The Department of Health has reacted with only limited enthusiasm to a call by more than 20 top academics in computer-related sciences for an independent audit of the technical feasibility of the NHS national programme for IT (NPfIT).
In response to an open letter (Computer Weekly, 11 April), the department said, "The national programme for IT is under constant review, scrutiny and audit by parliament and government bodies. We remain confident that the technical architecture is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer."
The professors wrote their unprecedented letter in part because they were concerned both about the technical feasibility of the NPfIT and the lack of transparency surrounding the project.
"Concrete objective information about NPfIT's progress is not available to external observers. Reliable sources within NPfIT have raised concerns about the technology itself," the letter said.
An investigation into the project by public spending watchdog the National Audit Office has been delayed by nearly a year. "The report is not expected to address major technical issues. As computer scientists, engineers and informaticians, we question the wisdom of continuing with the NPfIT without an independent assessment of its technical viability," the open letter said.
Although there is still widespread support for the aims of the NPfIT, it has failed to win the hearts and minds of the clinicians and NHS staff that will eventually use the systems, according to John Bourn, head of the National Audit Office.
The complexity of the project, delays, changes in leadership and policy issues that in part led to the professors' call for a technical audit have been tracked by Computer Weekly over the past four years.
The national IT plan is agreed at a seminar at Downing Street, chaired by the prime minister Tony Blair. A civil servant at the seminar, John Pattison, reveals that Blair has been told the programme will last less than three years.
Later, without any explanation to parliament, the plan becomes a 10-year scheme.
There has been no public consultation over the project, or discussion by parliament of the funding. In 2005, Computer Weekly asks for details of the 2002 Downing Street seminar under the Freedom of Information Act, and the request is refused.
NHS managers react to the national IT plan. They say they want change but see risks in centralising IT.
Computer Weekly reports that the "main problem the government faces is how to implement a strategy so dependent on central control across an organisation as complex and devolved as the NHS".
IT industry body Intellect in an article welcomes the NHS plan but Laurence Harrison, healthcare programme manager at Intellect warns that "the devil is in the detail". The same article questions whether the NHS and suppliers have the ability to deliver such a complex programme. It says, "The health service's history of implementing large, high-risk systems quickly is not good."
A Gateway review of the business case for a national care records service - including an integrated system for sharing electronic health records on 50 million people - finds significant problems. The independent assessment by the Office of Government Commerce raises concern about resourcing and whether it will be possible to manage and deliver such a large undertaking on time. The concerns turned out to be justified.
The NPfIT tells suppliers they can be removed from shortlists for contracts and excluded from doing business with the NHS for 10 years if they publicly question the project.
The warning is given at Avonmouth House, a conference centre in South London, on 3 December 2002, when suppliers meet to hear details of the national programme. One of the supplier's delegates records what is said for his company's internal minutes.
The Department of Health tells Computer Weekly it had "no intention of blacklisting suppliers" and that the warning should be understood in the context of the NPfIT wanting to hear criticism directly and not through the media. IT directors tell Computer Weekly of a climate of fear over speaking out about the NPfIT.
The NPfIT is criticised by some potential bidders when the Department of Health asks them to design some of the world's biggest and most complex systems in only five weeks.
On 23 May bidders say they are presented with a 500-page "output-based specification" document, which is described as a "work in progress" and not a final specification. They are to submit proposals of unprecedented scale and complexity by midday on 30 June.
A spokesman for the NPfIT dismisses supplier concerns about the procurement process. He says, "All bidders were made aware of the procurement timescale from the outset in order to be fully prepared for a process that is as rapid as good practice allows."
The Department of Health takes the extraordinary step of posting on its website three letters that are critical of Computer Weekly's coverage of a health IT conference at the NEC in Birmingham. Two of the letters are from the department's officials and are addressed to Computer Weekly.
This publication had reported comments about the NPfIT, some positive and some critical of the programme, which were made at a conference organised by the British Computer Society's Health Informatics forum and Assist, the Association for ICT Professionals in Health and Social Care.
The NPfIT says that the contract for booking systems had been part of the NPfIT's "ground-breaking schedule" - only 190 days had elapsed between advertising the contract and awarding it. This is unprecedented for such a system, it says, adding that the specifications had been "well-defined", and the degree of clinician involvement in the process had been high.
An independent report into the NPfIT lists the successes of the programme but also raises some profound concerns. It is published on an official NHS website, the National Electronic Library for Health, but is withdrawn after Computer Weekly quotes its criticisms to the NPfIT.
The paper says that too little attention has been paid to cultural, organisational and change management issues, and there has been insufficient clinician involvement in the building of the specification for a care records service - which includes a system for exchanging medical records electronically. The paper also says there is a lack of clarity over how much money will be available locally to implement national systems.
