Climate of fear in the NHS

NHS IT: Users and suppliers are afraid to speak out against the Department of Health. Tony Collins reports.

NHS IT: Users and suppliers are afraid to speak out against the Department of Health. Tony Collins reports.

Suppliers have joined users in speaking confidentially about the climate of fear in the NHS which stops them openly criticising the way officials plan to implement a £2.3bn national IT programme.

Companies spoke to Computer Weekly only with a promise of anonymity after Richard Granger, head of IT in the NHS, told suppliers at a conference that publicly questioning the national IT programme could result in them being cast into the abyss. Suppliers could also forget about any shortlist they are on or could be excluded from doing business with the NHS for 10 years, he said.

Suppliers are taking the threat seriously and, since Granger made his comments at a meeting of health service suppliers in London on 3 December 2002, users say they also believe that their careers will suffer if they criticise the national IT programme.

There is widespread support within the NHS for the government's plans to spend an extra £2.3bn on improving IT systems in the health service, but some suppliers and many users have profound concerns about the way the cash is being spent.

Criticisms include a rush to meet artificially-tight deadlines and an absence of evidence that hospital clinicians and local IT specialists will be committed to using systems that are imposed nationally or regionally.

A further criticism of the current strategy is that Granger may commission, and have a success in getting suppliers to deliver on, contracts but that may not be enough to improve substantially the care and treatment of patients. This is because two of the national systems, for patient records and the booking of appointments to be managed electronically, may go largely unused by the health professionals who would be the end-users.

One IT director at a trust in the North of England said, "I have a problem getting clinicians to use [electronic patient records] systems they were involved in buying. Some of our consultants even question the value of electronic health records. How will we get them to adopt systems they weren't involved in at all?" He asked for anonymity saying he "values his job".

His concern was underlined by some suppliers who said the Department of Health has published no detailed proposals on how it plans to introduce, alongside the new systems, organisational, cultural and technical changes in hospitals and GP surgeries. Without these changes, they say that systems will be installed for little or no useful purpose.

However, representatives from larger health service suppliers sympathised with Granger's threat to companies.

"He intended to make a point that he wants any criticisms to be made directly to him so that he can fix problems without being under the glare of publicity," said one delegate at the suppliers' conference last December.

In theory, suppliers who speak out cannot be removed from a shortlist for this reason alone.

European procurement law specialist Tim Williams, managing director of Aberdeen-based Tenders Direct, an e-tendering service, said EC competition directives contain rules which should ensure that no individual civil servant can shun a particular company for reasons unrelated to the specific deal.

But he said that in practice the Treasury is allowing the Department of Health to sign vague framework contracts - currently a grey area in European law - which allow specific contracts to be awarded without the process being in any way transparent.

"It is perfectly possible in practice for a supplier not to get a contract because its face doesn't fit," said Williams. "Things are not supposed to happen that way, but framework arrangements allow specific contracts to be awarded without any transparency."

Long-term framework deals cover most of the types of goods and services sold to the NHS.

A Department of Health spokeswoman said that Granger had no intention of blacklisting suppliers. The department did not deny Granger made the threat at the suppliers' meeting.

In a later statement, Granger said, "This procurement is going to be a five- to seven-year process and we need to select suppliers who can perform.

"This aspect of delivery and performance should be taken seriously and I was stressing the consequences of poor performance and failure to participate as a full partner."


What are framework contracts?   

Normally an IT tender issued by central government for goods or services that are more than £100,000, or £154,000 for local authorities, must be advertised in detail so that overseas companies can compete. The UK Treasury, however, has exploited a grey area of European law to make widespread use, particularly in the NHS, of framework contracts.  

Under these, a central government organisation can aggregate all its computer-related purchases into a single tender. All it has to do is list any number of suppliers, all conceivable goods and services, and estimate its total IT spend over many years.  

Once a framework deal has been set up, specific contracts can be awarded to any supplier on the list, without an advertisement. Theoretically central and local government could advertise a single vague framework contract that named every supplier in the IT industry, listed billions of pounds as the total spend and covered all types of goods and services. There would then be no need to advertise any specific contract, nor a requirement to award any contract.  

The Treasury defends framework deals saying they cut the time, costs and bureaucracy of buying systems. But Tim Williams, managing director of Tenders Direct, an e-tendering service, said, "There is little or no transparency on the way contracts are awarded once a framework arrangement is in place."

NHS IT programme   

The programme consists of four projects:  

  • A new infrastructure 
  • Electronic handling of prescriptions 
  • Electronic booking of hospital and other appointments 
  • The creation of electronic patient records.

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