What the next Government should do about the NPfIT

Tom Brooks, who spoke about NHS IT on last night’s BBC R4 File on 4 broadcast, has let me have his suggestions on what the next government should do about the NPfIT.

Brooks, a much-respected figure in health IT, writes:

The next Secretary of State for Health would be well advised to apply what is often known as the Harvard TEAMS test.

T – Is the proposal Technically sound or even feasible?

There have been major technical doubts expressed since the scheme’s inception. The new Minister should pick up the phone to Martyn Thomas and request him to form a professorial team to report on the technical issues.

The rejection by Ministers and the Parliamentary Select Committee of his offer a few years ago to conduct such a study is felt by many to have cost the taxpayer as much as a £1bn

E – Does the scheme make Economic sense?

The Treasury spokesman, Mr Mortimer, told the Public Accounts Committee that the Treasury did not believe there should be an overall business for the NHS IT programme. The Treasury got it wrong.

In November 1999, the NHS National programme was five years away and was going to cost £1bn.Now, for the same objective, it is still five years away and is going to cost £12bn. The new Minister should require a national NHS IT business case to be produced and published as a matter of urgency.

A – Is Accountability aligned with responsibility?

Currently, very few Trusts have direct contracts of consequence with the Local Service Providers (LSPs). Contracts are held centrally, and suppliers are accountable to the Secretary of State.

But the cost of poor implementations is felt locally by the Trusts. The new Minister should first suspend all new work under the contracts, and then announce a termination date for all contracts that are not for genuine national purposes, such as N3 and Choose & Book.

Trusts that wish to continue to use LSP services can contract for them locally and ensure that they provide value for money.

M – Are the Management arrangements sound and has the Management deployed been competent?

There are many areas of deficiency and even more questions. One perhaps is the anomaly disclosed in recent Parliamentary Questions. Why, in the three northern LSP areas, had less than £500,000 been paid to the LSP on Lorenzo deployment (set-up) activity and service charge (running cost) payments, while the total payment to the LSP in the Northern three areas had already exceeded £780m?

What has the management in the centre and the northern SHAs spent the £780m on if not on Lorenzo? The new Minister should transfer to local Trust posts at least half of all central and SHA IT management, thereby slimming down the expensive centralised bureaucracy, whose achievement record is suspect.

S – Are the arrangements Statutorily compliant?

The Opposition believes that the present Government policies for NHS IT are flawed.

Severe doubts exist over the arrangements for patient privacy and data protection, over responsibility for inaccurate patient data and the liability for errors arising from reliance upon it.

Questions are asked about Monitor’s apparent failure to vigorously defend the freedom of foundation trusts from SHA ‘interference’ and its role in the present sorry national NHS IT state of affairs.

Views have been expressed recommending that the Darzi ‘Five’ requirements for implementation by April 2010, but whose delivery has not been achieved by most Trusts, should now be put on a statutory duty basis.

Policy is unclear. The new Minister should abandon the national centralised patient data objective for NPfIT and would be well advised to adopt the principal Obama objective of “replacing all paper records by electronic ones for each practitioner” as a sufficient challenge for NHS IT during this decade, with its expectation of tight financial constraints and over-stretched NHS management and clinical staff.

Tories are uncomfortable on what they would do about the NPfIT – IT Projects Blog