A book on the NPfIT, written by four leading healthcare IT specialists, including Bud Abbott, a founding father of NHS computing, strongly supports the principles that underpin the programme but warns, "The level of complexity, the barriers to overcome and the means to achieve change are not agreed and are generally underestimated."
At an NHS conference in London, to which journalists were not invited, the health minister John Hutton and Christopher Bland, chairman of BT, who was knighted for his NHS work in 1993, speak of the NPfIT's risks and potential benefits.
Bland, whose company has won the biggest contracts in its history to implement key parts of the programme, says BT is excited by the challenge but "somewhat frightened by the enormity and complexity of it".
Winning more than £2bn in NPfIT contracts, Bland says BT feels "slightly like a dog chasing a car. What do we do if we catch it? Well, we've caught it".
Richard Granger, director of NHS IT, challenges press assertions that the national programme is being run under a cloak of secrecy. He says, "One of the things I find just repugnant frankly is this continuous charge of secrecy that is levelled by somebody, because I do not know of any other public sector programme that has been as open as we have."
Granger acknowledges that the NHS has severe shortages of high-level IT skills. A shortage of talented people is causing "big, big problems", he says.
Despite the difficulties, Granger remains confident about the future. He says that no major programme has achieved as much as the NPfIT in its first two full financial years.
Aidan Halligan announces his intention to leave the NHS. He had inherited the senior responsible owner role from John Pattison, who retired.
Computer Weekly reveals that the NPfIT could cost a minimum of £18.6bn - at least three times more than the announced figure - with a large part of the bill falling locally, on NHS trusts.
In a written statement to Computer Weekly, the NPfIT says that the business case for the programme estimates the total cost to be three to five times that of the procurement costs - the procurement costs being £6.2bn.
"It is generally accepted in the IT industry that implementation costs are some three to five times the cost of procurements. That is reflected in the business case that was made for the national programme," says the spokesman, who maintains that the initiative will "undoubtedly deliver benefits and savings beyond its costs".
A Computer Weekly reporter is barred from attending a press conference on the NPfIT chaired by the then health minister John Hutton at Richmond House, headquarters of the Department of Health. More than a dozen journalists from national newspapers and magazines pass through a security gate to enter the press conference. But when Computer Weekly's reporter approaches, a Department of Health press officer stands in front of the gate, barring entry. The barring denies an opportunity to Computer Weekly to ask the health minister about the NPfIT.
Computer Weekly calls for an independent audit of the NPfIT. Editor Hooman Bassirian says, "A forward-looking review would complement a study on the project's value for money by public spending watchdog the National Audit Office." The campaign is backed by MPs.
A spokesman for the NPfIT says, "We should like to place on record that we do not think it is appropriate for a commercial media organisation to be calling for an independent review of the national programme when that is rightly the role of the National Audit Office, which reports to parliament."
The House of Commons Public Accounts Committee learns that Richard Granger has never had full responsibility for the engagement of the wider community of clinicians. This means that the NPfIT has never had one person in charge consistently for persuading doctors and nurses to support the programme.
In a leaked e-mail, Richard Granger criticises a senior official at the Department of Health over Choose and Book, a part of the NPfIT which aims to allow patients and doctors to book hospital appointments online.
Granger says, "Unfortunately, your consistently late requests will not enable us to rescue the missed opportunities and targets." Richard Bacon, an MP on the House of Commons Public Accounts Committee, says the leaked e-mails could indicate that "the blame game has started in earnest".
In a memo, the NPfIT asks NHS trusts to refuse applications under the Freedom of Information Act for details of contracts signed under the programme.
Lawyer Dai Davis of Nabarro Nathanson criticises the blanket nature of the NPfIT's advice to trusts. But a spokesman for the NPfIT says the memo was quite clearly marked as guidance. "It did not purport to be instruction or direction and was never intended as such," says a spokesman for the NPfIT.
Accenture, the main supplier of NPfIT systems to two of the five "cluster" areas in England, reports a 67% drop in profits after accounting for expected losses from its work on the national programme.
It blames delays in part on its UK partner in the NHS project, iSoft.
Connecting for Health is critical of the wording of Accenture's statement on its predicted losses on the NHS contracts.
Leading academics across the UK send an open letter to the House of Commons Health Committee which echoes Computer Weekly's call for an independent audit of the NPfIT.
The NHS announces that Ian Carruthers, acting chief executive of the NHS, is to take on the role of senior responsible officer for the NPfIT.
Read article: Top UK IT experts call for audit of NHS programme