The public and private faces of the programme

The public and private faces of the national programme are in conflict - and the public face is winning. The side that perceives...

The public and private faces of the national programme are in conflict - and the public face is winning. The side that perceives an enormous gamble remains suppressed.

As one national newspaper put it, Richard Granger, the national programme for IT chief, "made clear that he would enforce the standard confidentiality rules governing procurement with such vigour that chief executives are terrified to discuss the programme in public".

"This has stopped suppliers trying to influence the procurement process by grandstanding about their wares. But it has stifled debate and made it hard for NHS staff and outsiders to assess its merits."

What public criticism of the national programme that does exist is dismissed by the Department of Health. Last year, after Computer Weekly published articles which included criticisms of the programme, the department replied by publishing ferocious criticisms of the magazine on a government website.

And when the department became aware that a senior health service employee had published a paper about the national programme on an official NHS website, it was suddenly withdrawn without her consent.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.

The department has an ability to make different critics appear as if they all belong to one category: Luddites. Those who publicly criticise facets of the programme are depicted as people who wish to see the whole programme fail.

But everyone in the NHS, even the programme's critics, supports its objectives. If it succeeds it could save lives: the new systems should reduce clinical mistakes by delivering accurate information quickly to doctors and nurses, at the point of care. It could mean no more missing and inaccurate health records.

The programme's critics take issue, however, with the apparent haste to sign huge contracts before new working practices are agreed with doctors, before there is certainty the programme can be afforded, and before anyone knows that the mass of clinicians will use the new systems.

Audit reports show that a project to introduce uniform systems in the Wessex health region ended disastrously in 1992 after contracts were signed in haste. Eventually money for the project ran out when end-users in district authorities, which had not participated adequately in the procurement, refused to continue to fund it.

Questions about what lessons from Wessex and other IT disasters should be applied to the national programme are not being aired in public by NHS professionals.

Despite their concerns, many IT specialists in the health service would prefer to ally themselves with the public face of the national programme: they feel inspired under Granger's leadership, recognise that the national programme is an opportunity that comes once in a lifetime, and will do their best to help it succeed.

They also, privately, share the reservations expressed by Bland: a fear of the programme's enormity and complexity, and not knowing whether it is a worthwhile risk or the world's biggest IT gamble. Some also worry that all the talk about the "NHS's vision" masks the fact that the programme may be too ambitious to work properly.

If the programme is a gamble, do taxpayers and patients support the idea of billions of pounds being risked on national IT systems that are imposed by the centre on a befuddled NHS? As with so many questions about the national programme, no one knows the answer.

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