Government responds to open letter to Gordon Brown on NHS National Programme for IT

The government under the new Prime Minister Gordon Brown is continuing to portray the NHS’s National Programme for IT [NPfIT] as a success and is rejecting calls for any type of independent review of the programme.

Robin Guenier, chairman of the medical online research company, Medix UK plc, and chair of the medicine and health panel of the Information Technologists’ Company, had written an open letter to Gordon Brown, which made recommendations to improve the NPfIT.

His letter, which represented his personal views, had, for example, called on the government to commission and publish an independent review of the business case for the NPfIT, in the light of progress and experience so far.

Robin Guenier said in his letter:

“Such a review is an essential element of any well-run project: as time and circumstances change, so inevitably the original business case can come to be seen in a new light. A project often derives substantial benefit and fresh focus from such a review.”

But Downing Street passed his letter to a civil servant in the Department of Health’s Customer Service Centre to answer. The civil servant David Wilson said:

“The Department does not consider there are grounds for an independent review of the business case at this stage. The contracts with suppliers have stood the test of time, including the flexibility to deal with changes to suppliers, and the costs of the programme remain under control.

“Although there have been delays to the delivery of some items, as explained above, much has been delivered early or remains on target. Annual statements of the costs and benefits of the programme will provide an ever increasing evidence base.

“On the question of better and closer engagement with the NHS, the attitude of users and interested parties to the NPfIT are generally positive and more NHS staff are favourable towards the programme than against.”

The specification, said Wilson, was built on “years of experience across the NHS and many clinicians were involved in the drafting”.

He added: “Relevant and appropriate clinicians continue to contribute to the effective identification of requirements, design and testing of systems being delivered under the NPfIT …”

In reply, Guenier emphasised to Wilson the “critical importance of the initial NPfIT objective of using IT to provide an NHS-wide system for the management of clinical information, as outlined in the Wanless Report and spelled out in June 2002 in Delivering 21st century IT support for the NHS”.

He said: “Without it, the continuation of a truly national healthcare service into the 21st century may prove difficult: as well as enabling a significant improvement in patient care, such a system would bind together what seems otherwise to be an increasingly fragmented NHS”.

He added:

“I am concerned however when NPfIT’s implementation appears unlikely to deliver that initial objective. I believe two things in particular have put such delivery at risk: failure to appoint a single overall full-time Senior Responsible Owner and failure to engage comprehensively with users, especially clinicians.

“These, with the current desirability of commissioning an independent review, were the subjects of the three recommendations made in my letter to the Prime Minister.

“I had hoped that the advent of a new PM and Secretary of State might bring a fresh approach to NPfIT. But that seems not to have happened: your letter is clear that none of the recommendations is even being considered.

“That is disheartening. Moreover, the NPfIT Local Ownership Programme changes (about 150 senior responsible owners!) indicate that the initial objective of an NHS-wide clinical information system may, in effect, have been abandoned – with dangerous consequences for the longer-term provision of a fully national service.

“Does the Department of Health understand the seriousness of this?”


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