What Blair, Microsoft and Cisco said at Downing St on NHS IT reform

On a planned IT-led modernisation of the NHS, Tony Blair said at a meeting at Downing Street on 18 February 2002 that there were three main issues:

– to ensure the NHS had the right systems

– how these were implemented locally by managers and clinicians

– how we increase the pace of development.

Blair’s comments were to Cabinet ministers, health and policy advisers, and representatives of IT suppliers who attended what was described to them as “the Prime Minister’s Seminar on NHS Information Systems”.

Some of what was said at the meeting has been disclosed in a set of Downing Street papers released to Computer Weekly by the Cabinet Office under the Freedom of Information Act.

Plans for an IT-led modernisation of the NHS were decided largely before the meeting at Downing Street. The purpose of the meeting, it seems, was to gain an endorsement of the plans and to see if patients could benefit sooner.

In 2002 a general election was expected by MPs of the three main parties to take place in 2005. The plans were for the main benefits of an NHS IT programme to have been delivered, including an electronic record for 50 million patients in England, by 2004/5.

Labour MPs would argue that Tony Blair wanted doctors to have access, as soon as possible, to reliable health records wherever they’re treating patients. This would increase the patient’s chances of receiving the best possible care or treatment.

But Conservative MP Richard Bacon, a member of the Public Accounts Committee, said the Downing Street papers indicated that compressed timescales for the national programme for IT – NPfIT – appeared to have been geared initially to improving Labour’s reputation for modernising the NHS in advance of the general election of 2005.

“It would be unusual for something major, where there are benefits to talk about, to brag about and boast about, for a minister in office not to be thinking about achieving results in time for an election.

“The instinct for Blair on a programme such as the NHS IT programme would probably have been: never mind the detail, don’t give me problems, just tell me when it’s going to work. And the Department of Health has told him what he wanted to hear.”

The record of what was said at the Downing Street meeting will indicate to some that there was a lack of dissent which damaged the usefulness of the early discussions over the NPfIT. There were no challenges to the assumptions in a briefing paper by the Department of Health that the main benefits of an IT-led modernisation of the NHS would be achievable by 2004/5. The NPfIT has since become a 10-year programme, due to finish in 2013 or beyond.

Arguably the record of the Downing Street meeting shows that the world’s biggest civil IT programme was discussed secretly, at the highest level, on the basis of politics, not on realism and pragmatism. And then it was announced to the NHS and to Parliament as a fait accompli.

Thereafter the programme’s most committed advocates spoke regularly about the need to make rapid progress – and billions of pounds of contracts to local service providers were awarded in record time, though executives at some of the potential suppliers said they were being rushed into preparing their bids.

The comments at the Downing Street meeting are recorded in a letter by Simon Stevens, an official at Downing Street, to Sammy Sinclair, an official at the Department of Health. The letter was written on 26 February 2002, eight days after the Downing Street NHS IT seminar.

This is the letter:

From the Senior Policy Adviser 26 February 2002

Dear Sammy


The Prime Minister held a seminar on NHS information systems with your Secretary of State, the Chief Secretary, Lord MacDonald, Lord Hunt, Sir Richard Wilson, Nigel Crisp, and Sir John Pattison on 18 February 2002. Paul Corrigan, Andrew Pinder, Peter Gershon, Neil Holloway, Kevin Dean, John Hall, Ian Walker, Ed Richards, Dominic Hardy, William Perrin, Wendy Thomson, Michael Barber and I were also present.

Your Secretary of State [Alan Milburn] opened by saying that IT was one of the key mechanisms for supporting NHS reform. The NHS was starting from a low base because over several decades there had been instances of high-profile project failures, and because of an historic lack of investment. The NHS spent between 1.5% and 2% of its budget on IT, compared with 6% in the US.

Continuing, Lord Hunt [now a minister in the Ministry of Justice] said that the vision for IT in the NHS was that it should underpin the reform programme and provide fast and convenient access to services, through booked appointments, electronic prescribing and electronic health records. Historically NHS IT had been dogged by too little managerial capacity and clinical ownership, but there was a real sense now that people were prepared to back IT developments. The key was to use stronger central direction to accelerate the pace of change and make more use of partnerships with the private sector.

