Department of Health
From Nhs It Info
Information for health: an information strategy for the modern NHS 1998-2005 (Sep 1998)
Department of Health
"Executive Summary: The purpose of this information strategy is to ensure that information is used to help patients receive the best possible care. The strategy will enable NHS professionals to have the information they need both to provide that care and to play their part in improving the public's health. The strategy also aims to ensure that patients, carers and the public have the information necessary to make decisions about their own treatment and care, and to influence the shape of health services generally."
Shifting the Balance of Power within the NHS (Jul 2001)
Department of Health
http://www.dh.gov.uk/assetRoot/04/07/35/54/04073554.pdf
". . . The balance of power must be shifted towards frontline staff who understand patients' needs and concerns. A shift in the balance towards local communities so that they reconnect with their services and have real influence over their development. Frontline staff need to be in charge of frontline services and have the power to manage to meet the local communities needs' always within the context of clear national standards and a strong accountability framework. The NHS must support frontline staff and engage local communities to deliver the necessary reform to deliver faster more responsive high quality services. . ."
Service Management (18 Sep 2006)
Department of Health
http://www.connectingforhealth.nhs.uk/delivery/servicemanagement
"Statistics: The NHS is an enormous community requiring services and support which will be greatly enhanced with the introduction of new IT infrastructure, systems and services by the National Programme for IT. The technology will effectively link the many disparate NHS organisations to create a truly national health service. However, implementing the National Programme is a huge and complex operation. As such, there will be no 'big bang'; instead, systems will be gradually phased in according to priorities and when NHS organisations are ready to implement them. Our Availability Statistics and Deployment Statistics demonstrate the progress we have made to date."
DH carrying out 'confidential' review of CfH (15 Nov 2006)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2266
"E-Health Insider has learned that an urgent 'confidential' review of the NHS IT programme and structure of Connecting for Health, the agency responsible for its delivery, has been launched by the new chief executive of the NHS David Nicholson. The new boss of the health service has commissioned a review of the £6.2bn NHS digitisation project as one of his first actions since taking up post in September. The CfH review, which has already begun taking evidence, is understood to be focusing on reviewing how to re-structure CfH to make it and the programme it is charged with delivering more locally responsive. Described to E-Health Insider as a 'confidential rapid review', suppliers have already been called in by a CfH study group to answer questions on the state of the programme with sessions being held this week. But some industry figures contacted questioned how thorough it would be and suggested the terms of reference were too limited. "It's a rush job," said one senior industry figure. "It appears to be very short and a not very thorough job." Those involved indicate that this is a review that dare not speak its name. "CfH are insisting this is not a 'review', and is nothing to do with the past but all about the future," explained one senior industry source.One CfH source stressed that the review was not being undertaken by CfH but by DH: "It's a review that's being done to us". However, several of the key figures conducting the review are understood to be senior executives from CfH. . ."
NHS chief executive to scrutinise Connecting for Health (28 Nov 2006)
Computer Weekly
"NHS chief executive David Nicholson has ordered a review of Connecting for Health, the organisation running the NHS's £12.4bn National Programme for IT. The Department of Health confirmed that Nicholson had commissioned the review, to be undertaken by CfH management 'to ensure that it is correctly structured and staffed to deliver the projected programme delivery schedule'. The review comes as CfH prepares for executive agency status. A DoH spokesperson added that a separate national programme was also under way, aimed at ensuring a shift towards 'local ownership' of NPfIT as 'an essential part of normal NHS business', in line with recommendations from the National Audit Office. Recent re-structuring of the NHS and the transfer of NPfIT contracts from Accenture to CSC created 'a good opportunity to undertake this work'. NPfIT is also set to come under scrutiny by the Commons Health Select Committee which has announced an inquiry into the programme."
Letter to Lord Warner
(Sent on 12 Nov 2006)
Letter to Mr David Nicholson
(Sent on 29 Nov 2006)
As of 12 December no reply to either of these letters had been received.
