Will politics hamper objectivity reviews of NHS IT?

Health minister Lord Darzi opens his interim ­review of the NHS - a report that is likely to have significant ramifications for the NHS's IT investment programme - by saying he is a doctor, not a politician.

Health minister Lord Darzi opens his interim ­review of the NHS - a report that is likely to have significant ramifications for the NHS's IT investment programme - by saying he is a doctor, not a politician.

But in his comments about the National Programme for IT (NPfIT) in the NHS, Darzi knows he needs to be the quintessential politician. He is a consultant in the field of robot-­assisted, minimally invasive surgery, and when mentioning the NPfIT in his interim report he manoeuvres delicately over the thin skins of ministers and officials who do not want to read any criticism of the scheme.

In highlighting the success of the Picture Archiving and Communications System (Pacs) in his report, Darzi's praise was in line with the marketing strategy of NHS Connecting for Health, which runs part of the NPfIT.

A confidential briefing paper by Connecting for Health to the prime minister on the progress of the NPfIT said in February 2007 that there was a plan to launch a "proactive campaign", based upon the success of Pacs.

Success story

It is true that Pacs is the big success of the NPfIT. It replaces costly x-ray film, which is easily lost, with stored digital images that can be interpreted by doctors on or off site. It is a highly successful medical technology that may result in patients needing fewer x-rays.

But Pacs was not part of the original core objectives of the NPfIT, which were to supply a national electronic patient record, electronic prescriptions, electronic booking of hospital appointments, and a national broadband infrastructure.

Pacs was parachuted into the programme in 2004. In a letter to senior responsible owners and regional implementation directors of the NPfIT on 15 September 2004, Margaret Edwards, director of access at the Department of Health, said, "I am writing to confirm the decision of the National Programme board to make Pacs a core service within the National Programme for IT

"The decision to make this a core service means that, with immediate effect, trusts should not therefore enter into, or continue with their own procurements for Pacs, but plan for deployment of the system as contracted for their cluster via the National Programme. I would be grateful if this could be communicated to strategic health authorities and trust chief executives as a matter of urgency, as we are aware that a number of trusts are currently involved in negotiations."

To the tactful Darzi, in his interim report the success of Pacs and the NPfIT were analogous. He also praised the linking of hospitals and GPs to a common secure network - the N3 broadband infrastructure supplied by BT. Local upgrades of the N3 broadband capacity can be expensive, and on its own the network brings few clinical benefits, but the bandwidth is an important advance on what the NHS had before, so it is a success of the NPfIT.

Clinical benefits

Darzi's report said, "The national infrastructure established by the NPfIT has connected every hospital and GP surgery to a common secure network. Clinicians should benefit from the implementation of digital access to x-rays and scans - Pacs. But I believe more work is now needed to ensure that the Connecting for Health programme delivers real clinical benefits, and I will be considering in the second stage of my review how best to achieve this."

It is welcome news. But IT directors in the NHS are entitled to ask why it is only after five years - the NPfIT was launched in 2002 - and after more than £2bn has been spent centrally on the scheme, that a professor is undertaking a review to ensure that the national programme delivers clinical benefits.

Separately, the Department of Health has ordered an internal review of the NPfIT to establish "will this work?" There is no indication that it will be published.

It is difficult to avoid the conclusion that these are political compromises, half-done replacements for a high-level published review of the NPfIT.

This is, of course, a £12bn scheme, the world's largest civil IT-based change programme. Those funding it, those whom it should benefit, those working on it, and those who should be working with it, deserve more than the passing reference to a review of clinical benefits on page 50 of Darzi's 54-page report.

One reason for the absence of an unrestricted, independent published review is that the NPfIT has become politicised. It has become a test of the ability of government to manage mega-projects.

This could explain why ministers and some Whitehall officials want NPfIT's realities locked in a dark room. They fear the full facts emerging into the sunlight and being judged harshly by a cruel world.

So the NHS and those funding it are denied the truth, the programme limps along without clearly understood and realistic objectives, and the government claims all is well.

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