Is NHS CIO the answer to a failing NPfIT?

NHS CIO Christine Connelly announced the departure of the man who is running the £12.7bn NHS National Programme for IT (NPfIT) in an e-mail last week.

NHS CIO Christine Connelly announced the departure of the man who is running the £12.7bn NHS National Programme for IT (NPfIT) in an e-mail last week.

Martin Bellamy has been head of NHS Connecting for Health, on a salary of at least £200,000 for less than a year.

He is joining the Cabinet Office to manage the government's cloud computing strategy.

Connelly recognises in her e-mail that news of Bellamy's departure - from a project which represents the government's largest IT investment - "probably fuels" uncertainty.

But that is nothing new.

Last week the Department of Health published 31 Gateway Reviews on the NPfIT.

They show that the programme was not only uncertain, but unfeasible from its launch in early 2002. While ministers were publicly praising early progress on the NHS IT programme, independent Gateway assessments of the scheme were raising doubts about the integrity of its design and foundations.

It was - and is - a problem with many large and risky IT projects and programmes in government. Once they have left Downing Street's launch pad, there is no way of stopping them. Money is committed, contracts are signed, and everyone involved has to try to make it work.

Flawed from the outset

In 2002 nobody who valued their career could have gone back to the then prime minister Tony Blair to say: "This NHS IT modernisation is a good idea but perhaps we are not going about it in the right way."

The Gateway reviews at that time show that the political priority was to appoint about five service providers as quickly as possible, rather than designing a system for patients. "We were told categorically that the OBC [outline business case] was specifically to gain approval for the procurement of the prime service providers," one review noted.

And nobody really knew what they were doing. The first Gateway review of the programme as a whole said in June 2002: "The people on the programme display a 'head office' mindset, with 'great thoughts' being developed at the centre and then disseminated. A successful programme does not work like this."

It warned that only staff with frontline experience could ensure that an application would actually work. But many of the 31 Gateway reviews, from 2002 to 2007, said the programme lacked engagement from staff. It is a criticism that sticks today.


But things are starting to improve. The original plans of the NPfIT - for a small number of nationally-integrated systems - have disintegrated. The government spent £4bn for little in return. Some hospitals that have pioneering NPfIT systems have lost track of patients and left thousands of them without timely treatment.

So tainted is the NPfIT brand that officials at the Department of Health now want to change the name of NHS Connecting for Health. CfH is seen as too closely associated with the NHS IT programme. A consultation on the future of CfH is underway.

The good news is that trusts are to be offered a choice of centrally-funded systems, starting with trusts in the south of England. They will be able to buy existing UK systems or the Cerner Millennium system directly from Cerner, not through a local service provider.

Choice may be extended to London and the rest of England too, if the CSC Lorenzo software fails.

Connelly seems to be asserting herself, listening, and taking a pragmatic view. She is still protective of the NPfIT, but perhaps not overly so. Her e-mail to staff about Bellamy does not mention the national programme. "Let's not forget the real appetite out in the NHS for quality informatics," she says.

Inside the NHS, executives want Connelly and her team to choose for the NHS only systems that are proven in the UK. That will make a change from calamitous installations of IT that has been successful in the US but has not been shown to work in the UK without years of customisation.

The NPfIT may be dead or dying. But at least Connelly is beginning to build some respect within the NHS for her informatics plans. She says in her e-mail, "The ultimate outcome - creating the best electronic healthcare systems and services in the world to help save lives and improve the quality of care - is an ambition we can all aspire to and share."

That is a message NHS IT professionals have heard many times before from head office. Perhaps Connelly can make it happen this time.

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