Health minister and BT chief talk of risks in delivering the NHS national programme for IT.
Two people leading the modernisation of the NHS have outlined their concerns about the risks and uncertainties confronting Tony Blair's multibillion-pound IT-led initiative.
Ministerial statements made in public about the national programme have focused on the benefits of the initiative and the award of technology contracts to implement it, which are worth an initial £2.3bn, rising to more than £6bn over 10 years.
But at a conference in London, to which journalists were not invited, the health minister John Hutton and Christopher Bland, chairman of BT, who was knighted for his NHS work in 1993, spoke of the programme's risks as well as its potential benefits.
Bland, whose company has won the biggest contracts in its history to implement key parts of the programme, said it will be a "real challenge" to get the initiative to work. He said BT was excited by the challenge but "somewhat frightened by the enormity and complexity of it".
BT's board, after winning more than £2bn in contracts, making the company the main supplier to the programme, felt "slightly like a dog chasing a car... What do we do if we catch it? Well, we've caught it", said Bland.
The success of the project, he said, can "only be measured if frontline staff - if nurses and doctors - are pleased with the services and support that we can provide them and if those services and support enable them to produce a significantly better quality of service to patients."
Hutton said it would be an "enormous challenge" to make a success of the programme and it would be "foolish to ignore the risks". Both men emphasised that the potential benefits to patients and staff of succeeding in the initiative were huge.
Their comments reinforce the concerns of some NHS staff that the programme represents the world's biggest civil IT gamble. Bland told the conference last month at the The Pit theatre in London's Barbican Centre that "no other country has attempted what collectively we are about to attempt".
Hutton spoke at the conference of IT and NHS professionals embarking on a "journey of exploration and discovery" and he said, "We know very clearly now what a huge challenge it is going to be but I also feel very strongly it is one we have to rise to."
Bland said he did not see any fundamental technical obstacles to success, and added that some of the technology being considered for the national programme is already working in London. He foresaw problems in integrating new and legacy systems and migrating data but he said, "Those are problems that I think can be overcome."
The single biggest problem is in "organisation and culture", he said.
Doctors, nurses and other NHS staff will have to change their working practices to suit the new systems and be trained to use them. And locums will have to be paid to cover clinicians in training.
The British Computer Society's Health Informatics Committee said the change management programme could cost more than double the funds allocated to the initiative so far.
Geoff Scaife, chief executive of Avon, Gloucestershire & Wiltshire Strategic Health Authority, said in a letter to trust and primary care chief executives, which urged them to back the national programme, "The change management, training and staff development implications [of the national programme] are simply enormous."
Bland referred to the complexity of the NHS. "We have partners we work very well with in securing this contract. But that is step one. Working effectively with those partners in implementation is, of course, a further and much greater step. And working across the NHS in a highly complicated organisation is a very significant challenge."
He added, "There will be rows, and what seem like almost insuperable problems that arise. All I can say from our standpoint is that we will do our best to work with you to resolve those problems and to find a way around them. BT is absolutely committed to this programme."
He added that BT was "well aware of the history of major IT projects in the national health service which, to put it politely, has been chequeredÉ This one can, and indeed must, be different".
Bland spent 14 years working in the NHS, in part as chairman of Hammersmith & Queen Charlotte's Hospitals Special Health Authority and then as chairman of Hammersmith Hospital NHS Trust.
During his time in the NHS Bland tried to persuade pathologists to adopt a common information system and common processes and procedures. He said his success could be rated at only two or three out of 10. "It was a salutary experience about the complexities of getting common systems across organisations that had been used to working in silos."
At the end of his speech Bland told the conference, "We at BT will work tirelessly and energetically with you to make this project a real success."
A spokesman for the national programme made no comment on Bland's speech, except to refer Computer Weekly to BT's press office. A BT spokesman said, "Any suggestion that BT thinks this programme is a gamble is nonsense.
"It is certainly a complex programme but BT has great experience of successfully delivering major programmes of change and managing complexity. That is why we were chosen by the Department of Health to play a key role in the programme."
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Computer Weekly campaign success
Computer Weekly's NHS IT Watch campaign was nominated last week for a magazine industry "Oscar". It was shortlisted by the Periodical Publishers Association, which represents hundreds of publishers.
The NHS IT Watch campaign plots major events in the management and progress of the government's £2.3bn national programme for IT in the NHS. Computer Weekly's Tony Collins was nominated business writer of the year. The winners will be announced on 5 May.