Whitehall pushed immature technology on NHS – government-funded report

Connecting for Health, which runs much of the NHS’s £12.4bn National Programme for IT [NPfIT], is expected to be criticised in a government-funded report into “early-adopters” of online health records.

A year-long study, the results of which are due to be published next week, is also expected to highlight criticisms of the government by some executives at NHS Connecting for Health [CfH].

The government wanted CfH to implement online health records quickly because of the high political profile of the scheme. This was despite the difficulties gaining support from clinicians, achieving the necessary changes within NHS organisations, and the technology being unproven.

The report by health researchers at University College, London, analysed the first go-lives of the national summary care record system, a key part of the NPfIT that was designed to give up to 50 million people in England an online summary health record, which would include details of allergies and medications.

Under the scheme, medical details from local patient records are uploaded to a national “spine” database run by BT.

The study is expected to find that there was widespread enthusiasm among the early adopters for the principle of the summary care record. But some staff told the study’s researchers that CfH pushed primary care trusts to implement the summary care record, despite the immaturity of technical solutions.

Staff implementing the project said they were asked to meet unrealistic deadlines. Local NHS project leaders struggled to reconcile political timescales with making the technology work properly. Some GPs embraced the scheme, but others believed they had been coerced into it.

Part of the study involved an appraisal of the work of CfH and researchers made recommendations for improvements.

Nearly all staff at CfH were said to be highly qualified but some told researchers they found the work stressful. They worked hard and far beyond their contracted hours.

NHS CfH, which employs 1,500 people, paid for the study into early-adopter go-lives of the summary care record programme at Bolton, Bury, South Birmingham and Dorset.

The report is expected to be published next Tuesday. It is expected to show the lengths to which some health officials were prepared to go to convey the right message to the public on the summary care record programme. A mass mailing letter to explain the benefits of the summary care record to patients went through 93 versions before it was sent.

Patients who took part in early trials were given the chance to opt out of having their medical details on a national database. But health officials paid for GP surgeries to have large plasma screens in their waiting rooms to show the benefits of the summary care record.

In what researchers considered an Orwellian scene, health officials equipped one GP surgery’s waiting room to show a PowerPoint presentation on a continuous loop to describe the benefits of the summary care records to patients. A GP at the practice said it had no control over the content of the plasma display which was “apparently ours for life”.

The researchers found that CfH had an internal organisation set up to document and disseminate the benefits from the summary care record but had no equivalent department to do the same on “dis-benefits” and risks of the project.

Whitehall officials collected information from NHS trusts about their progress and problems rolling out the summary care records. But knowledge failed to circulate efficiently. Staff at primary care trusts said they had not learnt much from other early-adopter sites.

CfH is itself a victim of pressure from the government to meet tight timescales and accelerate progress under the NPfIT.

The report is likely to say that politicians will need to recognise that it is impossible for CfH to go beyond the technology and help the NHS to make the necessary changes in the NHS while also adhering strictly to predefined goals and milestones.

The Department of Health is recruiting two executives – a CIO, and a Director of Programme and System Delivery to run the NPfIT – on salaries of at least £200,000 each. The new CIO will have an annual budget of £1.6bn.

Patients who were interviewed for the study broadly understood the potential benefits of the summary care record but questioned whether the scheme was a worthwhile use of public money.

CfH made no comment.


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