NHS National Programme for IT - the last of the government mega-projects

And so it came to pass – the £12bn NHS National Programme for IT (NPfIT) is no more, replaced by a decentralised approach that aims to save £700m.

The clock has been ticking loudly for NPfIT for some time, and while the formal death knell has finally been sounded today, its demise has been inevitable ever since the government white paper in July that announced the coalition’s radical reorganisation of the health service.

The Department of Health has managed to come up with a smart compromise that avoids the risk of legal action from the two main suppliers to the programme, BT and CSC. The existing central contracts with both firms remain in place, but NHS trusts will have the freedom to determine when, how – and most crucially, if – they avail themselves of the applications on offer.

The most contentious element of NPfIT, the Summary Care Records system that would put a national electronic patient records application in place, may yet be cut further, with a review underway that will report back by the end of September.

Officially, NPfIT is being “reconfigured” – but the announcement today by health minister Simon Burns gives free reign to local managers to pursue their own IT plans.

In effect, that means BT and CSC will have to compete for every deal they win in every NHS trust, instead of being rolled out automatically in the regions they were responsible for.

“Localised decision making and responsibility will create fresh ways of ensuring that clinicians and patients are involved in planning and delivering front line care and driving change,” Burns said in a written ministerial statement to Parliament.

And therein lies perhaps the main reason why the over-ambitious National Programme floundered – clinician’s anger at the lack of involvement they had in what they perceived as centralised decisions that took little consideration of their needs.

That fundamental flaw was the common theme through all the problems that ensued.

Project reports from the early days of NPfIT revealed poor relations with suppliers and concerns from clinicians. One of the original suppliers, Accenture, pulled out of the programme because it saw costs ballooning and profit shrinking. A second, Fujitsu Services, was sacked. BT was forced to make a £1.2bn write-off because of its contract to deliver NPfIT and had to renegotiate with the Department of Health.

But it wasn’t only the suppliers who suffered financially. In November 2008, the Royal Free Hampstead NHS Trust in London reported a £7.2m deficit as a result of problems with the rollout.

NHS IT managers will undoubtedly be pleased to have regained control over their own systems, but within a national framework that looks to take advantage of common systems that have been delivered by NPfIT such as Choose and Book, digital imaging and electronic prescriptions.

At the time the programme was initiated, way back in 2003, the concept of regional providers with some national applications was pitched as a compromise between total centralisation and complete decentralisation. In truth, it was what the technology available at the time was best at delivering.

Since then, the internet has connected everyone, and if you started NPfIT today, it would be blatantly obvious that you set common standards, and allowed everyone to do their own thing with a standardised, interconnected infrastructure.

For government IT, perhaps that is the most important thing to learn from the demise and debacle of the NHS programme. Technology changes faster than any such large-scale project can deliver, and putting in place a huge, 10-year programme based upon trends and technical limitations at its inception is doomed to failure.

The future of government IT is smaller, decentralised, faster to implement, standardised, interconnected systems. The lasting legacy of the NHS National Programme should be that it is the last of the overblown, over-ambitious mega IT projects.