Report exposes stark reality of NHS IT

Alan Shackman, an expert in NHS IT and contributor to the Public Accounts Committee report on the National Programme, gives his take on the way forward for the scheme

The Public Accounts Committee has done us a service by directing attention to the poor progress being made on the central plank of the NHS's National Programme for IT.

It has reminded us that most of the benefits of the scheme will be obtained by creating detailed electronic care records at the local level, and that it is the local Care Records Service which, together with central overheads, accounts for 82% of the NPfIT's total expenditure.

To their credit, the MPs on the committee have not allowed themselves to be diverted by the high profile that has been created for national services and the digital x-ray programme.

The report makes grim reading. We are told that the first phase of delivering local care records is already two years behind schedule, with no firm completion date identified. This is despite acute trusts needing to do no more than replace the existing patient administration system with one from the NPfIT.

By February 2007 only 18 trusts out of 150 had done this. Or had they? Well, no, actually. Not really. For in delving a little deeper, it transpires that due to delays in software development, no NPfIT patient administration systems are yet available in the three clusters served by iSoft, and in fact only old, pre-NPfIT systems have been implemented.

But it gets worse. What of phases two and three, the addition of NPfIT clinical functionality to patient administration systems, which are "the key to the delivery of clinical benefits"?

We are told that their implementation may scarcely have begun by the time the original local service provider contracts expire in 2014.

What do we make of Lord Hunt's statement that the Public Accounts Committee's report is out-of-date? Alas, the situation described above is only too up to the moment. The committee's report is out of date only in that the latest problems, such as those encountered by Milton Keynes General Hospital, came too late to be included.

Hunt really cannot claim that "we are on track to meet our broad targets" when no firm dates exist for any acute trust to obtain substantially more electronic patient record functionality than it had when the NPfIT began five years ago.

By all means let him extol successes in electronic prescriptions and digital x-rays, but it is like praising a major house building programme for having completed some garages and garden sheds even though the houses themselves are still empty plots.

So what is to be done? The report makes two sensible recommendations. It endorses the current move to make local chief executives accountable for implementation of NPfIT, but with one absolutely crucial proviso: that they are not merely given responsibility, but also "authority and resources." In other words, that budgetary responsibility and control of suppliers must also be delegated. The report then recommends that additional suppliers of core Care Records Service software are brought in to create an element of local choice.

Something along these lines is surely the way forward. But before we can start thinking in detail about cures, the patient must acknowledge his illness.

It all reminds me of the atmosphere in 1996, when everyone knew that however much it might tinker, the Conservative government was doomed.

About the author 

Alan Shackman is a contributor to a paper published in the Public Accounts Committee's report on the NPfIT. He is an independent consultant who has worked on electronic patient record-connected matters for more than 15 years, directly for NHS trusts. He was also an interim NPfIT programme director. He has been involved in a number of Electronic Patient Record procurements.


MPs dissect NHS IT plan's failings >>

Trust hits records trouble despite assurances to MPs >>

More about the National Programme for IT in the NHS >>

Tony Collins' project management blog >>

NHS Connecting for Health website >>


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