The government's Connecting for Health agency has launched a publicity campaign for IT modernisation of the NHS, but major questions remain unanswered
Connecting for Health, an agency of the Department of Health, last week launched an England-wide marketing campaign to spread the word about some of the key benefits of the National Programme for IT.
DVDs, videos, 1.3 million booklets and A3-sized posters will market the benefits to health service staff of the NHS Care Records Service, a scheme to give 50 million patients an electronic health record that can be accessed by any authorised NHS employee across the country.
The entire campaign will be branded and have a consistent visual identity, but it cannot hide the patchy progress being made thus far by the NPfIT.
A study released earlier this month by the British Computer Society's Health Informatics Forum - and reported on in last week's Computer Weekly - shows that support remains strong for the aims of the NPfIT.
It also indicates that NHS IT specialists and IT-literate clinicians still have a generally favourable view of the NPfIT.
In part, this is because work is being done by NHS staff across England to improve the quality of information held on patients and to replace outdated equipment. The programme is also regularly discussed at meetings of trust boards of directors.
But the draft consultation paper issued by the BCS, although setting out the benefits of the NPfIT, may also fuel concerns about whether the programme will be a long-term success.
One of the big unanswered questions is whether patients will benefit sufficiently from the new systems to justify the final cost, which has been put at anywhere between £6.2bn and £31bn.
Mark Britnell, chief executive of University Hospital Birmingham Foundation Trust, has asked, "Is the IT programme there to change the NHS or just to provide an IT infrastructure for the health service to use as it sees fit?"
The draft consultation paper issued by the British Computer Society's Health Informatics Forum, on which comments are invited from anyone before the final position paper is prepared, was written in part to provide constructive criticism on the NPfIT. The main points raised in the paper are as follows:
The importance of good communications
"It is recognised that communication is getting better, but its effect is patchy and perceived as one-way, not a dialogue or genuine debate. The requirement is for the talking to be catalytic to engagement, not just empty consultation. The ethos encouraged by government in general is much more open than that practised currently by Connecting for Health."
The dangers of misinformation
"It is recognised that some material should remain confidential and on a need to know basis, but the current climate of secrecy is excessive. Subsequent misinformation and speculation fills the vacuum and remains a serious risk to the success of the programme."
The need for full information
"Even in the early adopters [NHS sites which are among the first to go live] who are eager to move forward, they are constrained in their organisational development and business change by not knowing the detailed functionality being written now."
"There is still little evidence that Connecting for Health is listening to constructive operational criticism."
Systems that reflect clinicial need
"Clinicians see that informatics will improve healthcare but have yet to be convinced the products under development will reflect their requirements and realise operational benefits. Experiences to date with the emerging Patient Administration Systems and Choose and Book support this concern."
"It is felt that there is a medium-term funding gap estimated at over £10bn that needs to be covered locallyÉ Money could come from efficiencies created by Connecting for Health, but this means that trusts have to speculate to accumulate, and that may cause tension in fundamental operating priorities."
Managing change, not just installing new IT
"Healthcare practitioners not directly involved in Connecting for Health are not aware of how it will affect their ways of working, and few plans are apparent of how they will be engaged.
"All NHS staff will welcome being informed clearly about what is being delivered and when, and what associated tasks are planned.
"Health staff at local levels across the domain can become ambassadors among the general public if they understand more about the programme, its achievements and its objectives."
"Questions are being raised as to whether Connecting for Health is looking outward to harness impending environmental change or implementing yesterday's systems tomorrow. Local Service Providers are known for focusing on rewrites to their existing software, so the time available to participate in innovation will be severely limited."
Connecting for Health has so far declined to comment on the BCS paper.
A spokesman said: "We have still not formally been provided with this paper. However, we will give this due consideration once we have formally received it. We understand it makes some positive comments about NHS Connecting for Health and also suggests ways in which we could improve our engagement with stakeholders."
NHS National Programme for IT: the pain and the gain
In July, Esssex Strategic Health Authority reported that its areahad achieved "one of the largest National Programme for IT deployments to date, encompassing 300,000 records and the firstNPfIT Child Health implementation in the NHS."
It said a briefing has been supplied to ministers, noting the names of Essex and Local ServiceProvider managers who have "worked hard to bring this systemon line."
North East London Strategic Health Authority reported on 20 September that the supplier of a Child Health system, which records information relating to child protection and inoculations, gave notice that operational support was being withdrawn in March, later extended to June. London's Local Service Provider, the BT-led Capital Care Alliance consortium, agreed to provide an interim system, but the authority says there have been problems: "This application has been deployed across all the Primary Care Trusts and a number of initial operational difficulties are being resolved.
"The front-line child-health teams have found it difficult to resource the increased workload of sustaining their operational activity, supporting the development and assurance of the new platform and managing the migration of records. Poor initial system performance and printing difficulties have exacerbated this challenge, but these are being addressed by CCA service teams."