People will look back on NPfIT and wonder what fuss was about - Richard Granger, head of NHS IT


Kevin Barron, the chairman of the House of Commons’ Health Committee, gave a sympathetic hearing last week to Richard Granger, head of the NHS’s £12.4bn National Programme for IT [NPfIT].

Barron’s fireside friendliness towards Granger was a contrast to a hearing on 26 June 2006 when the House of Commons’ Public Accounts Committee investigated the NPfIT.

At that time Edward Leigh, chairman of the Public Accounts Committee began the hearing by telling witnesses: “I appeal to you for crisp answers”. Almost immediately he asked some tough questions about the causes of the delay in some NPfIT software; and he interrupted witnesses when he and other MPs thought they were not answering the question.

At the first hearing of the Health Committee last week into aspects of the NPfIT, chairman Barron, a loyalist Labour MP, gave Granger the chance to start the session by explaining, without interruption, the NPfIT’s successes to a packed committee room. Granger spoke for nearly 10 minutes, stopping only when he had finished what he had to say.

Granger began by setting out what he planned to cover in his comments. Then he explained that in 2002, when the government announced its investment programme in IT in the NHS, there were already many computers in use in the NHS.

“Almost all of them were characterised by being little more than glorified electronic filing cabinets. So if you wanted to move any info between buildings you typically had to move it using word of mouth or paper.”

He said there are 33,000 or so GPs in nearly 9,000 locations, none of which can move patient records electronically between sites although more than three million patients a year change the GP they are registered with.

“I don’t see how that mess can be described as a success yet some eminent GP IT advisers have described it as a success.”

In the last four years, said Granger, “we have doubled the availability of network connectivity to the NHS”. He added: “We now have 19,000 places connected up so we have one of the biggest virtual private networks on the planet. And people take that for granted. In some locations it does not work as quickly as the end users would like, usually because their equipment is badly configured.”

He continued: “We are now computerising to deliver prescriptions safely. We typically move 120,000 prescriptions electronically now on any given day.” The booking of a hospital appointment is completed electronically “about every 10 seconds”. Though this has not reached the targets, it is “nevertheless a significant volume”.

And “we have about 50,000 people go onto our national demographic database every day and access two million patient records. That’s something that didn’t exist three years ago”.

Further, through the use of the demographic database, letters sent to the wrong places have reduced from about 750,000 to “probably around a couple of hundred thousand”.

He said there was scepticism in the early 19th century over the introduction of the stethoscope. An article in The Times in 1834 had suggested it would not be used. He compared this scepticism of the stethoscope to “anxiety” over the adoption of IT, moving information between care settings, and serving patients as they move around the NHS. He said that people will “look back on this in a couple of hundred years time and wonder what the fuss was about”.

It was a view at one with Barron’s comments.

Barron said: “If you go back in years in medical history, into some of the things that doctors were doing at the time, which made major breakthroughs, people were sceptical about [these]. People were questioning even what their peer groups were doing in terms of whether it was the right thing to so.”

He said that that life expectancy has been extended to an “incredible” extent largely because of the “people doing things for the first time.”

In what seemed to be a criticism of 23 academics who have called for an independent review of the NPfIT Barron added: “Quite frankly if people were questioning [medical breakthroughs in history] on the basis of ‘we don’t think it will work’ or ‘it might not be manageable’ and everything else, we may not have made the progress through the centuries that we have done, in society in general and throughout the world. This sort of questioning every little minutiae, or potential every little minutiae, is something that is non-progressive, for what of a better expression.”

Good project management requires that assumptions are rigorously and independently challenged. There was little evidence in Barron’s questioning to indicate that he thought that any independent external challenge would be good for the programme.

Indeed anyone who expects Barron to persuade his committee to back the call by 23 academics for an independent review of the NPfIT is likely to be disappointed. Perhaps committee members can persuade Barron that an independent review would be a good idea. After all, a review could prove the nay-sayers wrong.

Indeed the review’s recommendations could, if acted on, assure the feasiblity of a programme that may be remembered in 200 years time.