New scrutiny for IT programme as bigger role for SHAs mooted (7 Dec 2006)
Health Service Journal
http://www.hsj.co.uk/healthservicejournal/pages/n/06107/it
"Major changes to the national programme for IT in the NHS have been signalled as the NHS chief executive launched a review and MPs announced an inquiry. The Department of Health confirmed last week that David Nicholson had ordered a review to 'ensure that [IT] is a normal part of NHS business, supporting the delivery of better quality and safer care'. At the same time, NHS Connecting for Health, which runs the programme and is preparing for executive agency status, is 'looking to ensure [the programme] is correctly structured and staffed to deliver'. HSJ understands the two moves together indicate a much bigger role for strategic health authorities and a slimmed-down central team. . . Confirmation of the changes emerged as the Commons health select committee announced a new investigation into NHS IT. The move was welcomed by the British Computer Society and academics, who have been pressing for a further review since the National Audit Office issued a surprisingly positive report on the programme's early years this summer. . ."
NHS plan signals shift to local IT ownership (11 Dec 2006)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2332
"A sharp shift of responsibility for NHS IM&T in England from the centre to local organisations is signalled in the service's new plan for 2007-8 published today. 'The NHS in England: the operating framework for 2007-8' was launched by NHS chief executive, David Nicholson, who says in his foreword: 'We are devolving power from the centre to the service in many ways, not least in how we allocate money, such as the unbundling of central budgets. 'Some of the key enablers of service transformation, such as the delivery of information technology, will also increasingly need to be driven and owned by the service rather than from the centre so that patients can get the full benefits as quickly as possible.' . . . Plans will be required from NHS organisations showing not only how local but national priorities will be achieved including: implementation of GP Systems of Choice; preparing for the National Summary Care Record; the completion of picture archiving and communications rollout; implementation and benefits realisation for the Electronic Prescriptions Service and further exploitation of e-booking. The framework also says plans should show how organisations will carry out the deployment and benefits realisation for patient administration systems and order communications and results functionality, in line with existing commitments and targets set by each SHA, in the context of existing commercial arrangements. . ."
GPSoC delivery goes local in IT devolution (11 Dec 2006)
e-Health insider Primary care
http://www.ehiprimarycare.com/news/item.cfm?ID=2333
Local NHS organisations will be required to draw up plans showing how they will deliver GP Systems of Choice implementation under new arrangements announced today. Primary care trusts, as commissioners, will be required to have their own comprehensive IM&T plan and work with all providers in their local health communities to align IM&T plans to enable patient-centred service transformation. The new requirements are part of a broad strategy of devolving responsibility for IM&T to local level announced in 'The NHS in England: the operating framework for 2007-8'. The framework was launched by NHS chief executive, David Nicholson, who says in his foreword: 'We are devolving power from the centre to the service in many ways, not least in how we allocate money, such as the unbundling of central budgets. 'Some of the key enablers of service transformation, such as the delivery of information technology, will also increasingly need to be driven and owned by the service rather than from the centre so that patients can get the full benefits as quickly as possible.' Nicholson is currently reviewing the National Programme for IT (NPfIT) and reports suggested he was keen to improve local ownership of the programme. . . Plans will be required from NHS organisations showing not only how local but national priorities will be achieved. These include: the completion of picture archiving and communications rollout; implementation and benefits realisation for the Electronic Prescriptions Service and further exploitation of e-booking. . . In addition to the responsibilities set out for PCTs, as commissioners, all NHS providers will have to have a forward looking IM&T plan which is 'core to their business, exploits fully the NPfIT opportunity and thereby demonstrates migration to the NHS Care Record Service.'
Health minister steps down (13 Dec 2006)
The Guardian
http://politics.guardian.co.uk/publicservices/story/0,,1971318,00.html
Lord Warner, the junior health minister, is to retire at the end of the year, Tony Blair's spokesman said today. The spokesman said that it was a "personal decision" by the 66-year-old peer to stand down. He strongly denied any suggestion that the minister's departure was connected to the troubled National Health Service IT project which he was overseeing. "His decision to retire has absolutely nothing to do with that at all," the spokesman said. "He genuinely wants to spend more time away from his red boxes." The Labour peer, who was once director of social services at Kent County council, and chairman of the Youth Justice Board for England and Wales, was considered a competent minister and a safe-pair of hands. The spokesman said that a successor will be appointed early in the New Year."
