What's in the Downing Street papers on the NHS IT programme?

A separate posting on this blog refers to a decision of the Information Commissioner to order the release of “sensitive” papers from a meeting at Downing Street in 2002 at which the NHS’s National Programme for IT was given tentative approval.

The meeting was chaired by the then Prime Minister Tony Blair and attended by several ministers, civil servants and business consultants. Computer Weekly requested the Downing Street papers in January 2005 under the Freedom of Information Act.

The Cabinet Offfice, on behalf of Downing Street, rejected our request. We appealed to the Information Commissioner who has now ruled that the papers should be published.

Today, 21 August 2007, we asked the Cabinet Office if it would appeal to the Information Tribunal against the decision of the Information Commissioner. It has until 10 September 2007 to submit a formal notice of an appeal.

Its spokesman said only: “We are still studying the decision.” He would not say whether the Cabinet Office will appeal. We would be surprised if it didn’t.

So what are Whitehall, Downing Street and the Cabinet Office hiding?

We know from Sir John Pattison, a participant at the seminar at Downing Street in February 2002, that ministers were told that a national programme would take less than three years, from April 2003 to 2006. It is now a programme lasting more than 10 years.

We also know that the Department of Health in early 2002 filled out a Project Profile Model – a form in which departments and agencies self-assess the scale, complexity and risks of IT- based programmes and projects. On the form, the Department of Health put the whole-life project costs of an NHS IT-based modernisation at an estimated £5bn. It is now estimated to cost £12.4bn.

The Department of Health did not publish the Project Profile Model for the NHS’s National Programme for IT [NPfIT] and indeed did not give a copy to the National Audit Office which spent nearly two years investigating the programme. I’ll publish separately on this blog the Project Profile Model for the national programme.

So one question on the suppressed Downing Street papers is: Did well-meaning consultants, civil servants and representatives of suppliers convince ministers and particularly Tony Blair that an NHS IT-based modernisation would be much simpler and cheaper and than it has turned out to be?

Some suppliers had thought that a National Programme for IT would resemble an airline reservation system, of which there were already many examples.

But an airline is a single organisation with staff under the full and direct control of a board of directors. The NHS comprises thousands of semi-autonomous businesses, each with their own way of doing things; and Whitehall has only limited control over them. So the risks of failure of a centralist National Programme for IT were always going to be extremely high. Did the Prime Minister full understand the risks when he made his decision over NHS IT?

And was the NHS at the seminar at Downing Street in 2002 depicted as irredeemably backward in its use of IT to make a national programme seem more urgent and vital? The reality at that time was that some parts of the NHS were backward and desperately needed more money for IT-based modernisation, and some other parts of the NHS had progressed well with programmes for electronic patient records and electronic booking of hospital appointments.

A well-funded National Programme for IT would at that time have been a good idea if it used as examples some of the most advanced sites and spread good practice to the rest of the NHS, on the basis of national standards and suppliers who met those standards. But was this even considered seriously as an option at Downing Street? Our suspicion is that it was not because it would have meant proceeding gingerly. Ministers want quick results.

These are some of the questions the Downing Street papers may help to answer. And if they do provide these sorts of answers, we would expect the Cabinet Office to continue its fight to stop them being released.

As the Information Commissioner said in his ruling, in quoting the Information Tribunal:

“It is not unfair to politicians to release information that allows the policy decisions they took to be challenged after the event.”

We also expect the Cabinet Office to appeal because it could delay by another year any publication of the Downing Street papers on the NPfIT. This may sound a touch conspiratorial but there is evidence that the government has used the Freedom of Information Act to delay the disclosure of contentious material – and has then derided that material as so out of date it’s irrelevant.

MP Mark Oaten, who requested a report on ID cards, told us that its disclosures would probably have made the front pages if it had been released when he first requested it.

In fact it was finally released more than two years later after a series of appeals – by which time (April 2007) the Home Office told BBC online that the documents were “incredibly out of date“.

Similarly Rod Ward, a senior lecturer who is a nurse with a background in A&E and also a much-respected blogger on the NHS, requested a report in January 2005 under the Freedom of Information Act on the closure of the NHS University.

The NHS University was planning to deliver more than 50% of its material via the web or the internal NHSnet. Some of its activities were transferred to NHS Connecting for Health which runs part of the NPfIT.

After Ward went through various appeals the government finally released the “Wells report” report this year – more than two years after his first request. It revealed that £72m had been spent on the NHS University before the government decided to close it down.

By the time it was released its contents were of little interest to a media that has a small appetite for disclosures of historic information.

So there is every reason to believe that the Cabinet Office will appeal the decision of the Information Commissioner over the Downing Street papers on the NHS’s NPfIT.

We’d like to think that the government and Whitehall would use the Freedom of Information Act to promote openness. But it’s clearly using it to delay as long as possible and preferably indefinitely the disclosure of embarrassing things.

So much for the claim of the then Lord Chancellor Falconer in 2004 that “good government is open government”.


Did Tony Blair approve the NHS scheme without knowing the full risks?

Government statistics highlight “unacceptable” freedom of information delays

More evidence of Freedom of Information Act delays

Head of the NHS national plan for IT confirms he will retire before the completion of project

BBC online report on a request by MP Mark Oaten for a report on ID cards under the Freedom of Information Act

The Wells report on the NHS University which was requested by Rod Ward under the Freedom of Information Act