NHS IT staff look for guidance on £2.3bn scheme, so why the silence on key issues?

Members of the influential National Clinical Advisory Board want open debate on the national programme but the minutes of their...

Members of the influential National Clinical Advisory Board want open debate on the national programme but the minutes of their meetings remain unpublished

Mystery - or rather secrecy - surrounds the work of the National Clinical Advisory Board, in which top medical professionals air their views on the biggest IT project in the world, the £2.3bn national programme for IT in the NHS.

Members of the board have approved sets of minutes for publication but none have been published on the Department of Health's website, except a one-page summary of the inaugural meeting in October 2003. There have been four meetings since then.

The absence of the minutes raises the question of whether publication has been blocked by the Department of Health because the documents contain constructive criticisms of the programme.

Richard Bacon, a member of the House of Commons Public Accounts Committee, and Vince Cable, former chief economist of Shell International and now Liberal Democrat shadow chancellor of the exchequer, are both critical of the non-publication of the minutes.

Cable said, "Good policy making is done in public so that everyone can contribute their knowledge and skills, not least the doctors, nurses and midwives who have to use NHS technology.

"Hiding information about spending millions of pounds of public money is not only likely to lead to bad decisions, but fuels the suspicion that the government has something to hide. If people working in the NHS are not comfortable that this project is working well, the government should encourage them to explain why, rather than stifling dissent."

The advisory board is a key organisation in the national programme. It was set up last September to give the Department of Health the views of clinicians on the national programme. The board's members are among the most respected in the medical profession. They include senior figures from the royal colleges of radiology, surgeons, physicians, anaesthetists, GPs, psychiatrists, nursing, midwives, obstetricians and gynaecologists, paediatrics and pathologists.

The then chairman Peter Hutton, who has since resigned, said last year that the purpose of the board was to "listen to health staff and shape the way the programme develops, in partnership with technical experts".

Nothing is known of the specific discussions but, according to the minutes of the inaugural meeting, it was due at its second meeting to debate "communication with NHS staff and the public" and "training and education". Many clinicians believe there has been too little communication, and not enough money put aside for the training of tens of thousands of doctors and nurses in using the new systems, and to pay for locums while they attend courses.

A spokesman for the national programme hinted that the minutes of the Clinical Advisory Board may not have been published because no agreement over the wording had been reached among its members.

"Minutes of meetings are published at www.doh.gov.uk/ipu/ programme once they have been approved by members of the National Clinical Advisory Board," he said.

However, Clinical Advisory Board member Peter Dawson, a professor and registrar of the faculty of clinical radiology at the Royal College of Radiologists, told Computer Weekly that he was unaware of any disagreements over publishing the minutes. He said he had seen sets of minutes which he had passed as satisfactory.

Meetings of the board members had been supportive of the national programme and had also aired constructive criticisms. Dawson said, "Of course, we have had occasional frank discussions but nothing that anyone need be sensitive about."

Apart from the minutes of the inaugural meeting last October, the minutes of meetings of another organisation whose formation was announced at the same time as the clinical board, the Public Advisory Board, have not been published on the Department of Health's website.

The Public Advisory Board consists of individuals drawn from patient, carer and citizen groups, including the Patients Association, Consumers' Association, Help the Aged, Mind, Mencap and the National Consumer Council. Like the Clinical Advisory Board, it has had five meetings.

The failure to publish could simply be an oversight, or perhaps no one had time to post the documents on the department's website. On the other hand, there is little evidence that the department welcomes constructive criticism about the national programme.

When the department became aware that a senior health service IT employee had published a paper in October 2003 about the national programme on an official NHS website, it was suddenly withdrawn without her consent. The paper was largely positive about the aims of the national programme but contained some detailed criticisms. With the paper withdrawn, a senior official at an agency of the Department of Health wrote to Computer Weekly attacking the paper's author.

Following criticism, the Department of Health published on its website some key documents and regular updates on the national programme. The updates make the most of the programme's anticipated benefits of improving the care of patients, reducing bureaucracy for doctors, increasing choice for patients, and stopping records going missing.

But it does not give the other side of the story: the contractual issues with the main supplier BT, surveys which show that consultation with clinicians is inadequate, the concerns among trusts and GPs about mounting costs, and disagreements over whether GPs should allow patient records to be transferred to a national database.

Trust IT executives and staff want specific, objective information about how most trusts are progressing with their local plans for implementing national systems.

Jean Roberts, lead for the policy task force of the British Computer Society's Health Informatics Committee, which represents many NHS IT specialists, said, "My personal feeling is that generic information is not what is now required. We want to know what is going on locally, when we are likely to see any benefits, and how we can help. Web-based progress reports would be most welcome."

A lack of openness has been a characteristic of several major public sector IT projects in which the benefits have failed to materialise, or have been delivered late and over budget. These projects include the £337m air traffic control system at Swanwick in Hampshire, which was five years late and cost more than double the original fixed-price contract; and the Libra contract to update magistrates courts' IT, which was supposed to cost £184m but for which the latest estimate is £390m.

Next month the prime minister Tony Blair is expected to give a speech which refers to the national programme. It is likely to be reassuring and perhaps even uplifting - along the lines of the information about the national programme that is published on the Department of Health's website.

Granger challenges claims of secrecy 

Richard Granger, head of IT in the NHS, insists that the national programme is being run in a spirit of openness.  At a conference last month he said, "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 was critical of some sections of the media, which was seen as an attack on publications that have reported bad as well as good news on the national programme.  He said, "[It is] very demoralising for staff to have one reality of a new system about to be rolled out, that they can see, and then to read something which suggests something else. People tend to quite concerned about that."

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