Don't let suppliers and civil servants grab NHS windfall

Gordon Brown's budget announcement of a 1% rise in National Insurance contributions to pay for improvements in the NHS has been...

Gordon Brown's budget announcement of a 1% rise in National Insurance contributions to pay for improvements in the NHS has been largely well received. Who in their right mind would argue against better hospitals and healthcare?

A substantial proportion of the NHS windfall will be allocated to IT. The Wanless Report, which informed the chancellor's thinking, recommended a doubling of IT spend in the NHS, and demanded that "stringent standards should be set from the centre to ensure that systems across the UK are fully compatible with each other".

But any intimation of centralised, integrated NHS projects must ring alarm bells. The public sector's record on IT project delivery is unimpressive. Why should we believe things would be any different this time?

When it comes to IT project management, it is a truth universally acknowledged that big is bad, and small is beautiful. With more than one million employees, the NHS is certainly big; meaning the prognosis for any centralised overarching IT project is likely to be bad.

The NHS should already know this from past experience. In the early 1980s Wessex Regional Health Authority had a vision for an integrated information system covering the entire Wessex Health Authority region. The ensuing IT disaster proved how difficult it is to impose integrated IT systems across a region, let alone nationwide.

If the change management process that must underpin any major IT project is mishandled, the NHS could find it has succeeded only in upping IT overheads and haemorrhaging even more money into the black hole of bureaucracy.

Moreover, the best, most imaginative and effective NHS IT projects have so far emerged at grass-roots level. Will these be allowed to continue? Or will they be forcibly canned for the "greater good" of centralisation?

Who will steer the spending of this massive cash injection? In an ideal world, any fresh project would spring from consultation with the GPs, pathologists and nurses who will use it and so will know what they want from it.

But the fear must be that it is the suppliers who stand to gain from huge, top-down project roll-outs that will set the agenda - and that the mandarins at the Department of Health will see in integrated systems a means of perpetuating their bureaucratic fiefdom.

If suppliers and civil servants stand to gain from centralised NHS projects, who might be the potential losers? Blair and Brown, certainly, as they now have to deliver results to justify increased levels of taxation. But it is us, the public, who stand to be the real losers, for an NHS IT debacle could leave us out of pocket and without a properly functioning health service.

Rather than looking to the suppliers to dictate future IT policy, the NHS might do better to identify its trailblazing IT managers and its most cutting-edge hospitals and use some of its windfall to enable them to disseminate their expertise around the country's regional health trusts.

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