Thought for the day: A complex operation for the NHS spine

The £2.3bn NHS National IT programme is an extremely ambitious project, and government should not be allowed to rush it, says...


The £2.3bn NHS National IT programme is an extremely ambitious project, and government should not be allowed to rush it, says Maldwyn Palmer.



The general release of the 600-plus pages of the NHS IT specification will alert interested parties in what a complex and ambitious project is being envisaged.

The OBS (output basic specification) for the national spine and ICRS (Integrated Care Record Systems) will, if nothing else, provide us with a wealth of acronyms for the near future. Scope and design of the plan is very far reaching and transcends the normal bidding procedure.

Readers of the document soon become aware that the how demanding the implementation of both the spine and local support will be to effect.

Innovation and future technology are mentioned as necessary to fulfil almost impossible criteria that will be the UK’s equivalent of sending a man to the moon. The sheer coverage of dealing with every citizen’s interaction with the NHS and allied departments is awesome and, to many ,an impossibility. The "can do" spirit is definitely going to be called into place to make this enterprise see the light of day.

Patient-centric is the jargon, but maybe clinician-centric would be more accurate to decribe the approach that's needed. Without the people on the front line being on board then the plan could wither on the vine.

There is also mention of acceptance of existing systems but who accepts them and who controls them will be another moot point. The present systems are in stasis while their developers and customers wait to see what the local providers will decide about their future. It is not unfair to say that the providers would prefer to replace them or, at the worst, buy them out so eventually they would all disappear.

The needs of the infrastructure, such as storage and communication hardware, are also worrying as is transaction crunching. "Deep thought" supercomputers will be needed at the spine to give response times that are acceptable. The designers of the Google search engine should be expecting a call soon, and IBM and others will be glad it stayed in the mainframe business.

The government has always been slow to recognise how quickly a resource can be overloaded and, although the spine will start off "thin" it will soon put on some weight. What data should be included and what should be deleted is a dilemma in itself.

Everybody wishes the project well but the extremely ambitious range of the initiative without any smaller trials or prototyping is worrying. It is almost as if the government was in a big rush to get the thing moving before someone changes their mind.

The sum of £2.3bn may seem large, but history reminds us that this could soon be £20bn or £30bn at the end of the day. Let us hope it does not become a black hole that some future government will be forced to pull the plug on and leave the whole industry in limbo.

If this project is a success and, if it modernises and increases the efficiency of the NHS, it will be the model for all future proposals. It will set the standard across the world and will be the envy of all.

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Maldwyn Palmer
was one of the first people to use the C programming language in the UK. He wrote the original mobile phone texting software for Orange and ran his own consultancy during the dotcom boom. He now writes technical articles and humorous books.

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