The NHS national IT programme's planned "ruthless standardisation" of all new technology in the health service bodes ill for the many localised electronic records and booking systems now functioning efficiently and making a difference to patients' lives around the UK.
By treating the NHS as a single entity for the purposes of systems procurement and implementation, the Department of Health (DoH) hopes to save hundreds of millions of pounds, and improve the patient experience by cutting waiting times and boosting the quality of clinical care. And, if central control of IT yields better statistics on how the NHS is performing, and therefore increases ministerial kudos, then so much the better.
But before we bid farewell to the notion of devolved responsibility across the NHS, let us point out the drawbacks of standardisation and centralisation. For there are real risks attached to such an approach.
Waste: adopting a centralised model for procurement could sideline hundreds of successful local systems and IT specialists, undoing five years of hard work since the DoH first demanded e-records and e-booking, in 1998. Consortia of suppliers will manage projects, over the heads of IT specialists in local trusts - the very people who have been accruing expertise in modernising NHS IT systems. A wealth of knowledge and experience will be squandered.
Failure: centralising will create large procurement projects, involving many healthcare organisations. The received wisdom among IT decision makers is that small is beautiful in project management, and that the larger a project is, the more likely it is to disappoint. The NHS has stumbled in the past when it has tried to manage mega-projects - most notably over the regional information systems plan at Wessex health authority that failed in the 1990s, and the computerised thesaurus of medical terms, Read Codes, which lost as much as £32m. Will they stumble again?
Cost: using prime contractors and large numbers of management consultants is expensive and increases levels of bureaucracy, further complicating the project and increasing its risk of failure. Internal strategy documents from the DoH itself suggest that employing outsourcing companies to handle the national programme will be costly. No UK software firms with considerable NHS experience are big enough to act as preferred suppliers in this model, and the government risks putting some of the most innovative companies in the sector out of business. The alternative is that these firms will contract with the preferred suppliers who will then sell their products on to the NHS at a premium.
Should all these drawbacks manifest themselves - should IT experience go untapped, costs spiral and projects founder - the DoH will come to wish it had favoured consensus and caution over ruthlessness and speed.