Reviews of the NHS IT scheme appear to be underway - comment

Health Minister Professor the Lord Darzi opens the introduction to his interim review of the NHS by saying he is a doctor not a politician.

But in his comments about the National Programme for IT [NPfIT] Lord Darzi knows he needs to be the quintessential politician. He is a consultant in the field of robot-assisted, minimally-invasive surgery; and when he mentions the NPfIT in his interim report he manoeuvres delicately over the thin skins of ministers and officials at Whitehall who do not want to read any criticism of the scheme, particularly by public figures.

Lord Darzi’s report mentioned the success of PACS – Picture Archiving and Communications System. So his praise was in line with the marketing strategy of NHS Connecting for Health, which runs part of the NPfIT. A confidential briefing paper by Connecting for Health to the Prime Minister on the progress of the NPfIT said in February 2007 that there was a plan to launch a “proactive campaign, based upon the success of the Picture Archiving and Communications System”.

It’s true that PACS is the big success of the NPfIT. PACS replaces costly x-ray film, which is easily lost, with stored digital images that can be interpreted by doctors on or off site. Patients may need fewer x-rays. It’s a highly successful medical technology.

PACS was not part of the original core objectives of the NPfIT which were:

– a national electronic patient record,

– e-prescriptions

– e-booking of hospital appointments

– a national broadband infrastructure.

PACS was parachuted into the heart of the programme in 2004. Margaret Edwards, Director of Access at the Department of Health, wrote on 15 September 2004 to the NPfIT senior responsible owners and regional implementation directors saying:

“I am writing to confirm the decision of the National Programme Board to make Picture Archiving and Communications Systems (PACS) a core service within the National Programme for Information Technology …

“The decision to make this a ‘core service’ means that with immediate effect, Trusts should not therefore, enter into, or continue with their own procurements for PACS but plan for deployment of the system as contracted for their cluster via the National Programme. I would be grateful if this could be communicated to SHA and Trust Chief Executives as a matter of urgency as we are aware that a number of Trusts are currently involved in negotiations…”

To the tactful Lord Darzi, in his interim report, the success of PACS and the national programme were analogous. He also praised the linking of hospitals and GPs to a common secure network – the N3 broadband infrastructure supplied by BT. Local upgrades of the N3 broadband capacity can be expensive and on its own the network brings few clinical benefits but the bandwidth is an important advance on what the NHS had before so it is a success of the NPfIT. Lord Darzi said in his interim report:

“The national infrastructure established by the National Programme for Information Technology has connected every hospital and GP surgery to a common secure network. Clinicians should benefit from the implementation of digital access to X-rays and scans – Picture Archiving and Communications System (PACS). But I believe more work is now needed to ensure that the Connecting for Health programme delivers real clinical benefits, and I will be considering in the second stage of my Review how best to achieve this.”

It’s welcome news. But IT directors in the NHS are entitled to ask why it is only after five years – the NPfIT was launched in 2002 – and after more than £2bn has been spent centrally on the scheme, that a professor is undertaking a review to ensure that the national programme delivers clinical benefits.

Separately, the Financial Times says a review of the National Programme for IT [NPfIT] may be underway to establish “will this work?” There is no indication that this internal review will be published.

It’s difficult to avoid the conclusion that these are political compromises, half-done replacements for a high-level published review of the NPfIT.

This is of course a £12bn scheme, the world’s largest civil IT-based change programme. Those funding it, those whom it should benefit, those who are working on it, and those who should be working with it, deserve more than the passing reference to a review of clinical benefits on page 50 of Lord Darzi’s 54-page report.

One reason for the absence of an unrestricted, independent published review is that the NPfIT has become politicized. It has become a test of the ability of govermment to manage mega-projects. This could explain why ministers and some Whitehall officials want NPfIT’s realities locked in a dark bedroom. They fear the full facts emerging into the sunlight and being judged harshly by a cruel world.

So the NHS and those funding it are denied the truth, the programme limps along without clearly understood and realistic objectives and the government pretends all is well.


Darzi commits to review of NPfIT

NHS shakes up £12bn IT programme – Financial Times

Lord Darzi interim report

NPfIT and the Downing Street papers: for and against publishing them

Brown government rejects calls for independent review of NPfIT