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Blair's NHS booking plan heads for national disaster

Tony Blair wants a nationwide computer system to enable patients to book hospital appointments, but NHS IT professionals warn against complexity which could lose up to £140m

It is rare for suppliers and purchasers to unite in opposition against a government IT scheme that is designed to help the public, but the two sides have become unlikely allies against a nationwide NHS project that they say will waste between £75m and £140m.

A computer system that would allow patients to book hospital appointments at times convenient to them could save the NHS money by cutting the number of people failing to turn up at the right time.

But what is drawing strong criticism from NHS IT professionals and suppliers is the idea of a single national system, as the complexity of the system means it could lead to another centrally-led NHS IT disaster, they say.

Users and suppliers say it would be much safer for the NHS to mandate national technical, procedural and data standards that accredited suppliers will have to adhere to when delivering booking systems to GPs and hospitals at a local level.

But an investigation by Computer Weekly has found that a document by the National Patient Access Team (NPAT), part of the Department of Health’s Modernisation Agency, favours a single national scheme, or a contract with a supplier for a national managed booking service.

This is despite an admission in the same paper that the project, when set against criteria laid down by the Treasury’s Office of Government Commerce, would be classified as “high risk”.

The document says that currently it is “not possible to be definitive” on whether it is appropriate to meet the Treasury’s stage-one Gateway Review, which requires robust business justification for a major project and adequate external authority support for the scheme.

The Office of Government Commerce devised the Gateway Review as a formal review that departments must undergo following a Cabinet Office’s report on best practice called “Successful IT: Modernising Government in Action”.

In addition, the NHS’s Strategic Outline Case (SOC) in the NPAT paper sidelines some of the best practice guidelines on avoiding IT disasters issued by the Cabinet Office and the Public Accounts Committee (PAC) last year.

Although this week the department said that the NPAT paper is only a draft document, the accompanying email says that the “entire process will be ‘rolled up’ no later than 5 February, when all the responses to date will be collated and incorporated into a new and final submission to government”. This will all happen “early February”, the email says.

Indeed, the briefing paper says the next stages will include an advertisement in the European Journal, followed by a procurement exercise and “award of contract”.

Rushed scheme?

The current proposals emphasise that meeting ministerial deadlines is one of the project’s main priorities. But senior NHS IT professionals say this may indicate that the scheme is being rushed to meet overly ambitious political objectives, with approval sought before the general election.

In 1999, Blair said that a booking scheme would prove a “revolution for the NHS”. He added: “When it is complete, it will mean that the NHS has the most advanced and patient-friendly arrangements for delivering treatment of any healthcare system in the world.”

However, users and suppliers also say that the Department of Health has underestimated the complexities of implementation, the risks of failure of a national system and the level of culture and procedural change that will be required.

Such is the sensitivity of the Department of Health to overt opposition, that individual suppliers and users would only speak anonymously. But their concerns are supported by the supplier’s trade body, the Computing Services and Software Association (CSSA), which says that a single national system will be a “disaster”.

In theory, a booking scheme would allow all patients to choose a convenient time for an appointment within a guaranteed maximum waiting time. At present, more than 10% of patients fail to turn up for appointments, wasting millions of pounds each year. If appointments were booked at the time of a patient visit, by agreement with the GP, there would be fewer missed appointments.

With Blair’s personal support, up to £40m has been earmarked for trial local booking systems at sites which include hospitals in West Dorset, the Royal United at Bath, South Durham Healthcare, Central Manchester, Royal Liverpool Children’s hospital, and City Hospital, Birmingham. Departmental documents concede that most of these have been successful.

But IT directors in some of the trusts involved in the trials say their systems could be sidelined or even made redundant if there is a single national system or managed service.

Phil Sissons, chairman of the Healthcare Group of the CSSA, said a single national system would in practice be difficult or impossible to deliver because of the unique booking arrangements adopted by consultants and staff in more than a thousand UK hospitals.

Any national system would have to take into account these local differences, while having multiple interfaces to other proprietary systems. It would involve a novel use of IT in the first procurement of its kind. There would also have to be major cultural and business process change across the NHS prior to the system’s introduction.

Yet there is mounting evidence that the Department of Health is pushing ahead with a single national system or a managed service under an outsourcing contract. A statement on 4 February by the health secretary, Alan Milburn, said there will be “a national appointment booking system by 2005”.

NPAT paper recommendations

Meanwhile, the NPAT paper, seen by Computer Weekly, says: “One of the fundamental assumptions on which the SOC is built, and one which has been endorsed by the steering group overseeing its development, is that there should be one common national solution.”

The paper recommends three options: one for a regional-based service, another for a national commercial system and a third for a national service. The cheapest favoured option, at £75m, is for a managed service, which is costed at less than half that of the regional solution. However, it does not go into any detail on the costs of altering local systems to interface with any national system.

The paper goes on to outline a timetable for awarding a contract next year, and implementation would begin in 2003.

This week a government health spokesman said: “To speak of a national system being imposed at this stage is premature and demonstrates a lack of understanding of the purpose of a SOC... the SOC is a vehicle for recommending a range of options to be taken forward for further development. It will not propose an absolute and final solution.”

But trust IT directors told Computer Weekly they believe that the NHS executive has already taken a decision in principle to impose its will on local hospitals. It can expect no serious opposition, partly because few critics will dare speak out.

One NHS IT manager said: “I can think of no single system of this size that the NHS executive has ever delivered successfully. Nothing in what I’ve seen suggests that this project will be the exception.”

Past failed NHS projects

  • 1992 Wessex Regional Health Authority’s Regional Information Systems Plan lost up to £63m after the region and the NHS executive sought to impose systems without user buy-in.
  • Early-1990s A centralist approach to a rushed IT delivery afflicted the Hospital Information Support Systems Initiative which lost up to £103m. The Public Accounts Committee said the NHS executive “went ahead with one project despite high costs and the significant risks involved” and ignored supplier warnings that the scheme was not feasible.
  • Mis-1990s A £32m Read Codes version 3 project failed, partly because it had little support among doctors and clinicians.

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