Sir John Pattison [then lead Director for the NHS IT programme] said that the starting point for the IT programme in the NHS was the relationship between the patient and the clinician – from GP consultation through diagnosis and prescribing support, to booking a consultant appointment and supporting the care pathway through treatment in hospital. The priority now was to accelerate the development of broadband connectivity and focus on the main areas outlined by Lord Hunt [booked appointments, e-prescribing and e-records]. In terms of delivery the NHS Modernisation Agency [since disbanded] was working with clinicians to help change working practices and drive compliance with standards.

The Prime Minister said that in his view good IT was a pre-requisite for a modern NHS. At the moment, it did not have the information systems which would enable it to delivery first-class health services. The main issues to be tackled were how to ensure the NHS had the right systems; how these systems were implemented locally by managers and clinicians; and how we increased the pace of development.

Neil Holloway (then Microsoft UK Chief Executive] said that the private sector was increasingly focusing on defining adherence to core standards in areas such as data exchange. The NHS should adopt this approach. This avoided the need to specify that every part of the health service had the same system but would ensure that they could communicate with each other.

Kevin Dean [Cisco] agreed that there was now a range of technologies which supported this approach, but they relied on ruthless central direction to ensure that everyone complied with standards.

Your Secretary of State of State added that, in the past, money allocated for IT had not been used for IT projects. The only way to ensure that this happened was to ring-fence it and insist that it was spent by the NHS against a set of national standards.

The Prime Minister said that it was clear that this needed a strong central focus within the Department and that now was a good time to make progress because Primary Care Trusts would shortly be taking up their full responsibilities.

Nigel Crisp [then NHS Chief Executive] said that the NHS was now receptive to a central approach in this field and that funds should be earmarked centrally.

Andrew Pinder [Cabinet Office e-Envoy] said that it was important to define a set of standards as quickly as possible as this would be the key building block for further developments. Electronic health records were another key component but DH [Department of Health] had to decide which of the pilot schemes it wanted to back to make quick progress. Increasing broadband capacity was equally vital, not least because this would enable electronic health records to be moved around the system.

Sir John Pattison agreed with these points and added that NHS staff would be receptive to changes in the way IT was delivered, even if working practices took some time to adapt.

The Prime Minister asked whether the programme could be accelerated. In the past, there had been uncertainties about the benefits and reliability of different technologies but these were now much clearer. Taking forward the programme faster than currently planned would help underpin the reform agenda and also provide visible evidence of NHS modernisation to patients and the public.

Peter Gershon [then head of the Office of Government Commerce] responded by reporting that the Office of Government Commerce was taking forward work to compress the time needed to procure systems. There was scope to reduce the time between project conception and the awarding of the contact if those involved had a clear idea what they wanted. The Department needed to monitor private sector interest in the NHS IT programme to ensure it could meet demand.

The Chief Secretary asked whether the new NHS systems would be compatible with those used by Social Services to ensure efficient data transfer at the interface between the two sectors.

Sir John Pattison said that the Department was currently exploring how medical records would be transferred, perhaps using a unique NHS identifying number, although this was not the only solution.

The Prime Minister asked about work in progress across Government in this area and asked Sir Richard Wilson [Cabinet Secretary and head of the home civil service] for a paper outlining latest developments, including the possibility of a single identifier for individuals.

Summing up the Prime Minister said that it was clear that good IT had a major role to play in helping secure fast and responsive NHS services. It was an area which had seen significant underinvestment in the past but one which would undoubtedly benefit from greater investment in the future. There would be further discussions in the context of the Spending Review. He agreed with the priority areas of work outlined by Sir John Pattison, but asked the Department of Health to look again at its implementation programme and accelerate it where possible. Greater central direction of the programme would help provide momentum and ensure that NHS organisations complied with standards. He would be grateful for a further paper on progress and options for faster implementation in due course.

I am copying this letter to the private secretaries to the Chief Secretary to the Treasury, Lord MacDonald, Lord Hunt and Sir Richard Wilson.

Yours sincerely

Simon Stevens

Sammy Sinclair

Department of Health


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