For this blog, Robin Guenier has written a response to a paper by the British Computer Society’s Health Informatics Forum which suggests a way forward for the NHS’s £12.4bn National Programme for IT [NPfIT]. Guenier’s credentials and the context of his comments are mentioned separately on this blog – here. Guenier’s remarks follow.
Guenier’s commentary is headed: “Note on the British Computer Society (BCS) report “The Way Forward for NHS Health Informatics” – a report by the BCS Health Informatics Forum Strategic Panel.”
“The BCS report contains some welcome and challenging recommendations – especially that the focus of the NHS National Programme for IT (NPfIT) should be on local implementation, that developments should be evolutionary (“building on what presently works”), that there has to be greater emphasis on standards, that there must be a clear definition of the planned NHS Care Records Service and that there should be greater emphasis on data quality.
“The adoption of these recommendations by the Department of Health would be an important step towards more effective IT in the NHS. The BCS is to be commended for taking this initiative.
“Nonetheless I believe it may have missed an opportunity. NPfIT is a vast and ambitious project and, as the report notes, its success is a key to the future of the NHS. Yet, by any reasonable measure, NPfIT has essentially failed to deliver what was promised for it in 2002 and 2003 (the report’s section 2.3 summarises much of this) and seems likely to continue that failure, especially regarding the integrated clinical record which was originally seen as the central element of the entire project.
“I appreciate that the BCS was unable to cover all aspects of the project in a short report. However a comment on the basic reasons for that failure could have helped to establish a wider understanding of what needs to be done now to get NHS IT to the standard needed to support 21st century healthcare.
“It is widely acknowledged and well documented (see for example recent National Audit Office and Office of Government Commerce (OGC) reports and recommendations) that there are certain basic requirements for project success. In particular, the following are seen as critical:
• A clearly articulated business plan that sets out what is proposed, the benefits that are expected to be achieved, the evidence on which that proposal is based and a statement of all expected costs showing how they are justified by the expected benefits.
• A strong, well defined overall management structure for the project, headed by a “Senior Responsible Owner” (as defined in recent years by the OGC and Cabinet Office) with full responsibility for implementing the business plan from inception to delivery.
• From the outset of the project, detailed, widespread and continuous consultation with and involvement of key users – in the case of the NHS, that means in particular clinicians (doctors, nurses and other healthcare professionals).
• Based in particular on that consultation, the alignment of current working processes with the proposed new systems – or, where more appropriate, the alignment of the new systems with current processes.
• Such changes to the initial business plan as may be necessary to take account of the outcome of the consultation and alignment processes. This may require quite radical change to the original plan.
“Many commentators accept that none of these applied to NPfIT; small wonder it is facing difficulties. This is not mentioned in the BCS report which says, “Criticism that results in the NPfIT being perceived as a total disaster in the eyes of the public and politicians will achieve nothing.” That strikes me as dangerous. Not to consider that the project may be in serious trouble is likely to reinforce complacency – a more probable route to disaster.”
Robin Guenier – January 2007