Effective local initiatives in danger of being cut short in favour of national NHS IT plan

A world-renowned professor of telemedicine warns that health IT professionals are feeling ignored and fear the NHS IT programme...

A world-renowned professor of telemedicine warns that health IT professionals are feeling ignored and fear the NHS IT programme will override local projects

Narasimha-Moorthy Shastry, professor of telemedicine and medical imaging at the United Bristol Healthcare Trust, wants to be a champion for the £2.3bn IT investment the government is pouring into the health service.

He has devoted his career to showing how the innovative use of IT can improve healthcare and has consistently delivered results. Civil servants from the Department of Health and leading members of the National Health Service Information Authority beat a path to his door.

Shastry's work attracts a steady stream of health service colleagues, international experts and major suppliers who all want to learn from his experience.

His department's latest achievement is to oversee the implementation of a trust-wide IP-based virtual private network. This, with a storage area network and network-attached storage system, has effectively integrated all the hospital's IT and patient care systems. Thanks to the support of a forward-thinking IT department, administrators, clinicians, colleagues and suppliers, this has been achieved at a fraction of the price quoted by big-name suppliers.

Yet Shastry is a worried man, and he believes other leading health informatics professionals in the UK share his concerns.

He fears the centrally dominated national programme for health service IT is crippling local initiatives. Programmes that are already delivering real clinical benefits could, he said, wither away long before the national programme and the giant consortia that will run local NHS IT can deliver improvements to the health infrastructure.

The government's IT plan for the NHS aims to deliver a national booking system, national patient records, electronic prescriptions and a broadband infrastructure that will be procured with national contracts and run by five private sector consortia of "local" service providers.

But Shastry said there is a danger that the national plan covers the same ground as previous plans and is not focused on clinical delivery. He is also concerned about the potential for wastage as ill-conceived projects are pushed out to meet arbitrary timetables.

These concerns are exacerbated by the mixed messages and lack of communication Shastry believes emanate from the organisations driving the programme.

Shastry highlighted a speech made by NHS IT tsar Richard Granger in March to the Healthcare Computing conference, in which he appealed for support and promised health service IT practitioners that they and the systems they have developed will have a key role in the future.

In his speech, Granger said, "We are talking about joining up and implementing best practice, not sweeping the board clean. You are essential to providing support, knowledge and expertise to deliver this programme."

Shastry saw this as a plea for help. However, he said, "Granger talks about making the best use of our existing asset base and an integration and upgrade programme, yet if we are an example, it is not happening.

"I get visits from Granger's colleagues and from the NHSIA. They take a lot of my material, incorporate some of my ideas, but nothing comes back to me."

While Granger's team is busy gathering material to write the specifications for the new NHS infrastructure, trusts, administrators, IT departments and suppliers are reacting by delaying investment and implementations.

High-profile pilots such as the Blackberd electronic patient record project are being canned, and local initiatives are withering. That may not be Granger's intention, but Shastry said, "There are so many conflicting messages from the centre. When you are told there will be no funding available for local activities it starts to frighten off those responsible for local projects. What happens is that no one wants to accept responsibility and 'pass-the-buck' becomes the culture.

"It is not practical to stop what is happening today because the Department of Health and the NHSIA want to lay down what will happen tomorrow.

"It is easy to cut things short. It is also easy to build something fresh. Tying the legacy system with the new system is the most difficult task as we cannot afford to throw away the legacy systems. Unless we maximise what we have, we will waste resources."

Shastry said there is a misconception about many local NHS initiatives. "Innovation can be misconstrued as something that has just begun, but many of these systems are in action for patients, day in, day out."

There should be no problem with local initiatives, provided they are built on the principles of interoperability and open standards, he added.

"There are many local initiatives across the UK where this has been taken on board," said Shastry. "The people running them may have their own agendas but the fact that they are interoperable and based on open standards should make it easy for them to integrate into national programmes in two to four years."

Shastry is desperate for the £2.3bn to be used effectively. He acknowledged that Granger has undertaken an enormous task with very tight deadlines, but said the NHS IT chief could calm the fears of health IT practitioners by putting over simple, clear messages.

"He should send a message to the health authorities saying not to curb local activities and initiatives. He should look for open evaluation and feedback to the centre of local initiatives. He should seek out local champions for the national programme and he should constantly emphasise that interoperability and open standards are at the heart of everything to be developed."

Yet Granger has mainly focused on engaging the supplier community and has said there is not time for a widespread consultation within the NHS.

The stakes are high for people like Shastry. "The NHS has a long history of short-term clinical projects that are put in place and then the plugs are pulled," he said. "The result is cynicism among clinicians and paramedics towards new implementations.

"Clinicians, IT staff and supplier companies cannot work in isolation. We cannot work with the feeling that the centre, though it has picked our brains and has even implemented some of our ideas, has not acknowledged us. It creates the impression that we have been rejected."

The Department of Health has taken some steps to try to ensure clinician buy-in, including advertising for clinicians to advise on the design of the national system. But if people like Shastry feel rejected, it will have profound implications for the national IT programme. Without champions in every health authority and trust with a proven track record of innovation that can directly benefit patient care, the chances of getting user buy-in on new systems, let alone extracting maximum benefit from the £2.3bn investment, are slim indeed.

Who does what?

Five local service providers will be responsible for the delivery of IT services across England, including:

  • Integrated care records
  • Integration or replacement of existing systems to conform with national standards
  • Standard desktop front-end for applications and services
  • Legacy systems management
  • Area-wide helpdesk
  • Business process re-engineering.

National infrastructure service providers will be responsible for the enabling infrastructure for NHS modernisation, including broadband.

National application service providers will deliver discrete application services such as electronic appointment booking and electronic transfer of prescriptions.

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