Has Lord Hunt, minister in charge of NHS National Programme, fallen into the trap of over-optimism?


On 19 March 2007 Lord Hunt, the Health Minister in charge of the NHS’s National Programme for IT [NPfIT] showed a slide at HC2007, the annual healthcare IT conference at Harrogate, which suggested he did not see the technology for the world’s biggest non-military programme as a principal challenge.

The slide outlined “challenges to future delivery” and said:

– “The technology has already been delivered – the remaining hurdle is to utilise these systems fully at local level.

– “The key challenges and risks to delivery are now not about the technology to support NPfIT but about attitudes and behaviours which need to be the focus of attention as we move forward.”

Executives on the boards of NHS trusts could argue that Lord Hunt is right: it will be harder to persuade doctors and nurses to use new national systems than it will be to install them.

But board directors could also argue – and are arguing – that the technology for joined up systems in the NHS remains a key risk and challenge.

Less than a month ago, for example, Yorkshire and the Humber Strategic Health Authority listed as one of its principal risks that “fit for purpose products are not delivered on time” from the suppliers to the NPfIT.

Yorkshire and Humber is one of many health organisations to list as a principal risk the possibility of non-delivery of fit-for-purpose systems from the NPfIT suppliers. The Audit Commission, which audits the accounts of many NHS trusts, has categorised the NPfIT as a “red risk” for 2007. There will be more on the Audit Commission’s concerns about the NPfIT later on this blog.

We do not blame Lord Hunt for what is in his slides. Ministers are usually too busy to prepare their own speeches and slides. We do question the author of his slides who remains anonymous. Is this accountability at work?

Another of Lord Hunt’s slides sought to show how the NPfIT has made a difference. It said that in 2002 the NHS was the victim of an “archaic, chaotic system.” Today there is “better, safer care”.

It is true that in 2002 IT in the NHS did not have the profile or funding it has today. But chaotic is an exaggeration. Good use of IT was patchy. By 2001 work on electronic booking systems was well advanced, as were programmes for electronic patient record systems built to national standards.

A Department of Health publication in 2003 said:

“The introduction of booked appointments was extended still further with all trusts introducing booking in two ‘long-wait’ outpatient specialities or procedures by March 2002. By the end of March 2002, more than five million patients had benefited from booking their hospital appointment at their convenience.”

So much for chaos in 2002.

And in July 2000 Alan Milburn, the then Secretary of State for Health, said in the NHS Plan:

“The NHS has been at the centre of a range of pioneering medical and technological breakthroughs….The British system of primary care is envied and copied throughout the world. The NHS continues to work at the cutting edge of new forms of health services, inventing new ways of meeting patients’ needs, with pioneering developments such as NHS Direct, the Commission for Health Improvement and the National Institute for Clinical Excellence … The World Health Organisation recently reported that the NHS was performing better than Germany, the United States and Australia.”

So much for chaos.

Cynics would say that you cannot expect ministers to tell it like it is, the old Whitehall adage being: “Never mind the facts – it’s the message you get across that counts”.

We have more faith in Lord Hunt. He is a minister of integrity. We hope he will not succumb to over-optimism and hyperbole, as did his predecessor Lord Warner. Over-optimism is a failing that has helped to bring down many a costly IT-based programme – the Single Payment Scheme for farmers, for example.