You take a new top IT job. But as you settle in you find a cacophony of unco-ordinated, unstandardised projects with no overall business case. The task that has been set is seriously underfunded with no prospect of more cash. You have responsibility for several high-profile projects, but you do not have the authority you expected.
And all this in an area riddled with fiefdoms, conflicting agendas and reluctant end-users.
What do you do? Play along with existing short-term targets, cherry-pick quick wins, and tidy up the most blatant efficiencies, especially in procurement? You could seek advice from top consultancies, especially those your boss rates, and build yet another IT strategy.
This is the sort of mission impossible faced by 37-year-old Richard Granger, the NHS IT tsar. His job is to join up the NHS electronically, by building centralised national systems for patient records; appointments booking; prescription transfers; and communications infrastructure.
He is cash-starved, getting £1.2bn less over the next two years than the government's Wanless report proved is needed.
And there are at least two other government spanners in the works. The deregulation of pharmacies spells the end for many community pharmacies, and the creation of foundation hospitals has encouraged some large hospitals to go their own way on e-records. To cap that, many doctors and many more hospital consultants do not use e-records, and Granger's brief does not cover many critical secondary healthcare areas.
Insiders suggest that Granger's solution is a two-year plan to work with an army of consultants and through his new standards-building National Design Authority, to sort out what really needs to be done. The end-result will be yet another NHS Information Strategy for 2005-2011.
So how far are we marking time right now? Will the NHS get the deliveries it expects? Will we see yet another fresh start for NHS IT in 2005?
What do you think?
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