NHS IT – are things about to change?

NHS Chief Executive David Nicholson: not focusing on successes and glossing over challenges.


The Annual Report of the NHS Chief Executive David Nicholson, which was published on 27 June 2007, has barely a mention of the NHS’s £12.4bn National Programme for IT [NPfIT].

For years the NHS, the IT industry, Parliament and the media has been groomed to believe that the NPfIT is not merely an IT strategy but a programme that would transform the health service, as Bazalgette’s sewers put an end to cholera epidemics.

As recently as May, Stephen Timms, then Chief Secretary to the Treasury [who has now left the Cabinet], praised the achievements of the NPfIT using the words “heroic” and “epic“.

“I pay tribute to the epic transformation underway in the NHS through investment in IT. It’s heroic in scale …” he said.

But Nicholson’s annual report, his first since becoming Chief Executive last year, has a commendably different tone. Perhaps he is falling in behind Gordon Brown’s promise of a new type of government, one which admits its problems.

Indeed if ministers lose the aura of arrogance that goes with a pretence or otherwise of invincible self-assurance this could be one of the best things to happen to the NPfIT. For when problems with the NPfIT are officially admitted the programme is likely to gain credibility in the eyes of doctors, MPs and the media.

“Now is not the time for self-congratulation,” says Nicholson in his annual report. “Patient expectations are rightly high, but public perceptions and confidence are low…”

He adds that annual reports are “traditionally the opportunity for the Chief Executive to set out all they have achieved over the preceding year, focusing on successes and glossing over challenges. But I have never believed in following tradition or precedent for the sake of it.”

The report doesn’t dispense with congratulation. It refers to the NHS’s surplus of £510m, a cut in cancer waiting times from diagnosis to treatment to one month, and other achievements. But the only specific mention of the NPfIT is this:

“Rather than talk about a national IT programme, we have to talk about the very real patient benefits …”

There is then a reference – rightly in my view – of how a patient’s life was saved because a consultant was able to view at home, at 4.15am, images of the person’s brain. Paul Jones, a helicopter pilot with Yorkshire Air Ambulance Service, says the consultant diagnosed a brain haemorrhage.

This was because of the picture archiving and communications system, which was not one of the original core NPfIT objectives but a vital system nonetheless.

Absent from the annual report is a list of statistics on how the NPfIT is transforming the NHS. Indeed Nicholson mildly cautions the NHS against spin.

Yet Connecting for Health, an agency of the Department of Health that runs major parts of the NPfIT, has a website that glows with statistics:

– Bookings of hospital appoints through Choose and Book, one of the main NPfIT systems: 4,125,856

– In a single day 20,512 bookings

– Over 85% of all GP practices have used Choose and Book to refer their patients to hospital.

– Prescription messages issued electronically: 24,731,734

– Prescription messages issued electronically in the last week: 861,518

– Connections to BT’s NHS broadband network called N3: 19,822

– Images stored using picture archiving and communications systems from NHS Connecting for Health: 268,272,120

– Messages sent daily using the NHSmail system contracted for by Connecting for Health: 983,152

No doubt praise is due but it’s difficult to know, in the absence of a published independent review, whether these statistics mean that the investment of more than £2bn so far is value for money. And what does it all mean to patients?

The sharing of medical records across the NHS – the Care Records Service – was the main objective of the NPfIT. And it’s not mentioned in the list of statistics.

So Nicholson is right not to give a list of NPfIT’s statistics in his annual report, at least because they mean little out of the context of risks, challenges, issues, problems and disruption.

He is even prepared to criticise his department. The former Health Secretary Patricia Hewitt simply blamed deficits on the trusts.

Nicholson says:

“Deficits don’t happen overnight. They take two to three years to build up. People in the NHS and the Department of Health knew that it was happening and didn’t take sufficient action when necessary”.

Nicholson is beginning to sound like a genuine reformer, a leader not hewn from a block of pride. But can he change a Department of Health whose culture, for as long as we remember, has preferred self congratulation and glossing over problems to telling it like it is?

The NPFIT could fade in importance and effect if its problems are not tackled in earnest. And they cannot be tackled until it’s admitted officially that the programme is in trouble.

Nicholson and Alan Johnson should show they’re not bound by pride to stick to the former government line that there should be no independent published review of the NPfIT.


Annual Report 2007 of David Nicholson, Chief Executive of the NHS