Rush to fulfil prime minister's NHS vision tripped up IT programme

Expert argues that national programme is being built on unstable foundations

“If I live in Bradford and fall ill in Birmingham then I want the doctor treating me to have access to the information he needs to treat me,” said Tony Blair in 1998.

This may have sounded like poetry in the Downing Street press office, but was its subsequent interpretation the Achilles’ heel from which the National Programme for IT in the NHS (NPfIT) could never recover?

As the new millennium dawned, the Department of Health goal of providing IT support to health clinicians concentrated on assistance at the point of care. There were plenty of solid projects underway on which to build such 21st century IT for the NHS.

In April 2000, the Public Accounts Committee published its report on the Information Management and Technology Strategies of the NHS Executive. It accepted the NHS Executive’s goal of a “direction of travel” towards “lifelong  electronic health records for every person in the country”.

But the committee also endorsed the view of the NHS Executive that five types of electronic patient records needed to be built first, before the consolidation of health records could be undertaken. These fives types of electronic patient records addressed the needs of professionals in mental health, acute hospital, GP primary care, community services and social care.

The Public Accounts Committee was particularly pleased with the emphasis the then NHS Executive chief executive Alan Langlands put on local implementation, “which stressed the need to involve end-users”.

Undeterred by the practical “local care records first” theme of the Langlands era, Downing Street kept its sound bite in the public eye. The prime minister spelt out his vision to the government e-Summit in November 2002. He proposed that 600 million pieces of paper a year  could be eliminated from the NHS. Of course, others were left with the task of trying to work out how.

The recruitment of the NPfIT team in the autumn of 2002 set the framework for action. Buoyed no doubt by the promise of a share of the £6bn that the prime minister dangled before the e-Summit, and fuelled subsequently by the £2.3bn of new IT investment funds allocated to the Department of Health, the NPfIT set off at breakneck speed.

Forgotten, apparently, was the need for a first stage of five types of electronic patient records – a foundation upon which to build. The NPfIT concentrated right away on putting the national central building blocks in place, signing up a supplier for a national electronic booked appointments database in October 2003, and BT for the national element of the Care Records Service in December 2003.

Announcing the BT contract, the then health secretary John Reid revisited the Downing Street press office theme and promised that the new Care Record Service, “will be of particular use to accident and emergency staff who can access information about emergency patients and help to diagnose them more quickly”.

Was this one step too far? Certainly the absence of good electronic patient records at the point of care was overlooked. Certainly the advice of the Public Accounts Committee that “departments should consider carefully whether projects are too ambitious to undertake in one go” was discounted. The NPfIT was unable to publish a gateway review report to demonstrate that it could manage the ambition.

Others more readily expressed their doubts. Even health minister John Hutton admitted that it would be an “enormous challenge” to make a success of the programme and it would be “foolish to ignore the risks”. Christopher Bland, chairman of BT said it will be a “real challenge” to get the initiative to work. He said BT was excited by the challenge, but “somewhat frightened by the enormity and complexity of it”.

The NHS Confederation, in an assessment of the NPfIT said, “The IT changes being proposed are individually technically feasible, but they have not been integrated, so as to provide comprehensive solutions, anywhere else in the world.”

MPs are now showing real concern about the national programme’s deeply disappointing lack of progress. Few leading practitioners in health informatics believe that integration can be achieved before the essential building blocks of local electronic records are in place at individual trust level.

The Downing Street soundbite is now eight years old. Without a fundamental shift in strategy away from national dreaming to local electronic record building, another eight years could drift by and the NHS would still be deluged with paper.

Tom Brooks is a management consultant and a member of the Parliamentary IT Committee and the Worshipful Company of Information Technologists. He has successfully managed national healthcare projects such as the NHS Number Programme for England & Wales

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