What the doctor ordered

When the national programme for IT in the NHS (NPfIT) - now being renamed Connecting for Health - started, I had serious...

When the national programme for IT in the NHS (NPfIT) - now being renamed Connecting for Health - started, I had serious reservations about it. I still do. But it is pointless to bang on about them now. A lot of our money has been spent on it and vastly more is committed to what is the world's largest civil IT project.

NPfIT is well on its way. And the NHS needs this change: NPfIT's objectives are admirable. So the questions now are: do those objectives seem likely to be achieved and, if not, what must be done to improve the outlook? Unfortunately, no one outside (and not many within) the NHS can truly answer either. From the beginning, the project has been extraordinarily secretive. Too often, instead of fact, commentators have had to rely on rumour - a hopeless basis for judgement on such an important subject.

The curtain was raised recently when the National Audit Office (NAO) reported on Choose and Book, a part of NPfIT that will enable GPs and patients to book referral appointments electronically. The findings were not very encouraging, especially regarding the lack of support from GPs. There is inevitable concern that progress elsewhere might be equally disappointing.

Call for audit

So it is easy to understand the call for an independent audit, which is strongly advocated by Computer Weekly. But the present signs are that it is unlikely to happen. Although it is encouraging that the NAO will report on wider aspects of the project later this year and although NAO reports are most valuable, they are different from what might be produced by a major international consultancy.

So is continued uncertainty inevitable? Possibly not. I am quietly encouraged by two current developments. There is a prospect that doctors may at last be about to get involved in a project that affects them so intimately. They, more than anyone, understand what is needed and their detailed involvement in NPfIT is its best hope for proper scrutiny, constructive comment, process change and ultimate success.

That prospect arises from the appointment of six "national clinical leads", led by Alan Burns who, as director of service implementation, reports not to NPfIT management but outside NPfIT to the Department of Health. Their job is to engage clinicians and NHS management in planning and preparation for the implementation of NPfIT.

At a recent conference, the clinical leads made some interesting comments. For example, their aim was to "fully engage all healthcare practitioners"; they recognised that there had been "insufficient emphasis on change management"; and they were "not mouthpieces for NPfIT". If they are able to follow through on these, it must make a difference.

Practical concerns

Detailed feedback from individual doctors, in particular, would inevitably throw up practical concerns requiring attention. But, more than anything, doctors' engagement is essential if what seems to be a growing clinical disenchantment with NPfIT is to be reversed. The programme cannot succeed with unenthusiastic clinicians.

But it is an immense task for only six people with what appear to be limited resources. The engagement of all users, and the project changes that will result from that, are now the most important element of the programme. But they will cost money - probably a lot of money - and will take time - more time than is thought to be available.

The other reason for being quietly encouraged is that there will soon be a new government. Whoever it is cannot conceivably want NPfIT to fail. That government may therefore be more likely to consider the advantages of an independent audit. Also, unrestricted by immediate electoral issues, it may find it easier to face the consequences of the task given to the clinical leads, listen to clinicians and act to remedy their concerns. Whatever the consequences in cost and time, these are essential to the project's success and, therefore, to the viability of the NHS.

Robin Guenier is chairman of Medix UK, a business that uses the internet to provide services to the medical profession and the pharmaceutical industry. In 1996 he was chief executive of the Central Computing and Telecommunications Agency, reporting to the Cabinet Office, and was subsequently appointed executive director of Taskforce 2000 by the DTI

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