Anyone new to the NHS’s £12.4bn National Programme for IT – NPfIT – can gain a quick understanding of some of the challenges involved by reading the comments made by doctors in a survey published this week by online market researcher Medix.
Statistics in surveys can be hard to digest but Medix has included 301 comments from clinicians. I’ve selected some of them. The first comment I mention is particularly apt even though it is anonymous. I’ve chosen other comments mainly because doctors elected to be named. I struggled to find many positive comments about the NPfIT; and some of the more negative range from the excoriating to the merely venomous.
A total of 1,026 doctors responded to the Medix survey on the National Programme for IT: 437 GPs and 589 mainly hospital doctors. About 300 of them wrote comments.
The 1,026 figure represents more than one percent of the 90,000 or so doctors who practice in England and are, therefore, affected by the National Programme for IT [NPfIT]. It’s a good sample by the standards of any survey.
Connecting for Health, which runs the IT part of the NPfIT, says on its website that the programme is “making good progress” and that as new systems evolve there will be a “resolution of any problems that arise”. It also says that within the NHS “more staff are favourable to the NPfIT than unfavourable” which is not necessarily comforting if say 20% of the NHS’s workforce of more than one million are unfavourable. Indeed the views of most doctors in the Medix survey show that Connected for Health cannot take their support as guaranteed.
It is unlikely that a major IT-based project in the public sector will succeed if it does not have the support of end-users. This was one of the clear messages in an excellent report by the National Audit Office on what makes IT-based change projects and programmes successful. The report was published last Friday.
In the case of the NPfIT, a ministerial admission of what has gone wrong, what mistakes have been made, what lessons have been learned, and what needs to be done now, would help win support. But openness and honesty are seen by some in Whitehall as signs of defective genes.
This may help to explain why the health minister Lord Warner is against commissioning and publishing an independent review of the NPfIT.
A selection of comments from doctors who took part in the latest Medix survey on the NPFIT follows. The first comment is from a clinician who does not want to say anything that is attributable because he says the Department of Health “only wants good, on message announcements and does not want healthy debate”. He claims that Whitehall officials are “in this mess because all that is wanted are those who will agree” with them.
Other comments on the NPfIT which exclude the more vitriolic:
Laurence Gant, Accident and Emergency consultant, Homerton University Hospital NHS Foundation Trust: “NPfIT is already improving the care delivered to patients. My personal real time access to information is of huge value in ensuring efficient high quality emergency care.”
Dr. Chris Dey, Specialist Registrar, Radiology, Southampton General Hospital: “This government has a record of not listening to public sector workers and NPfIT is no exception. There has never been any true two-way consultation … We welcome the money but it has been used inefficiently …”
Mr Michael Bishay FRCS (orth) Consultant Orthopaedic Surgeon, Royal United Hospital. Bath, UK: “Slow to be implemented, very expensive to run, several problems with day to day running of the partially implemented services.”
Unnamed: “It [the NPfIT] should not be about connecting Penzance with Penrith, it should be about connecting Penzance Hospital with Penzance GP Practice.
Dr Scott Thomson: “Some excellent ideas that may well improve patient care but is in danger of failing because it is too politicised and political imperatives are not matching clinical ones.”
Mark McCartney, GP, Cornwall: “The confidentiality risks of the centralised clinical record are now becoming a big issue for patients. I have already received several requests forbidding me from uploading these [patient records] … The programme has stifled innovation and development of IT in the Primary Care sector, and has been a huge waste of money…”
Riccardo Audisio, Consultant Surgical Oncologist, Whiston Hospital, Prescot, Merseyside: “A relatively small involvement of clinicians’ input has occurred – I personally volunteered to contribute at the onset of the project, because of my previous experience in Italy and the US, but the game was set without significant input from clinicians.”
Dr Neville Staunton, Crouch Oak Family Practice, Addlestone Surrey: “With regard to patient confidentiality, a centralised system to be accessed by thousands of practitioners must be less secure than a locked filing cabinet. A less than benevolent government will undoubtedly be able to access medical records, for whatever purposes it deems fit. This is why I will not be using this system.”
Caleb McKinstry Consultant Anaesthetist, Cheltenham General Hospital: “In principle a good idea, but I have reservations regarding confidentiality. We are paralysed in intensive care at the minute, as we wished to implement a local electronic system, but it is looking likely that we will be forced to take the Cerner system [hospital software, bought centrally, that is due to be used throughout Southern England and London] which none of us have seen…I do not believe the quoted time frame of two years [for the installation of Cerner]. I can see us sitting here in five years time still seeing a botched service being implemented piecemeal… The Connecting for Health website is useless. Our PACS [digital x-rays – Picture Archiving and Communication System], however, is excellent and has palpably improved patient care.
Andrew Millar, Consultant Physician and Gastroenterologist: “The concept of NPfIT is absolutely correct. The method of implementation has been woefully inadequate. Two or three hospitals in the UK should have been chosen to develop the software locally and then these Trusts should have been linked up to a virtual national database initially. We should not have spent billions on systems developed in the US for a different environment….”
Richard J Thwaites, consultant paediatrician, Portsmouth: “Sadly the history of non military public sector IT projects in the UK is a catalogue of disasters and I fear the same may happen again here. It is of interest that as far as I know no other country in the world has attempted anything on anywhere near this scale.”