Is NPfIT essential to NHS frontline?


“As a Government we will continue to support the delivery of the national programme for IT in the NHS.”
Ivan Lewis, Health Minister, House of Commons, June 2007

Alistair Darling told BBC’s Andrew Marr programme yesterday:

“The NHS had a quite expensive IT system that, frankly, isn’t essential to the frontline. It’s something that I think we don’t need to go ahead with just now.”  

But Darling’s claim that the NPfIT is not essential to the frontline contradicts the very basis on which the programme was launched: to help avoid unnecessary deaths. The idea of the NPfIT was that clinicians would have at their fingertips the accurate information they needed to avoid mistakes.

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It’s worth contrasting Darling’s comments about the inessential nature of the NPfIT with what ministers and officials at the Department of Health and NHS Connecting for Health have said about the importance and success of the programme.

It appears that Labour has changed its mind about the NPfIT because it is in financial trouble. If it’s not essential to frontline services, why did the government launch the scheme in 2002 as the world’s largest non-military IT programme? 


angela eagle.jpgAngela Eagle, Exchequer Secretary to the Treasury,  told Parliament in October 2007:

“Without the [NPfIT] programme, the NHS could no longer function, and it is already providing essential services and significant benefits to tens of thousands of clinicians and millions of patients. It is therefore a success story that ought to be acknowledged.

“For example, more than 5.5 million appointments have now been made using the choose and book system, representing 44 per cent of first referrals. In addition, 397 million diagnostic images are now stored centrally, and 42 million electronic prescriptions have been used in a service that is now available in 41 per cent of pharmacies and 47 per cent of GP surgeries.

“Nearly 400,000 users are registered to use the NHS care records spine, with 45,000 NHS staff accessing it daily….”

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caroline flint.jpgCaroline Flint, then Health Minister,  told the House of Commons in June 2007:

“I am sure that Opposition Members will join me in congratulating NHS Connecting for Health, which was commended even in the recent Public Accounts Committee report on IT projects.

The outgoing chief executive of the Office of Government Commerce, John Oughton, said:

‘I think the procurement process for Connecting for Health was an exemplary example of procurement. It was run to a very tight and rapid time scale; it started when it was intended and completed when it was intended; and it produced a very good result. I do not think any of the suppliers were disadvantaged in that process.’

“… each software delivery from BT, the contractor concerned, has been on time for more than 12 months.

“Similarly, the quality management analysis system for GP payments was delivered on time. The picture archiving system is on time. The core software for choose and book and the electronic prescription service has been delivered on time,

” … the Labour Government believe that a properly supported and financed national programme for systems in the NHS is absolutely essential to how we deliver health services in the 21st century…”

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gordon brown.jpgGordon Brown, House of Commons, July 2004:

“A great deal of work has been done in setting up that very extensive IT programme. As I understand it, the National Health Service uses more IT than any organisation outside NASA –  the space centre – in the United States of America.

“It is therefore very important that it is got right. New people have been brought in and the whole system has to be modernised. It is important that electronic records can be properly developed and that nurses and GPs’ surgeries can be in regular contact with hospitals.

“It is in all our interests that the programme works. Before the hon. Gentleman pronounces that it is not working, he should look at the evidence of all the efforts that have been mad (sic) to ensure that it does. It is certainly very important to the future of our health service–we would agree on that.”

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lord-hunt.jpgLord Hunt told the Harrogate healthcare conference in 2007:

“I think there are lots of issues that need to be discussed, lots of challenges that we have to face up to, but we can do that with confidence.

“I do think that in the end we do need to display confidence, that we are on a hugely important voyage, one that will be successful and that will go hand in hand with the modernisaton and improvement of the national health system as a whole.”

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Tony Blair, from the official minutes of a Downing Street meeting in February 2002, which set the NPfIT in train:

 “The Prime Minister asked whether the programme could be accelerated. In the past, there had been uncertainties about the benefits and reliability of different technologies but these were now much clearer. Taking forward the programme faster than currently planned would help underpin the reform agenda and also provide visible evidence of NHS modernisation to patients and the public.”

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NHS Connecting for Health, which is part of the Department of Health (2004):

“The [NPfIT] programme is £6.2bn which is fully funded by the government for 10 years…You will see a target of 3.5% to 4% of total NHS budget to be spent on making the right information available to run the NHS and serve patients, and we will sit well within that envelope…

“Digital Information leads to Health  – 10.8% of patients on medical wards experience an adverse event, 46% of which were judged to be preventable. One third led to greater morbidity or death, this means almost 1,300 hospital deaths each year could be prevented.”

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john reid.jpgJohn Reid, then Health Secretary, in 2005:

“All of the patients by next year will be able to book if they want online. All of that is on schedule.”

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stephen timms.jpgStephen Timms, Chief Secretary to the Treasury in 2006:

“Nowhere  are those opportunities greater than in the National Health Service and I pay tribute to the epic transformation underway in the NHS through investment in IT.

“It’s heroic in scale and it’s going to be transformational in impact.”

Links:

NHS IT programme to be scaled back – Techmarketview

More questions than answers – CW Editor’s blog

RIP NPfIT? – GP informed

What’s happening with the NPfIT – IT Project’s blog

Who said what at Downing St meeting which launched NPfIT – IT Projects blog

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"The NHS had a quite expensive IT system that, frankly, isn't essential to the frontline. It's something that I think we don't need to go ahead with just now."

This simple statement appears to indicate a complete lack of understanding of what "The National Programme" is. It is NOT an expensive system. It is a myriad of complex and interrelated (and some of them expensive)systems, some of which ARE required by frontline staff.

However, what has been happening for the last five years or so is the assumption that the National Programme is synonomous with the single national electronic record.

NPfIT (as delivered by Connecting for Health) is a programmes of work with many elements: one of which is that national electronic health record.

This national record was unfortunately given a higher priority that it deserved and could have been developed later once the local systems were in. The more essential (and justifiable) developments were those for frontline staff to use. Systems which gave them access to information about their patients; gave them decision support tools and the ability to work in a more 21st centuary environment.

There is STILL a requirement for that.

There was a clear and strong business case for these local developments.

There was never a business case for the national electronic record.

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Fair point - indeed Glyn Hayes, formerly head of the BCS Health Informatics Forum, makes the point that the e-prescriptions element is more important than a national e-record. It could save many lives by reducing errors in the administration of drugs.

I read countless NHS papers which refer to Serious Untoward Incidents caused by patients being given the wrong drugs, or the wrong mix of drugs, or the wrong quantities.

As you say decision-support systems ie those that tell doctors what drugs/treatments/equipment works best in practice - would be invaluable.

But, it has to be said, that the NPfIT as originally planned is now accepted as a failed project. That said the NHS still needs better systems - and a local electronic record to replace paper is surely a must.

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Sean is of course absolutely right in all he says. And in describing requirements of acute hospitals one can do worse than quote direct from the 2008 National Health Informatics Review. This sets out the 'Clinical 5’ of key needs

 A PAS with integration to other systems and sophisticated reporting.

 Order Communications (Order Comms) and Diagnostics Reporting (within the Trust and ordered from primary care).

 Letters with clinical coding (discharge summaries, clinic and A&E letters).

 Resource scheduling (for beds, tests, theatres, etc.)

 E-prescribing (including ‘To Take Out’ (TTO) medicines)

The trust I am currently helping with a procurement would most certainly benefit enormously from these.

But any way, I note that Andrew Lansley in the Commons today seems to have repudiated the Chancellor's Sunday morning little tease with Andrew Marr

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