And what was left out of UCL report on the Summary Care Record
A senior executive working for the NHS says that, for the National Programme for IT [NPfIT], the new health CIO Christine Connelly could be what cold water is to a man dying of thirst.
But her success will depend on her freedom of action and the frankness of the briefings she’s given.
Serious problems cannot be tackled if they’re not officially acknowledged to be serious; so one hopes that Connelly will be given the unadorned facts, and be allowed to acknowledge them publicly. This honesty at the top would be good for the NPfIT.
It’s equally likely she, and her new colleague Martin Bellamy, will be expected to go to market with the Party line, promoting NHS IT and the NPfIT, at home and occasionally abroad, drawing on a confidential briefing on the programme given to the then Prime Minister Tony Blair in February 2007.
Blair was told in a briefing paper entitled “NPfIT stocktake“, which was obtained by Computer Weekly, that the “key challenges and risks to delivery were now not about the technology to support NPfIT but about attitudes and behaviours which need to be the focus of senior management and ministerial attention as we move forward ….much of the programme is complete with software delivered to time and to budget.”
That was doubtless what Blair wanted to be told but it was sophistry. The main objective for the NPfIT is a shareable electronic health record; and that part of the programme is running at least four years late, largely because the programme’s design is too grand to put to practical purpose.
David Nicholson, Chief Executive of the NHS, says that when he was appointed it was made clear to him that he was responsible for the success of the NPfIT. So he’ll expect his top team, especially Connelly and Bellamy, to be convinced that much of the programme is complete, having succeeded in the face of opposition from medical trades unions, some journalists and leading academics.
One would hope Connelly and Bellamy will be allowed to have their own minds on the NPfIT. But the programme has always been more political than practical, a poster of government’s commitment to technology and modernisation. It’s unlikely that Connelly and Bellamy would have been appointed if they were likely to go off message by pointing out that the poster was badly ripped from the start.
So, at worst they will become travelling curiosities, or phrase-makers to ministers and some senior officials who are preoccupied with image, public relations and hyperbole – in other words spin.
The official marketing line for the NPfIT is that problems are to be regarded as “teething” whatever their nature or duration; and the programme is to be promoted on the basis of its future more than the present – undated predictions are especially acceptable, an unsubtle blend of present and future tense as in:
“NPfIT is making the NHS even better because it will make the lives of patients easier as any medical staff will be able to access a patient’s records electronically. For example, casualty staff can see what medication or allergies the patient has, no matter where the patients doctors surgery is. This information can be accessed in seconds, and doesn’t require the patient to remember their whole medical history.”
The Department of Health’s preoccupation with the right image for the NPfIT was exemplified by the editing of a report by the University College, London, on the early adopter trials of the Summary Care Record, a central part of the NPfIT.
Connecting for Health paid for the UCL report. A comparison of the (confidential) draft UCL report and the final version shows that many sentences and phrases which would have been disagreeable to the most ardent supporters of the NPfIT were left out.
These are some parts of the draft UCL report that were edited out of the final version:
– …”Primary care trust informants felt that ‘communications’ in CfH [Connecting for Health] were oriented more towards presenting its corporate image to the press than helping Early Adopter sites communicate with patients and the public.” [This sentence was removed in the final report.]
– “Many CfH staff said quite openly ‘the left hand sometimes doesn’t know what the right hand is doing’.” [Removed]
– “Primary care trusts were told by CfH to keep their local MPs briefed …” [Removed]
– “The summary care record remains an immature technology which staff describe as clunky …” [The word “remains” is changed to “is currently”. So the final report says: “The summary care record is currently an immature technology …”]
– “There is tension between the “national programme” and “local ownership” which the National Local Ownership Programme [NLOP] has not solved.” [Removed]
– “Email appears to be preferred to actually speaking to someone.” [changed to: “Email appears to be the preferred mode of communication.”]
– “[CfH] is a quango – an ‘arms length’ body that is neither within nor fully outside the DoH.” [removed]
– “The general culture is one of command and control (described by one senior CfH executive as “discipline” and by one primary care trust informant as ‘bullying’..” [‘Bullying’ was changed to “extremely pushy”.]
Will Connelly and Bellamy be content to participate in this sort of old-style Department of Health marketing, as enunciators of official NPfIT “truths” and statistics?
They will know this would be a waste of their time, not least because the NPfIT is now only part of NHS IT, not even an important part for an increasing number of trusts that are buying, and planning to buy, their main systems outside the programme.
In case Connelly and Bellamy do find themselves caught up with the promotion of the NPfIT and end up claiming all is well apart from minor delays, poor communications, teething problems at some hospitals and a few noisy, unmanageable doctors, they could do worse than consider the facts at Barnet and Chase Farm Hospitals NHS Trust. Excerpts from various trust board papers related to the problems at Barnet and Chase Farm are published in a separate entry on the IT Projects blog.
10 reasons the NPfIT is making the NHS even better – August 2008
New Health IT leaders with salaries totalling 400k – IT Projects blog
UCL report on Summary Care Record – UCL website
Is Summary Care Record plan feasible? – IT Projects blog
Robert Mugabe, spin and the NPfIT – IT Projects blog – April 2008
Fujitsu’s leaving is a sign of NPfIT strength – minister – IT Projects blog, July 2008
Complaints to Barnet and Chase Farm Hospitals NHS Trust leap after NPfIT go-live – Computer Weekly – August 2008
Systems and cars always crash – Consultant-News.com
Patients left untreated after NPfIT go-live – August 2008