Your shout: NHS IT, the value trap, NPfIT

Readers discuss working in IT for the NHS, CIOs stuck in the value trap and the NPFIT in the light of recent terror attacks

Enjoying the challenges at the sharp end of NHS IT

Khali Itani, Medical Physics Department, UCL Hospitals NHS Trust

I enjoyed Liz Warren's article on working for the NHS, and I wanted to add a little flavour to the comments about the breadth of IT projects in NHS trusts.

I work in a medical physics department, and the amount of IT work that we do is unimaginable. Technologies range from infection-clean keyboards, baby-mother video monitoring systems, and building video matrix boxes for a multitude of audio visual systems - such as slide projectors, scanners, PCs, magnifiers and projectors - to specifying mobile computers that are fit for purpose in different settings with an NHS trust.

What makes NHS IT projects more challenging and interesting than most is that we not only have to worry about the IT technicalities of a project but also the instrumentation aspects of electrical safety, infection control etc. Adding to all that is having to deal with patient/staff confidentiality and consensus. It is not all about software projects and managing records electronically.

It has certainly been a very exciting job for me for the past eight years, and I am sure there will always continue to be something new to keep me going for plenty more years to come.

When it comes to training, I think that the NHS is doing its best. Let us not forget that the NHS is a huge organisation and it needs a huge budget for training its thousands of staff. Unfortunately, IT courses are expensive, but this does not mean they are ruled out. You just have to present a strong case to get them approved.

Projects aren't done until the system is retired

Colin Beveridge, Chief executive, Hadley Grant

In Brian McKenna's piece "CIOs' tenures are shorter than their projects", Sean Finnan, vice-president and managing director, EDS UK and Ireland Commercial Business, says, "CIOs are caught in a value trap 60% to 80% of IT budgets are being spent on keeping current environments alive. Chief executives see most of their money being spent on just standing still."

I would suggest that there is nothing surprising in these statistics because most IT budgets are about maintenance rather than development. However, an interesting corollary is the generally accepted maxim that 80% of the lifetime costs of an information system are incurred after the initial implementation.

Nevertheless, I can safely say that none of the hundreds of business cases I have reviewed over the past 10 years reflected the 20/80 cost profile. At best, the sponsors usually build in a "reasonable" - ie token - amount for a year or so to justify a three- or five-year return on investment.

In my experience, these provisions are rarely adequate, never extend to the likely longevity of the system, and never include provision for eventual decommissioning.

This problem appears to be endemic, if not systemic, in the way most IT departments operate. We should have the maturity to recognise the seriousness of this issue and start to do things differently. Until we do, our professional integrity remains flawed and our customers will continue to experience unexpected costs.

We need to accept that systems development continues throughout the lifecycle of an information system until it is finally retired. Development is most definitely not simply a journey that ends with a successful implementation.

Terror backlash could hit faith in patient data plan

Rob Tweed

In view of the recent terrorism threats perpetrated by doctors within the NHS, I wonder whether anyone in the National Programme for IT has considered the implications for their electronic patient record?

Control of access to and use of this personal information has, of course, been the focus of a great deal of concern and debate, but I would guess that, of all potential users, doctors would have been the one group that members of the public would have felt should have legitimate access.

I would guess that feelings may now have changed somewhat.

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