose and Book systems in Greater Manchester where the MR1 upgrade has been installed, and the system cannot find the patient's correct identification number on the Personal Demographic Service of the National Programme for IT [NPfIT], it will create a duplicate record.

Connecting for Health, which runs the NPfIT, says that up to 400 duplicate records are being created every day. It denies there is any effect on the care and treatment of patients.

Internal documents show, however, that the problem is being categorised as a potential risk to safety. To avoid accurate patient data being lost in the mingling of correct and incorrect records, a team has been formed to merge the records carefully and safely.

Comment

When Computer Weekly began researching the cause of duplicate patient records at Manchester we contacted one of the trusts involved, the University Hospital of South Manchester NHS Foundation Trust.

The immediate reaction of a spokeswoman for the trust was to say that she had received a note about the incident a few days earlier from Connecting for Health, which runs the National Programme for IT [NPfIT].

"I am looking at it now," she said. "It is saying: 'if trusts have any press inquiries regarding the GM [Greater Manchester] Incident they should contact the Connecting for Health press office."

The note was dated 27 April 2007, several days before Computer Weekly contacted the trust. It seemed, therefore, that neither Connecting for Health nor the trust had issued any statement on the problem of duplicate records in Greater Manchester. They were prepared, however, to make a statement if a journalist rang. This may appear at first to be effective crisis management but it's not a good way to disseminate lessons.

The following are separate events reported as "Major Incidents" to NHS Connecting for the Health, which runs the NHS's National Programme for IT [NPfIT]. The particular incidents mentioned below were categorised as "Severity One".

After attacking the media for inaccurate reporting of aspects of the National Programme for IT [NPfIT], NHS Connecting for Health, which runs the programme, has accused some NHS trusts of "inaccurate reporting" of incidents that involve NPfIT systems.

An academic study of staff views of the progress of the National Programme for IT [NPfIT] locally has found that financial deficits and poor communication have hampered its implementation.

And the study found that continuing delays could constitute a growing risk to patient safety. The research was published online on 17 May in the British Medical Journal.

It's not good news for the NHS's National Programme for IT [NPfIT] that Richard Granger, Director General of NHS IT and head of the technology part of the scheme, is to leave.

Lord Hunt, the health minister most closely associated with the launch of the NHS's National Programme for IT, has left the Department of Health in Gordon Brown's shuffling of ministerial posts.

Less than four months ago, in March 2007, Lord Hunt told the HC2007 healthcare conference at Harrogate that he was pleased to be back as health minister.

Caroline Flint, a Health minister and government spokeswoman on the NHS’s National Programme for IT, has been moved out of the Department of Health as part of Gordon Brown’s ministerial changes.

A medical organisation cited by the Department of Health as a reference site for the NHS Care Records Service has been criticised by a US regulator after 1.3 million sensitive files went missing.

Analysis

NHS Connecting for Health has published on its website one slide from a “confidential” briefing presentation to the former Prime Minister Tony Blair on the NHS’s £12.4bn National Programme for IT [NPfIT], following inquiries by Computer Weekly.

Other slides in the presentation to Blair, which Connecting for Health hasn't published, give an insight into how officials wish to counter criticism of the programme.

In an interview before he announced he was leaving his job as Director General of NHS IT, Richard Granger is reported to have criticised some early installations of software from Cerner, a US-based health software supplier.

In CIO Magazine Richard Granger referred to Cerner whose "Millennium" software is scheduled to be deployed by NHS trusts across Southern England and in London as part of the £12.4bn National Programme for IT [NPfIT].

Fujitsu, the local service provider to the NHS in Southern England, has chosen Cerner as its main software subcontractor.

Richard Granger was quoted as saying:

“Sometimes we put stuff in that I’m just ashamed of. Some of the stuff that Cerner has put in recently is appalling. It really isn’t usable because they have been building a system with Fujitsu without listening to what the end users want. They have taken some account but they then had to take a lot more. Now they’re being held to account because that’s my job.”

