Thought for the day: The real NHS IT challenge

The head of NHS IT has a colossal technical task on his hands in delivering £2.3bn of new systems on time and on budget. But this...

New Asset  
The head of NHS IT has a colossal technical task on his hands in delivering £2.3bn of new systems on time and on budget. But this is dwarfed by the challenge of winning buy-in from the medical professionals at the front line, argues Lindsay Clark.



Richard Granger, the director-general of NHS IT, has one of the toughest jobs anywhere in the computer industry. If he succeeds, the national IT programme could still be an unmitigated disaster.  

Bear with me on this. To succeed the NHS, or rather the Department of Health, must meet two challenges simultaneously. First, it has to deliver a £2.3bn national IT programme, consisting of a national patient booking system, electronic patient records, electronic prescribing and IT infrastructure, on time and to budget.

This is a colossal task the like of which has rarely been attempted in public or private sector. Hundreds of suppliers must be managed to deliver adequate service levels. A myriad of technologies must be made to work together.

Thousands of IT professionals, some with little experience of healthcare, must be melded into coherent teams and driven to deliver systems to incredibly tight deadlines. The systems must be able to make millions of complex medical records easily accessible, while maintain strict privacy standards.

This is the bit Granger is responsible for. I have no doubt he is a tough cookie and capable of delivering. The scary thing is - this is the easy bit.

Here’s the tough bit. For the national health service IT programme to be successful, working practices in the NHS must modified to fit with the IT systems it delivers. Granger is not responsible for this. I’m not sure who is, but ultimately it will be the Department of Health.

There is a useful analogue with business IT systems. In business IT, you must either make the application fit your business processes, or get enough management buy-in to change business processes to fit your IT. But the NHS is not like a business. It is a loose bunch of tribes and discrete organisations, each with its own culture, values and hierarchies.

Doctors make up the top tribe and I doubt that they’ll be in the mood to have new working practices forced on them. Most GPs don’t even work for the NHS, and are instead independent contractors - and they are currently in fraught negotiation over their national contract. Meanwhile, many hospital doctors are still unhappy with the national contract introduced by the Department of Health earlier this year.

The problem for the Department of Health is that few doctors are even aware of the national IT programme, let alone feel they have been consulted. Yet the department is currently specifying the systems it expects doctors to use.

When Granger faces the top brass of NHS IT at Healthcare Computing 2003 in Harrogate tomorrow, he’ll do a convincing job of selling the national IT programme. The question is how will doctors react at the British Medical Association’s annual representatives meeting in June this year.

What do you think?

If the technical challenge is just the tip of the iceberg, what's the best way to win buy-in from end-users? Tell us in an e-mail>> reserves the right to edit and publish answers on the website. Please state if your answer is not for publication.

Lindsay Clark is managing editor (news) of Computer Weekly.


Read more on IT legislation and regulation