The stethoscope, Richard Granger and the NPfIT

A blog reader has taken issue with comments made by Richard Granger, the Director General of NHS IT, who compared the initial distrust by physicians of the stethoscope with the anxiety of some in the NHS over adopting new technology as part of the NHS’s National Programme for IT [NPfIT].

Richard Granger’s comments had been published in the blog entry “In 200 years people will look back on this [the NHS’s National Programme for IT] and wonder what the fuss was about – Richard Granger, head of NHS IT.”

Richard Granger had told the House of Commons’ Health Committee in April 2007:

“In 1834 The Times said, regarding a significant piece of medical technology, that, ‘it will never come into general use notwithstanding its value. It is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble to both the patient and the practitioner; and because its hue and character are foreign and opposed to all our habits and associations. It is just not going to get used’.

“That was The Times writing about an invention from 1816 which I do not think we generally consider to be adverse to medical practice now. They were writing about the stethoscope. I think the adoption of IT systems that move information between care settings and serve patients as they move around the NHS is in a similar position, of a great deal of anxiety because of the introduction of the new technology. People will look back on this in a couple of hundred years’ time and wonder what all the fuss was about.”

Now a blog reader makes this point:

“I’m not sure the stethoscope is such a good analogy here – it’s [a] tool that can be produced on a linear production line. Information sharing however requires standardising data, linking up secure networks and getting standardisation between those networks to ensure secure dataflows with integrity and accessibility. Making this work requires a much more complex project and take-up is much more difficult. Practitioners only had to subscribe to the idea of using a stethoscope one at a time once it was on the market, whereas stakeholders and endusers all need to subscribe to something like this more or less simultaneously to launch in order for it to be effective.”

My comment:

Richard Granger was right that there is usually distrust among the medical professions of anything new. The blog reader is also right that the stethoscope has the beauty of simplicity. The same cannot be said of the NPfIT.

And the stethoscope has stood the test of time. Other more complicated ideas haven’t, some of them launched by the Department of Health.

That’s not to knock the main original aim of the NPfIT – few could dispute the need for a reliable electronic health record that’s shareable and, unlike a paper record, doesn’t get lost. But an unnecessarily complex IT programme cannot be justfied on the basis that its orginal main aim was sound.


In 200 years people will look back on this [the NHS’s National Programme for IT] and wonder what the fuss was about – Richard Granger, head of NHS IT