Jeff Jacklin, Head of ICT at Milton Keynes General Hospital until April 2006, has given a candid account of the NHS’s National Programme for IT [NPfIT] from the viewpoint of a user.
His article in E-Health Insider is revealing even for someone who has observed the NPfIT since it was announced in 2002. Jeff Jacklin has 35 years experience in the IT industry, the last 20 at director level within the NHS.
This is a summary of some of the points he makes:
– A very different customer-supplier relationship. For a start you have to accept that you are unlikely to deal directly with the system supplier…Of the first 19 people I met from Fujitsu, only one had any NHS experience. This is not to say that they weren’t very good people, many of them were extremely proficient but trying to extract the nuances of patient waiting list suspension rules from a guy with only retailing experience made for interesting dialogue.
– [There is a ] reversal of past practice … the supplier [checks] the suitability of customers prior to implementation. In many respects this is no bad thing. However the balance is wrong with the customer having very little opportunity to examine the credentials of the provider and even less sway in changing anything which concerns them. This can cause real difficulties for both parties.
– During the PACS [digital x-ray systems) deployment in Milton Keynes there were three major problems, any of which could have halted that programme.
– The first problem was funding. At one time the trust board [at Milton Keynes] refused to support the business case [for PACS] because of the affordability issues of capital investment. The same funding issue also proved to be an issue for subsequent trusts and was only finally overcome with regional intervention and financial support.
– The other two problems would never have arisen in a traditional procurement. The Local Service Provider insisted that the PACS workstations could not have virus protection software installed on them. They contended that the contract performance (and therefore associated payment) levels could be affected by third-party software…
– Similarly there is no provision for customer, or user, acceptance testing in the NPfIT contract …At Milton Keynes we were not prepared to implement a major operational system ignoring such key steps and this led to further conflict.
– One might have expected Connecting for Health [which runs part of the NPfIT] to intervene under such circumstances and they did – they told us to take our virus software off our workstations and not to use the testing scripts we had developed prior to going live. The repercussions went to chief executive level before such irresponsible practices were avoided.
– … The Local Service Provider sees Connecting for Health as the customer and both these parties are increasingly contract-focused not customer-focused. As the intended customer this is a very uncomfortable development.
– There is a major piece of work in determining exactly what is in and out of the Care Records Service central contract. With Connecting for Health’s insistence that trusts don’t need to see the contract … then it is inevitable that there will be some ignorance about the true costs and responsibilities of the programme.
– Make sure you know the full cost and who is funding all aspects of data migration, data cleansing and system integration … it’s not the Local Service Provider or Connecting for Health
– [There is a] flawed approach to design which is driven by reducing costs through the obsession for centralised computing in an age of devolved technology. This experience must make one fearful for a fully functioning National Data Spine (NDS) and although the concept is commendable I for one have no confidence in the likely outcome. Unfortunately a discredited NDS could be the legacy by which NPfIT is remembered…
– [A] challenge is in galvanising existing system suppliers to help you untangle and decommission their systems, and as a result ending their income stream… Some suppliers have profited immensely from the delays to Care Records Service, through massive increases in support costs over the last two years with minimal development in return.
– The understandable reticence of current suppliers to maintain and develop their systems has done a great disservice to the NHS resulting in a development hiatus which has further tarnished the reputation of computing within the service. Don’t under-estimate the costs or difficulties in ending this relationship.
– … It is imperative that NHS IT professionals remember who they are really working for. Be true to your principles and there is still a chance that you will deliver a successful programme that will provide real benefits for the patients, and the clinical and administrative population in your community.
– Don’t be overwhelmed or bullied by the tactics of some who would have you act as their mouthpieces and faithful lapdogs. It’s clear that many aspects of NPfIT are not defendable in a non-biased community so don’t try. Expend your efforts in promoting the realistic benefits that are tangible and demonstrable and arm yourself with as much experience and wisdom from successful deliveries as is possible. I wish you well.”