Frank Burns, former NHS IT head, gives hard-hitting critique of NPfIT

Frank Burns, former head of NHS IT, has broken a long-standing silence over the health service’s National Programme for Information Technology.

His unrestrained critique of the programme has been published by the House of Commons’ Health Committee as part of its inquiry into aspects of the NPfIT.

His evidence adds further substance to calls by 23 academics for an independent review of the National Programme for IT [NPfIT] in the NHS.

He said there was, and is now, a “grotesquely over simplistic view of the transition from paper records to electronic records in the Health Sector”.

And he observed that contracts on the scale of the NPfIT meant that “any major problem affects large swathes of the NHS simultaneously”.

He added: “Worryingly this has also been found to be true for system failures where these have occurred.” On 30 July 2006 the failure of a CSC data centre at Maidstone affected for several days 80 trusts across England – a IT problem of unprecedented scale in the NHS.

He also questioned whether the NPfIT will meet its main objectives. “Many in the NHS believe that by the time the systems procured are implemented and taking into account the need to standardise and simplify to allow simultaneous multiple site implementations–what they end up with will not be the sophisticated clinical management systems that they need for modern healthcare.”

Burns was Chief Executive of Wirral Hospital Trust, one of the largest in the UK, for 16 years. In recognition of his work at Wirral Hospital in developing one of the UK’s most successful clinical information systems, he was seconded for 18 months to the NHS Executive Board as Head of IM&T for the NHS.

He was the principal author of Information for Health, the Information Strategy for the NHS published in September 1998, which provided some of the underpinning objectives for the NPfIT. He was member of the national taskforce set up and chaired by health minister Lord Hunt to implement “21st century IT” – the 2002 strategy document that launched the NPfIT. He now describes himself as an independent healthcare consultant.

In his paper Burns gave a summary of how the NPfIT came into being.

“The top down approach with centrally procured systems that characterises the current national programme arose from the acknowledged failure of the local implementation approach advocated by the 1998 Strategy Information for Health.”

He added that it was “important to note, however, that the clinical emphasis and local approach advocated in Information for Health was universally and enthusiastically supported by all the key professional bodies”.

The Information for Health strategy failed through lack of financial support and not being given enough priority by local managers, who, he said, were understandably preoccupied with “ever more demanding waiting time and other targets”.

It was clear at the time of launching Information For Health that some senior managers and political advisors would have preferred a more prescriptive approach. He said:

“This was principally attributable to a desire on the part of CEOs to have this traditionally challenging and difficult agenda delivered by the “centre” as a gift wrapped and imposed solution.

“Many CEOs, Department of Health officials and advisors simply assumed that clinical IT could be rolled out across the NHS in the same way that “check out” technology could be rolled out by a supermarket chain.

“This was then, and is now, a grotesquely over simplistic view of the transition from paper records to electronic records in the Health Sector.

“The problems encountered by the national programme provide graphic and painful evidence of the consequences of underestimating the complexity of implementing clinical IT systems and of trying to impose standard solutions on healthcare professionals.”

Like many in the NHS he questioned the strategy of having a national summary record and a more detailed local record. “As argued previously the more urgent practical requirement for the NHS is not the emergency record but the integrated local record that supports 99.9% of day to day care”.

And he pointed to the impression that the most important part of the contracts with the local and national service providers – BT, CSC, Fujitsu – were the penalty clauses for non delivery.

“Whilst this has properly ensured that the NHS shouldn’t pay for what it hasn’t had, the better outcome would be if the NHS was in a position to pay up for timely delivery of what was bought.”

He advocated an “urgent review of the most effective way of accelerating the capture and availability to all health professionals of clinical information about individuals that is spreading over an increasingly wide range of public and private sector providers”.


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