HC2008: learning lessons from the National Programme for IT

Matthew Swindells, the health service's departing chief information officer, cracked a joke that went down well at the HC2008 annual healthcare IT conference at Harrogate last week.

Matthew Swindells, the health service's departing chief information officer, cracked a joke that went down well at the HC2008 annual healthcare IT conference at Harrogate this week.

He said that in 1989, as IT purchasing manager for a health authority in the Thames region, he had bought a "Casemix" system for Eastbourne Hospital - and this year the supplier is due to deliver the finished product.

Many in the audience laughed or smiled because they knew he was only half-joking. IT-related progress in the NHS moves so slowly that the eye can barely perceive it. The National Programme for IT [NPfIT] in the NHS was supposed to change that.

Ministers wanted action, and quickly. Cynics would say that what ministers wanted quickly was their comments in innumerable media articles and broadcasts on how New Labour was using IT to modernise the NHS.

As one executive working for the NHS and the Department of Health put it, "Everything had to done at a speed of 100mph -it did not seem so important where we were headed".

Officially, the Department of Health was saying that 21st Century IT - the document which launched the NPfIT in 2002 - had to be implemented as "rapidly as practicably possible".

In record time, Whitehall officials awarded £6.2bn worth of contracts to suppliers Accenture, Fujitsu, CSC, BT and Atos Origin to deliver a small number of standardised systems. The catchphrase of the NPfIT became "ruthless standardisation".

Swindells last week described the euphoria that greeted the announcement of the national programme. "You will remember the fit of excitement at being able to drive things from Whitehall, the world's largest train set."

Now, six years on from the announcement of a national programme, some NHS staff and those working for the suppliers say significant IT-related change has become slow and tentative, and at some trusts has all but stopped. They depict the NPfIT as a behemoth that nobody knows what to do with.

In some ways things are worse than they were before the NPfIT. Hospitals were able to buy what they needed. Several trusts were combining for consolidated purchases of electronic record systems, which could have been mature products today - had they been allowed to go ahead. They were cancelled because of the NPfIT.

Computer Weekly has recently reported on some of the trusts that have put major IT plans on hold. Trusts receive money from Whitehall for buying patient administration and other core systems under the national programme. But if those systems do not arrive - and patient record systems are running three years late - what are trusts to do? If they bypass the NPfIT, and some of them are doing just that, they have to fund major IT systems with hospital money and risk becoming outsiders to the national programme.

Regular surveys by online researcher Medix have shown that doctors have wanted the NPfIT from the start. The signs are they still want it. IT executives in the NHS also want the programme. But around the conference at Harrogate - a conference organised by the British Computer Society - the feeling was that the NPfIT is not working and may never work.

Swindells put it well in his speech, which opened the HC2008 conference. He said that NHS Connecting for Health, which runs part of the NPfIT, has been asked to "find the problems in what they were doing and start to diagnose solutions". At 10 separate events 1,000 NHS staff gave their views.

Swindells said, "The message that came back from those 1,000 staff was loud and clear: absolute support for the vision. There was no sense out there that people said: 'I wish we were not doing this, give us the money back and we will do something different.'"

But, Swindells said, "There was considerable concern about whether we were going to make it work and a real fear that they had not got the training and the skills to take advantage of it when it came into their organisations. We have taken that away."

Some in the NHS argue that there should be no national programme in the sense of centrally controlled IT that is imposed on trusts. That goes too for a national programme in a guise of a local one - the so-called National-Local Programme for IT.

There should instead be a choice for trusts of IT systems that should ideally, but not over ridingly, meet technical standards that are set nationally.

Some independently minded NHS executives have long thought that the NPfIT should cease to be an amorphous programme under which integrated systems throughout the country deliver all that IT should and could.

Better, they say, to have reliable electronic patient records within local boundaries to replace paper records that frequently are lost than a grand, risky, controversial scheme for national records that exists only in ministerial statements of intent.

Yet ministers continue to hope that two main products - Cerner's Millennium system and IBA Health's "Lorenzo" in the North will give the NHS much of what it needs. But some see this strategy as a single circular railway around England that drops people off a long way from where they want to be.

How did the NHS end up like this, in such a mess? Some Whitehall officials see this as a pointless question. They want to decide where to go now. But others say it is important to learn from history to avoid making the same mistakes again.

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