Changing behaviour will be harder to achieve than IT implementation.
The joint head of the world's largest civil IT-led scheme says that changing human behaviour and culture in the NHS outstrip technological matters as the biggest challenge now facing the £2.3bn project.
Aidan Halligan, joint senior responsible owner of the national programme for IT in the NHS, made his frank comments to Computer Weekly as the Department of Health prepares to go live this summer with the initiative's first national systems.
His remarks, coming less than two months after his appointment was announced, mark a significant shift in emphasis. Major statements on the programme in the past focused on the initiative's potential benefits, successes in meeting project milestones and achievements in putting in place outsourcing deals.
But Halligan, a practising clinician and deputy medical officer at the department, says the success of the programme will depend on much more than IT.
"The biggest challenge is a fundamental understanding that successful implementation depends on far more than automation and attention to hardware, software and networks," he said.
"The most significant obstacle in similar projects has been the lack of attention to the human element of changing behaviour. The obstacles are not technological or resource but cultural."
His warning is consistent with statements from, among others, the Health Informatics Committee of the British Computer Society, many of whose members work in the NHS. The committee pointed out in this year and last that changing working practices of thousands of nurses and doctors to exploit new systems may be a bigger task than introducing new technology.
Last week Glyn Hayes, BCS Health Informatics Committee chairman, said, "We are delighted that real issues are being recognised, always the biggest part of surmounting a problem. We would go further and stress the need for all clinical, technological and other health professionals to be 'on side' - involved, motivated and competent to make the implementation deliver."
Halligan said the timescales set by the programme were "tight". "Our first simple goal must be to identify and develop the local transition leadership team."
Openness amidst ongoing secrecy
Halligan's frank and open approach contrasts with continuing secrecy in parts of the national programme. For example, executives have refused to publish some technical and project details on the national care records service, although these were set out in complex slides presented at the Healthcare Computing conference last month. A programme spokesperson said, "We have not published our slides as these are being regularly updated as [the national programme for IT] moves towards implementation. Instead, we have published the NPfIT brochure and newsletter, which contain all the relevant information."