Not unlike politics, IT management has long been an ideological affair.
There are those who believe firmly in the mantra of outsourcing, for example, and equally those who just as strongly oppose it.
And like political ideology, IT trends go in cycles. When centralised becomes unpopular, so we go distributed; .from mainframe, to client-server, and these days back to the consolidated datacentre.
But when you put together the ideologies of both politics and IT, you get what in technical parlance can be known as a complete bugger’s muddle. Or in more topical terms, the NHS IT programme.
For many months now, the Tory party have promised to review the troubled £12bn NHS National Programme for IT (which, as an aside, would at least have the side benefit of getting rid of the awful acronym NPfIT) and now they are in power it looks like it is happening.
NHS CEO David Nicholson confirmed yesterday that an announcement on the future of NPfIT is due within the next four weeks. He was talking at a press conference announcing the government’s major overhaul of the way the health service is run and structured. The reorganisation will see the abolition of primary care trusts and strategic health authorities, with consortia of GP practices driving patient care and treatment options.
The move is a clear shift from Labour to Conservative ideology. Labour went for a centrally-controlled, state-funded, target-driven NHS. The Tories want local autonomy, private sector involvement, and results-driven measurements of success. Apply those comparisons to pretty much every area of the public sector and you can make some fairly firm assumptions about what the next few years holds for central and local government.
Of course, such a radical ideological shift in management priorities needs an equally radical shift in IT priorities to make it work.
NPfIT was centrally controlled, state funded, and target driven. The same IT strategy will simply not support the NHS the Tory and LibDem government want to build. So how much of the existing investment can be salvaged?
The Choose and Book appointment booking system is to be beefed up – ironic, considering how unpopular it was with GPs when first rolled out. Communication systems such as the Pacs electronic imaging application for sharing X-rays and scans have been a success. And the N3 broadband network will come into its own as the IT connecting to it becomes increasingly decentralised.
The two likeliest fallguys from the new plan will be BT and CSC, the last suppliers standing in the Summary Care Records (SCR) project to roll out national electronic patient records.
The government whitepaper on NHS reform, called Equity and excellence: liberating the NHS, makes it clear that electronic records are here to stay.
“We will enable patients to have control of their health records,” says the document. “This will start with access to the records held by their GP and over time this will extend to health records held by all providers.”
The key phrase in that sentence is “health records held by all providers”. Clearly there will be more suppliers than just BT and CSC, whose SCR and patient administration systems have been the most problematic and delayed aspects of the whole IT programme.
We heard last year of David Cameron’s slightly wild idea that patient records could be stored online by Microsoft or Google, who both provide online health record software in the US where the health system is very different from the UK.
But even if we’re not going to all sign up to Google Health just yet, the principle that Cameron was promoting is likely to happen, with more private sector providers of SCR-like applications competing for business from the new GP consortia.
In IT terms that’s a whole new challenge – linking up many disparate systems to provide a coherent whole that allows patients to “share their records with third parties” as promised in the whitepaper, and “enabling patients to communicate with their clinicians about their health status online” as part of an “NHS information revolution.”
Clinicians will welcome having greater local control over their IT choices, and hospitals that have been forced to stick with out-of-date systems that were meant to be replaced by the central projects run by BT and CSC will have the autonomy to press ahead on their own.
But that won’t end the IT challenges for the NHS. From centralisation and control, we will move to standards and integration. And as any IT professional will know, standards are a whole other form of technical ideology.
Good luck with that.