NHS IT project should not be at the expense of patients or of the media's independence

The media must remain free to hold the NHS IT project accountable for its shortfalls

Computer Weekly agrees with several of the points made by Richard Holway - for example, that health officials should be applauded for trying to stop suppliers from ripping off the NHS and taxpayers.

And there are other advantages of the National Programme for IT (NPfIT). Hospitals that had cumbersome, unreliable and old green-screen technology are having it replaced under the NPfIT.

A new broadband network has been installed, x-ray systems are being rolled out - though this was happening before the advent of the NPfIT - and there are some innovative uses of IT: for example by the East of England Ambulance NHS Service Trust, whose paramedics use handheld computers to beam information ahead to the hospital.

But the main purpose of the £12.4bn spend on the NPfIT is not to show how well suppliers can be managed, or to put new technology into ambulances, whatever the undoubted benefits. A key objective of the programme was to deliver an electronic health record for 50 million people, accessible by any authorised user across England.

At a meeting last week of health IT experts, the audience was asked whether the chief objective of the NPfIT should still be the delivery of a national electronic health record. No hands went up. Some thought it better to work towards a less ambitious scheme, to deliver a reliable and easily accessible local electronic medical record rather than a national care records system which may not materialise.

This brings to the fore one of the main concerns about the NPfIT: that nobody has any real idea whether it will meet its original objectives, or whether some of those objectives are now obsolete.

An independent review could ascertain whether the NPfIT will deliver what the NHS needs. But Caroline Flint, minister for public health, has rejected the call by 23 leading academics for an independent review in part because she says there have already been many internal assessments of the NPfIT.

She has refused to publish all of the reports, which raises suspicions that much is being hidden - or worse, that there is much to hide possibly the fact that the programme as originally configured by the government in early 2002 was fundamentally flawed.

We learned last week that the Rural Payments Agency had sailed through a series of red lights set by "gateway" reviewers appointed by the Office of Government Commerce. The project was a disaster. How could it happen? The National Audit Office explained at a briefing that nobody at the time had dared ask, "Is what we are doing, and how we are doing it, a good idea?"

That is where the media has an important role: reflecting the views and concerns of those in the IT industry and medical professions whose voices the arch-enthusiasts would rather drown out.

We do not want the NPfIT to end up like the rural payments project, which ultimately caused widespread distress. Yet the NPfIT is projected to cost about 40 times that of the rural payments scheme, and it is immeasurably more complex. And it affects lives.

Richard Holway refers to the pain that inevitably accompanies big projects. So far the pain that has accompanied the NPfIT has included cancelled operations, people turning up for consultations and not being expected because health staff have been unable to access lists of appointments, and systems at 80 trusts failing simultaneously - a misadventure that could not have happened before the national programme.

So we do not agree that the media should be criticised for criticising. We think it crucial on any big IT-related programme that those involved should tell it like it is. Because if they do not, they accentuate the need for the media to do so.

It is true that the media has made much of the departure of Accenture from the NPfIT. But the ease with which the supplier can be replaced is not the main issue. The question is, why did it leave? Does it know something the other suppliers and health officials would rather not?

We are also concerned at suggestions that the NPfIT is Richard Granger. Without Granger's impressive drive and conviction the programme is more likely to disintegrate but the programme was conceived many months before he joined, on the flawed basis it would cost £5bn and take less than three years. The NPfIT is a programme involving ministers, officials and thousands of NHS sites and people. It does not belong to one man.

If the NPfIT delivers what the health service needs, which may conflict with what ministers originally set as its objectives, it is likely to save lives. But the point was made at last week's meeting of health IT experts that if it goes wrong it could cost lives.

So any argument that dismisses the potential for causing harm by arguing that "any large programme is painful to implement" is dangerously simplistic. We should not experiment with peoples' lives on the basis that some good will eventually come from the pain.

We hope the billions spent on the NPfIT will eventually improve the care and treatment of millions of patients. This is more likely to happen if the media remains independently-minded, well-informed and free to say what needs to be said about the NPfIT.

If it simply writes up Whitehall's speeches and press releases, and publishes selective quotations from NHS people, as some officials would like, the IT industry and the health service will be robbed of its independent voice, and the programme will continue to suffer from a lack of openly expressed dissent.

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