Bite the NHS bullet

The new NHS IT plan is a laudable attempt to bring order to the chaos and waste that characterises today's health service IT...

The new NHS IT plan is a laudable attempt to bring order to the chaos and waste that characterises today's health service IT procurement. But it faces three big obstacles: legacy standards, clunky hospital information systems and an acute skills mismatch.

The plan says that the use of standard technologies and data formats will now be a pre-condition of gaining central funds.

That is welcome. But there are huge obstacles that need every bit of the "urgent and co-ordinated action" the plan promises.

Two of the biggest short-term problems concern legacy information standards that are still being rolled out. NHS Net, the project to provide online access for all GPs, was based on the X.400 standard, while the rest of the world uses SMTP for e-mail. Meanwhile, the NHS electronic pathology messaging system is based on Edifact, while the rest of the world is adopting XML.

By March 2001, the NHS will have a plan to standardise on SMTP and XML - but it is also determined to carry on with the existing plans.

Clearly, NHS Net is too far down the line to be reversed, but the Edifact project could be scrapped in order to implement XML as a national standard.

To make NHS IT work properly long term, managers in the health service must be empowered to solve the long-standing problems of poor supplier relationships, fragmented procurement and a poor skills mix.

Hospital information systems

The 1990s saw hospitals attempting to roll out complex, ERP-style hospital information support systems. The resulting waste of taxpayers' money has been well documented. Today, many NHS trusts are still struggling to get their large, proprietary hospital information support systems to work internally - never mind communicating with the rest of the NHS or the patients themselves.

These systems face all these problems and more as the NHS plan demands interoperable systems geared to the needs of the patient.


Local implementation groups for the new NHS strategy have had an injection of funds. The problem is spending it wisely. Some NHS managers believe the present technical infrastructure is too inadequate to spend that money in a "joined-up" way. They predict a further string of small disasters as the funds are squandered on a string of isolated "e-projects".


Finding and retaining IT staff skilled in e-commmerce-like technology will be crucial for the plan to succeed. Yet much of the modernisation money for the NHS has to be spent as one-off, non-recurring investment. That means an IT manager can spend half a million on an e-mail project but is not allowed to use any of it for salaries.

The commitment to e-projects, without a parallel commitment to realistic IT salaries, could speed up the brain-drain from the NHS those with legacy skills get trained up in Java and .asp and head for the green hills of the booming e-commerce sector.

In short, the new plan's target-driven drive to standardise NHS IT contains the seeds of its own destruction unless the Government bites the bullet on legacy standards, legacy systems and legacy pay scales.

Read more on Operating systems software