Warnings in 2002 on the NHS's National Programme for IT were prescient

In July 2002, shortly after the NHS’s National Programme for IT [NPfIT] was announced, Computer Weekly published a comment piece on the risks and lack of debate.

The article was by Robin Guenier who is now chairman of the Medicine and Health Panel of the livery company, the Information Technologists’ Company. The article expressed his personal view.

With hindsight it’s possible to see that most of its (unheeded) warnings have materialised. He warned for example of the potential disruption – and some boards of directors of NHS trusts have issued apologies to patients after troubled go-lives of new national systems.

The full article is on the wiki of the NHS 23. The 23 are leading computer science academics who are campaigning – as is Computer Weekly – for an independent review of the NPfIT.

Below is a summary of what Guenier said in July 2003 on the government’s announcement of the NPfIT. He refers to “Delivering 21st Century IT Support for the NHS“. This is a document published by the Department of Health in early 2002 that set out plans for the NPfIT.

Guenier said:

“… We are told it is “the IT challenge of the decade” and “a Herculean task”. Why don’t people learn? Why are big IT projects seen as a badge of virility — a sign that we really mean business?

“They nearly always cause trouble: the bigger the change the bigger the trouble, especially in the public sector. Difficulties with this Government’s earlier IT plans for the NHS (this is the third) demonstrate that the risk is especially great for such a uniquely complex organisation — employing 1.3 million people with over 50 million potential patients.

“Ambitious IT changes rarely deliver what is promised and commonly cause serious inconvenience for those they are intended to benefit: in this case, the patients. Surely anyone who wishes the NHS well would be striving to introduce the minimum necessary IT change, the smallest possible challenge?

“This is not a Luddite rant. Computing systems are an essential part of healthcare delivery. There is undoubtedly a case for extension, innovation and improvement and extra funding is plainly needed. But, particularly for the NHS, plans for change, however desirable, must be balanced against risk …

“The recently published Department of Health plan, Delivering 21st Century IT Support for the NHS, sets out a massive programme involving massive risk. Yet the case for that programme is not, to use current medical jargon, evidence-based.

“It starts with a “vision”. Vision, with integration and centralisation, is one of the most dangerous words in computing. Central control and “ruthless standardisation” will bring about a wonderful new world where health professionals and managers will have instant and simple access to a wealth of information (case histories, test results, research data, resource services, etc.) designed to support the patient “quickly, conveniently and seamlessly.”

“This dream requires a major new NHS-wide IT infrastructure, a new procurement strategy and centrally defined data and system standards, focusing initially on national health records, booking systems and prescriptions. It sounds splendid.

But such plans always do, particularly when technically naive senior civil servants, in alliance with enthusiastic industry representatives, are painting an idealised picture for ministers. That’s before the dull practicality of the real world intervenes. Four examples:

1. Ruthless standardisation means that perfectly good but non-standard local systems — often introduced after much trial and agony — that are at last working and serving staff and patients, will have to go. There are many such systems. Is dismantling them really a good idea? Is it desirable to pile new problems and “challenges” on health professionals and management — let alone the patient?

2. IT is constantly changing: it’s salutary to recall that Bill Gates recognised the importance of the Internet only about seven years ago. A standardised system defined today with, as is proposed, a “limited portfolio” of “compliant” equipment could be wholly obsolete in just a few years. Yet the plan’s full implementation will take eight years. In other words, the NHS could be setting out on a course of pain and disruption for a period going way beyond the foreseeable future, only to be left with a hugely expensive museum piece.

3. The NHS’ IT skills are inadequate. Delivering 21st Century IT Support recognises this and, after considering various options for implementing the plan, opts for one that involves outsourcing many of its major components. But is it acceptable to put effective responsibility for much of our healthcare delivery into the hands of big computing and telecommunications businesses? What happens when, as seems likely, this proposal runs into opposition?

4. Electronic Patient Records (EPRs) are a critical component of the programme. The concept involves huge problems: health information is far more complex in nature and detail than, for example, financial information. The Government has already experienced difficulties: although 35% of NHS Trusts were supposed to have implemented EPRs this year, so far only a handful have done so and the target of 100% by 2005 looks increasingly difficult. And concerns about data privacy and human rights are a growing worry, particularly sensitive regarding such a personal matter as health. Recent ID card worries suggest that a centralised system for health records would exacerbate these concerns.

So an exciting vision risks damage and disruption for an already vulnerable healthcare service. The Government even recognises this: Delivering 21st Century IT Support notes that “significant risk will be involved”. And a senior Department of Health official recently described it all as “incredibly ambitious … we’re betting the farm on this”. Why? Where is the evidence that such risk is justified?

“… Some months ago, the Chancellor spoke of his wish for a great debate about the future of healthcare in Britain. It hasn’t happened yet. But, as the programme defined in Delivering 21st Century IT Support does not get fully started until April 2003, there is time for a widely based and informed debate about whether these proposals are a risk too far and, if so, what is the better course. Not consultation, debate. I believe it would be widely welcomed by NHS staff, healthcare professionals and the public.


An open letter to Gordon Brown on the National Programme for IT in the NHS

Why do govermment projects fail so often

Brown must be open on IT projects