Evidence mounts for NPfIT review

It is often said that good results on IT-related projects and programmes rely on good communications. This helps to explain why the NHS's £12.7bn National Programme for IT (NPfIT) is such a good case study - an exemplar of how poor communications corresponds with poor results.

It is often said that good results on IT-related projects and programmes rely on good communications. This helps to explain why the NHS's £12.7bn National Programme for IT (NPfIT) is such a good case study - an exemplar of how poor communications corresponds with poor results.

The point is underlined by the details which have emerged this week on the confusing and, as it turns out, overly optimistic public and internal communications over the go-live of the Cerner R0 e-records system at Weston Area Health Trust.

The Care Records Service is the most important part of the NPfIT and Weston was the second trust in England to go live with the Cerner system, Nuffield Orthopaedic Centre being the first.

The idea of the Care Records Service is to give 50 million people in England an e-record that can be accessed wherever it is needed. Doctors support the idea even though some have lost faith in the ability of the Department of Health and NHS Connecting for Health to make it happen.

The Department of Health's public communications over Weston began in 2006, when it tried to use the trust for political advantage. This backfired. In a memo in 2006 to MPs of the Public Accounts Committee, who were sceptical about the claimed successes of the NPfIT, the Department of Health quoted Weston as being particularly satisfied with its installation of the Cerner system.

In fact Weston came to regard its Care Records Service as disruptive and "never going to deliver what the NHS needed", according to a paper this year to the trust's board of directors.

All trust boards need to report externally on how many patients they are treating, for what, and how quickly. Patient administration systems such as Cerner Millennium should provide this information, at least to ensure that trust boards are paid for treating people.

But in the 18 months since its go-live, Weston was never sufficiently certain of its management information from the system to know it would get paid. A deleted section of a draft report of Weston's Audit and Assurance Committee said in February 2008, "The fact remains that the trust is still not at a stage, despite 18 months of work, of having the certainty that we are able to communicate on activity [treating patients] and charge for all the work undertaken".

The Department of Health also miscommunicated when giving an assurance to the Public Accounts Committee that mistakes from an earlier go-live of the Cerner system at Nuffield Orthopaedic Centre would not be repeated.

Weston repeated some of the mistakes at Nuffield. Both Nuffield and Weston - and other trusts since - have had difficulties producing external statutory reports on their care and treatment of patients.

What has happened at Weston could answer the question so many in the NHS are asking: how is it that mistakes are unknowingly replicated every time a trust goes live with the Care Records Service?

The answer, from the facts at Weston, is that the board of a trust which is due to go live with Cerner is assured that problems at other trusts have been solved. But the team going live find out only too late that the problems are still there.

It is arguably time for the Department of Health to come clean about the NPfIT. Trust after trust has gone live with Cerner only to find that problems have not been fixed.

It is uncomfortable for Computer Weekly to criticise the NPfIT in this way. Many thousands of people are working on the programme, or have a stake in its wished-for success. They want it to work. So do doctors. Paper-based records that go missing can cause lives to be lost unnecessarily. E-records make unequivocal sense.

But the NPfIT is demonstrably not the best vehicle to deliver e-records. We say again, but now with more evidence in our possession, that there needs to be a thorough, independent published review of whether the NPfIT will meet the needs of NHS trusts.

Meanwhile, money continues to be poured into the programme - before anyone really knows whether the money is being well spent or wasted on archeologically excavating ground which has little or nothing worthwhile beneath the surface.

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