We asked for a comment from NHS Connecting for Health, whose chief executive is Richard Granger. We put it to CfH that a number of hospital trusts were preparing to implement to Cerner's systems and were already, before Richard Granger's reported comments, concerned about the risks of failure and the uncertainties over how well Cerner's Millenium product could be adapted for widespread use in the UK. We asked whether such concerns may be deepened by the reported comments about Cerner.

An official at NHS Connecting for Health did not play down Richard Granger's remarks.

David Nicholson, Chief Executive of the NHS, has appointed three top-level executives who could provide some of the skills of the outgoing Director General of NHS IT Richard Granger.

The appointments, to strengthen leadership at the Department of Health, could indicate that top management of the £12.4bn National Programme for IT [NPfIT] in the NHS is to become more diffuse.

The most notable appointment is that of Mark Britnell, one of the NHS's most experienced NPfIT executives, who has been appointed Director General for Commissioning and System Management.

Last year Mark Britnell was Chief Executive of University Hospital Birmingham which installed a "Reference Solution Patient Administration System" from CSC, the main NPfIT local service provider with contracts worth about £3bn.

The President of CSC Europe, Guy Hains, met Britnell last year at the hospital.

CSC said in a promotional brochure that Britnell's hospital was "at the forefront of the current transformation in the NHS".

Mark Britnell was later appointed as Chief Executive of the South Central Strategic Health Authority and was lead Senior Responsible Owner of the NPfIT for the South of England.

He has worked closely with David Nicholson on plans to try and revive support for the NPfIT among the boards of directors of local trusts and strategic health authorities. Britnell was national Senior Responsible Owner of the NPfIT Local Ownership Programme [NLOP].

NHS Connecting for Health, which is largely responsible for the NHS's £12.4bn National Programme for IT [NPfIT], is facing new financial pressures.

In the foreword to his first annual report of the NHS’s National Programme for IT [NPfIT], Richard Granger gave an account of the scheme's progress and some of its challenges.

At that time, in 2005, Granger expected that the organisation he managed, NHS Connecting for Health, would publish another annual report a year later.

This was the prediction he made in NHS Connecting for Health's 2004/5 annual report: “I am confident that our Annual Report for 2005-2006 will contain details of our success in delivering systems which will help tens of thousands of NHS personnel to better serve millions of patients using tools which have been delivered by NHS Connecting for Health”.

But there would be no more annual reports on the NPfIT. And thus no further annual account on the progress NHS Connecting for Health.

The future of the National Programme for IT [NPfIT] is looking indistinct.

Computer Weekly is today [14 August 2007] publishing a series of articles that, when considered together, suggest that the government wants the NPfIT to blend into NHS IT in general. The NPfIT would, therefore, have less of a clearly discernible – and controversial – character.

There are some of the recent developments:

- There are signs the programme is in flight from ruthless standardisation

- Whitehall has dropped plans to give NHS Connecting for Health, the organisation set up to run the programme, the status and independence of an executive agency

- Officials are struggling to find money for plans to localise the scheme

- A more diffuse leadership at the Department of Health is poised to subsume some of the skills of Richard Granger, the departing Director General of NHS IT.

We congratulate Barnet and Chase Farm Hospitals NHS Trust on becoming the first London hospital to go live with the Cerner Millennium patient administration system as part of the National Programme for IT [NPfIT]

Although it’s the basic, non-integrated R0 release of the system, it combines the data from two separate patient administration systems, the McKesson TotalCare system and IRC PAS - no small feat. Another major challenge has been training staff to work in a different way.

Corporate America hates the word “but” whether spoken or written. But sometimes it’s unavoidable.

Progress is a beguiling thing. Pushing a broken car up a hill is a form of progress. Before the advent of the NPfIT in 2002, there were regular announcements of advances in regionally-based electronic patient record systems. Now we’re delighted when a single patient administration system – unlinked to others – goes into a hospital without too much disruption.

Links:

Head of IT at Barnet and Chase Farm NHS trust quits

Barnet and Chase Farm Hospitals NHS Trust announces go-live of new Cerner system

Barnet and Chase Farm switch on Cerner

October 2001 - MInisterial statement on progress with electronic patient record systems

A separate posting on this blog refers to a decision of the Information Commissioner to order the release of "sensitive" papers from a mee