NHS plan could face escalating costs and staff resistance to new systems, says BCS

BCS publications support the national programme but warn targets may be missed

The government's £2.3bn IT-led modernisation of the NHS may run into serious cash problems or fail to meet expectations.

This warning comes from healthcare IT specialists who want the modernisation to succeed, but have concerns about its "escalating" costs and whether tens of thousands of doctors and nurses will change their ways of working to take advantage of new systems.

The risks are contained in a book, Information in Healthcare, and in a position statement dated March 2004, both of which were published by the Health Informatics Committee of the British Computer Society.

The society strongly supports the principles that underpin the modernisation plan, the national programme for IT in the NHS. It says that patients, NHS managers and clinicians need access to accurate and relevant information at the point of care, but also highlights the continuing confusion about what is covered in contracts with new local service providers.

"The total cost of local ownership of solutions has yet to be worked up, including management of change, capacity increases and capability enhancements. The total cost appears to be rising rapidly over and above previous perceptions, especially in the field," the BCS said.

Many questions about the ownership of electronic health records, their management and the protection of data have yet to be answered, said the statement. It added that tight deadlines and constraining influences "should not be allowed to govern free expression of personal reflections and good ideas".

Information in Healthcare was published at the start of the Healthcare Computing conference in Harrogate last month. It was written by four leading healthcare IT specialists, one of whom, Bud Abbott, was a founding father of NHS computing.

It said that the national programme for IT in the NHS will result in the successful technical implementation of infrastructure projects. But it added a warning about the NHS care record service, a key part of the initiative that should lead to everyone in England having access to their own electronic health record.

"The NHS care record service has grown from the electronic patient record, electronic health record and emergency health record concepts and, in its proposed form, would appear difficult to justify. The necessary difference in the working practices of different types of organisation does not appear to have been taken into account. However, it is the only realistic option for the envisaged change and must be given every opportunity to succeed," the book stated.

The authors said the biggest challenge will be to create and sustain the necessary changes in organisations and working practices.

"The level of complexity, the barriers to overcome and the means to achieve change are not agreed and are generally under-estimated," the book stated.

They added in conclusion, "The past suggests that targets will be missed and high profile failures will be reported. Failure will be met with surprise, although the seeds are there for all to see, the guilty will be doing something else and the innocent will take the blame. There will be successes and progress will have been made, albeit less than is possible or desirable. The lessons, techniques and experience to succeed exist, but are being disregarded by some key decision makers".

The national programme would not comment on the BCS book and statements when asked by Computer Weekly, but it issued a briefing paper at the Harrogate conference that took on the question of whether the national projects are too big and too complex to work effectively.

"The national programme is an IT platform that will ensure that all systems within the NHS can work together. It is not one enormous IT system. National applications including the NHS care records service and the electronic booking service will be delivered locally," it said.

The briefing paper also said the national programme would fund the cost of training material for those teaching users of the new systems.

NHS plan is all about leadership       

Aidan Halligan, joint senior responsible owner of the national programme, has made an indirect comparison between the leadership skills of Richard Granger, director general of NHS IT, and Ernest Shackleton, leader of an attempted trans-Antarctic expedition in 1914.  

Halligan said commitment and top-notch leadership were important to the success of the national programme.  

"I believe more and more that it is all about leadership," Halligan told the Healthcare Computing conference 2004 at Harrogate. "You look at Richard [Granger] and his particular style. You look at Shackleton. He led 27 men for two years and achieved none of his targets and almost killed them all. 

"Yet he is the basis of every MBA at Harvard Business Review that I have seen for the past five years. The most extraordinarily powerful advert in human resources terms was this one by him. 

"'Men wanted for hazardous journey. Small wages, bitter cold, long months in complete darkness, constant danger, safe return doubtful, honour and recognition in the event of success.' I think that is the reason we joined the NHS."

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