Comment and analysis
A study published this week into the summary care record – a pivotal part of the £12.4bn NHS’s National Programme for IT [NPfIT] – raises questions about the underlying assumptions behind the scheme, and highlights flaws in the organisation which runs it.
And Computer Weekly has learned that significant changes were made between a draft report by researchers at University College, London, and the approved final report. The final report softens or omits some of criticisms of the government and NHS Connecting for Health [CfH], which runs much of the NPfIT. Even so the final report is enlightening, comprehensive and authoritative.
The year-long study by researchers at University College, London, finished on 30 April 2008 and was paid for by CfH. Researchers spent 1,500 hours studying the working practices and cultures of staff at CfH and at early adopter sites.
Among the study’s most serious criticisms in the study are matters that some in Whitehall will find peripheral, perhaps even unimportant: that Connecting for Health is trying to control the language of the summary care record programme– and that it has a “controlling approach to the release of information”.
The control of language and information raises questions about whether Connecting for Health has become too ideologically enmeshed with the NPfIT to want the power of private board of directors to stop, curtail or order a genuinely independent review of a programme that may be failing. Indeed the 1,500-strong CfH owes its existence, in the main, to the NPfIT.
The control of language and information about a project is a common factor in several IT disasters Computer Weekly has investigated, such as the failure of the Performing Right Online Membership system at the Performing Right Society (now the MCPS-PRS Alliance) and the failure of the Analytical Services Statistical Information System at the Department for Work and Pensions.
When large and complex programmes start to fail an early casualty is clear information about its progress: Ian Watmore, formerly government CIO, has described it aptly as “radio silence”.
Those involved in the programme because overly sensitive to the language used in official or internal reports on the progress of the project; and indirect, ambiguous and eclipsing language is preferred to harsh clarity: serious problems are depicted as in the past or transient, soon to be overcome, and probably have been, by the time the report is finished – even through the problems have existed for months, and years in the case of the NPfIT.
A degree of control of information was manifest at the outset of the evaluation of the summary care record by researchers at University College, London. They were asked to study the technology and the progress with the summary care record – but believed themselves excluded from questioning the programme itself.
This is what researchers said in the draft and final reports:
“At the outset of this evaluation, CFH made clear to us that we had been contracted to evaluate “an Early Adopter phase, not a pilot”, and that our findings would be used to “inform the wider roll-out of the programme” (hence, implicitly, that it was not our role to seek to reverse the original high-level policy decision to fund the programme).
“Nevertheless, the main question which many stakeholders wanted us to answer was ‘Should large amounts of public money have been put into the Summary Care Record programme in the first place?’.”
In their draft report only the researchers say they were asked specifically not become embroiled in political issues – which some would regard as the most important parts of any programme that may be in trouble or failing.
“… we were asked to evaluate the implementation of the Summary Care Record as a technology and avoid getting embroiled in political issues. But the political context proved impossible to ignore, since it formed the backdrop for key decisions, both local and national.”
The researchers at University College, London, went on to produce excellent reports, though the draft used more direct language and was clearer than the final version; and though the report was prompted by a recommendation of a ministerial taskforce CfH deserves credit for commissioning and funding it, and agreeing to publish it.
Even so the control of information as highlighted by the UCL report is a worrying sign. And it may also have wasted money and particularly the time of NHS staff and officials: a letter to patients on the benefits of the summary care record went through 93 versions before being sent out; DVDs were produced on summary care records which, the UCL report said, were greeted with amusement by a focus group as “unrealistic” and “propaganda”; and large plasma screens were bought for GPs who took part in the early-adopter programme, also to show the benefits of the summary care record.
Indeed the report’s researchers lumped together – for the first time in an official report related to the NPfIT – those who hold extreme views in favour of the programme with those who hold dogmatic views against it. They said:
“An early finding of this evaluation was that those who felt strongly about the summary care record – champions and change agents on the one hand; lobbyists and conscientious objectors on the other – had a tendency to frame issues in terms of simplistic and morally absolute dualisms, and to cite selected ‘facts’ in support of their position. Furthermore, our interpretation was that these people unconsciously sought to blame a host of problems on what they characterised, disparagingly, as the ‘other side’ … This mutual demonization … has to a large extent overshadowed sensible debate.”
The evaluation suggests caution. In response CfH’s statement seems to suggest it will continue as quickly as possible. But is it in an objective position to judge the NPfIT? How objective is the government when making decisions on the future of the NPfIT on which £4bn has been spent so far?
When those who took part in the study at primary care trusts were asked towards the end of this evaluation year what single change they would wish to make in the summary care programme, the most common response was “[CFH should] just give us the money and let us get on with it”.
In separate entries I’ll mention some of the changes in the draft and final reports, and the main points they make.