John Pattison was put under pressure to act quickly after he joined Tony Blair, Cabinet ministers, policy advisers and IT suppliers in a meeting at Downing Street on 18 February 2002. The meeting gave birth to what became the world's biggest civil IT programme.
Pattison was the Department of Health's headquarters director of research, analysis and information. After the meeting, he was asked to produce an implementation plan for what became the NHS National Programme for IT (NPfIT). He was also asked by the end of May 2002 to report on the programme's standards, specifications and governance proposals. Only a month later the NPfIT was formally announced.
Downing Street papers released to Computer Weekly last week, after a three-year campaign, show why it was such a rush. Blair had asked repeatedly for the programme's three-year timetable to be brought forward.
Opposition to disclosure
The importance of the papers can be judged from the Cabinet Office's efforts to keep them hidden. It opposed our request for the papers under the Freedom of Information Act partly because "disclosure of the information may disrupt the proper consideration of NHS IT projects in coming years" and "information as to the format of the meeting demonstrates the way in which the policy relating to NHS IT was developed and approached".
It is clear why the government had wanted the papers suppressed. They reveal that the policy-making discussion that spawned the UK government's biggest IT programme was informal and compressed. The record of the meeting was sparse: there were no minutes, only a later letter from one official to another which summarised comments by a few of the participants.
No independent appraisal
There was no formal proposal for the meeting. There was no independent appraisal of the idea of an IT-based modernisation of the NHS, only an enthusiastically-worded paper from the Department of Health.
It promised, in return for the right level of investment, that by 2004/05 patients would be able to access their online records and know that if they had an emergency away from home a summary of their health records would be available electronically.
It was taken for granted at the meeting that the NPfIT would go ahead, and nobody questioned whether it should, or whether it would work. Pattison later revealed that it was a "given that all appointments will be booked electronically by 2005".
Events have shown that the timetable was hopelessly optimistic. Today the NHS is only trialling summary care records. And though an increasing number - about 45% - of hospital bookings use the electronic Choose and Book system, most are still booked by phone.
Lack of investment
The then secretary of state for health, Alan Milburn, opened the meeting at Downing Street in 2002 by saying there had been an historic lack of investment in NHS IT: the health service spent between 1.5% and 2% of its budget on IT, compared with 6% in the US.
Blair said it was clear that a strong central approach was needed. Now was a time to make progress, he said, asking whether the programme could be accelerated. Taking the programme faster than currently planned would help underpin the reform agenda and provide visible evidence of NHS modernisation to patients and the public, he said.
Blair asked the Department of Health for a further paper on "progress and options for faster implementation".
Had the programme been brought forward to the weeks before the end of 2004/05 it could have brought visible and important benefits for patients shortly before the general election of May 2005. But as plans unravelled, officials extended the timetable for the programme from less than three years to more than 10 years.
Today there are no specified dates for completion of the National Programme for IT, which raises questions about whether it could continue in different forms indefinitely.
The National Audit Office is due to publish a report in the next two months on whether the programme has been value for money. Computer Weekly has learned that by April 2008 about £4bn of central funds will have been spent, which excludes local funding.