Confidence wanes as timetables for NHS service and IT reform diverge

NHS IT: A user's perspective on implementing the £12.4bn National Programme for IT

In July and August, my NHS region was putting together a communications plan on the NHS's technology programme.

Under the plan, every NHS trust had to inform every member of staff about the National Programme for IT (NPfIT) and the huge benefits that were just around the corner.

While we scratched our heads about how we could approach this task, we witnessed one PR calamity after another.

First, the CSC datacentre failed and every NPfIT system in the region was down for three days or more. Soon after this we read about the meltdown of NPfIT supplier iSoft on the front page of The Guardian.

Given this, we have been left wondering quite how to sell the benefits of Connecting for Health - the agency that runs the NPfIT - to our staff. And we are also struggling to understand how the NPfIT can deliver our IT ­strategy aims.

A major worry is the mismatch between Connecting for Health's delivery timetable and the timetable for NHS service reforms.

The latest roadmap informs us that the integrated clinical IT systems desperately needed to implement these reforms will not be delivered until 2009 or later.

The goal of enabling patients to wait no longer than 18 weeks from GP referral to hospital treatment is one of the most significant reforms in the history of the NHS.

But IT systems are needed to track every patient that has been referred for treatment, and to know how long they have been waiting. For the time being, trusts have been told they have to develop their own interim solutions.

Under NHS financial reforms, hospitals are to be paid for activity undertaken, rather than being paid under block commissioning agreements, which was the prior arrangement.

But the time needed to effect improvements in information services and IT to support this has been underestimated. Once again, trusts have been left with no alternative but to develop interim solutions.

So, over three years on from the inception of the NPfIT, what is its status?

The delivery schedule for the NHS Care Records Service (CRS) has slipped alarming. Realistically, the core components of the CRS - integrated care pathways and electronic prescribing - will not be available until 2010 at the earliest.

NHS trusts are losing confidence in the delivery roadmap and are beginning to procure alternative solutions outside the Connecting for Health umbrella.

NHS trusts that have implemented Connecting for Health systems are struggling to cope with poor system performance and service availability issues.

The NPfIT local service provider is working flat out to resolve these issues. However, a great deal of damage has been done in terms of deteriorating user confidence and satisfaction with Connecting for Health systems.

The CSC datacentre outage was downplayed by Connecting for Health as disappointing but not serious in its impact on patient care. What cannot be underestimated from this, however, is the impact this may have on future roll-out plans for the CRS.

NHS trusts will not implement electronic prescribing unless very high levels of service availability can be guaranteed. Connecting for Health may now have to insist that trusts produce contingency plans for unplanned downtime in excess of 12 hours.

Unless a maximum of two hours of unplanned downtime can be guaranteed, I envisage many NHS trusts opting out of the NPfIT.

Finally, the deteriorating financial positions in many NHS trusts may end up having a significant impact on NPfIT implementation plans. Connecting for Health is funding the purchase and development of IT systems.

However, NHS trusts are responsible for implementation, and they are already reporting large affordability gaps in their NPfIT project plans.

The author of this article, who requested to remain anonymous, works as an IT director in the NHS

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