Richard Granger, director general of NHS IT, last week praised the consistency of the work carried out by his team headquartered in Leeds, but was less complimentary towards some parts of the health service and suppliers.
Giving an update on the NHS national programme for IT (NPfIT) at the Healthcare Computing conference in Harrogate, he said some "upgrade activities have taken longer because existing suppliers have found things more challenging than originally estimated".
And some outages at GP sites of national systems, such as Choose and Book - a means of booking hospital appointments by phone or online - were because of the "absence of accredited and configured environment in the end-user domain".
Granger's speech was measured and well-received. He put no blame for the delays of more than a year in the delivery of core systems within the NPfIT on any deep-rooted flaw in the programme, or on the central teams helping to manage the scheme.
When looking at why some projects were successful and others difficult, "One of the big things that is becoming apparent is that there is a lot of variability in the supplier community and in the NHS itself," Granger said.
The central team at Connecting for Health, the government agency managing the NPfIT, was "often consistent in what it is delivering" but was finding the results of implementations at NHS sites were variable.
"On some occasions a solution that has proved extremely popular, successful and easy to implement in one part of the country has had extreme difficulties in another part," said Granger. "The year going forward is going to be about getting under the lid of some of some of those variabilities. I think a lot of that variability is not the team that is headquartered at Leeds; I think it is other factors. Of course, I would say that wouldn't I?"
Granger said it was three and a half years since he started working for the NHS. "I think it fair to say that a lot of things are not as people thought they would be. A lot of things have been more difficult and a few things easier."
He reminded delegates that one of the main reasons for the NPfIT was to save lives by, for example, ensuring that a summary health record is available to doctors when they need it.
Granger said there was a "a lot of work to do yet" but most of it is "well underway".
"As the dependency on the systems we are delivering increases, we will see the stresses and strains that you would expect of systems of this type. So it is no surprise that systems fall over, message queues saturate, hardware fails and you have to go through the process of dealing with that."
He added, "Things that are going wrong with these network systems are quite subtle to solve," but it is not always the fault of central systems but of the way people have configured their systems and have not followed requirements.
"It is wasting a lot of resource sending teams out to do detailed diagnoses of things like that when I would rather we were spending the time fixing the real things that were going wrong," he said.
Granger keeps pressure on suppliers
Delivering the national programme for IT has put strain on the supplier community, said director general of NHS IT Richard Granger.
When suppliers signed contracts with the Department of Health, they took on the risks of not completing assignments, and other financial risks.
"We have seen those risks mature," said Granger. "It gives me no pleasure that this is happening, but this is an awful lot of public money and one of the things we set out to do is not repeat the errors of the past and not have a situation where taxpayers were bankrolling suppliers whose products did not work or who were not able to deliver things in a reasonable timescale. I do not think we are at the end of the road on this yet."
Call for change
Richard Granger would like there to be a fundamental behavioural change in which doctors moved from taking pride in individual record keeping to a "communitarian system" in which people prided themselves on passing information to prescribed standards between sites. He said it was quite easy to "let people put rich systems in, in their own domain, which don't work with other systems". And it could be "quite challenging to move records between the same system on different sites".
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