Lord Warner was spearhead of blairite NHS reforms (13 Dec 2006)
Liberal Democrats
http://www.libdems.org.uk/news/lord-warner-was-spearhead-of-blairite-nhs-reforms-pugh.11543.html
"Commenting on Health Minister Lord Warner's announcement that he is retiring, Liberal Democrat Health Spokesperson, John Pugh MP said: "Lord Warner has been the unelected spearhead in parliament of the Blairite NHS reforms and was consistently on message. "With the massive NHS IT project struggling and hospitals financially destabilised, he will be relieved to step down before the problems start to multiply. "The pilot may have been dropped but the ship is still heading for the rocks.""
Minister responsible for NPfIT to retire (14 Dec 2006)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2347
Lord Warner the health minister responsible for the £12.4bn NHS IT project is to retire at the end of the year. No 10 has announced that the Labour peer will retire at the end of the year, in what was described as a "personal decision". The BBC reported that Downing Street had denied that his departure was linked to the growing difficulties over the NHS IT programme, and delays to the implementation of the national electronic record system. Since the 2005 election Lord Warner - a former special advisor to Jack Straw - has served as deputy to health secretary, Patricia Hewitt, with direct responsibility for some of the most contentious aspects of the government's health reforms, including the ministerial lead on competition and choice. Lord Warner, 66, has been closely linked to the CfH programme and repeatedly dismissed any criticism of the project. In October he rejected calls by leading computer science academics for a review of the technical architecture of the project to establish the scale of the risks facing the National Programme for IT (NPfIT). In June following the publication of the National Audit Office (NAO) report on NPfIT Warner was bullish about the progress of NPfIT, despite the NAO report stating that NHS Care Records Service was two years late and the total cost of the project had doubled to £12.4bn. At the Department of Health press conference on the NAO report Lord Warner told E-Health Insider that he was absolutely sure both the summary national part of CRS and the detailed local clinical record components of CRS would be fully delivered by 2010. 'I have no doubts in my mind whatsoever.' And in May Lord Warner appeared to muddy the waters over the cost of the programme when he said the price tag for NPfIT, by then officially stated as £12.4bn, would actually end up as £20 billion. A No10 spokesman told the Daily Mirror that Lord Warner's retirement was not linked to the NHS digitisation project: "His decision to retire has nothing to do with that at all. He wants to spend more time away from his red boxes." It is not clear which health minister will take over Lord Warner's responsibility for the NPfIT, which is currently being reviewed by the DH."
Text of letter sent from the Department of Health to patients expressing concern over electronic care records (Dec 2006)
Department of Heath
http://www.connectingforhealth.nhs.uk/newsroom/all_images_and_docs/guardian-letter.pdf
"I am replying to your letter addressed to the Secretary of State regarding your participation in the NHS Care Record Service (NHS CRS). Your letter raised some specific concerns about your personal health information being held electronically in a new NHS database as a summary care record, indicating that having your information held by the NHS in this way may cause you substantial unwarranted distress. You therefore asked the Secretary of State for Health to stop the process of adding your information to the new NHS database. I have responded to the reasons you have indicated for your distress in detail in an annex to this letter. However, much of what has been published on this matter is inaccurate and I am therefore providing the context for my response by setting out the reasons for the introduction of the NHS Care Records Service. . ."
Hunt returns to DoH (9 Jan 2007)
Kable's Government Computing
http://www.kablenet.com/kd.nsf/Frontpage/EE91BAFA0C04451D8025725E0041616B?OpenDocument
"After a four year gap Lord Hunt is back at the Department of Health, preparing to tackle the troubled NHS IT programme. Lord Hunt of Kings Heath returned to the Department of Health on 8 January 2007, and is expected to resume responsibility for the £12.4bn NHS National Programme for IT (NPfIT). Hunt resigned from his post as health minister nearly four years ago in protest against the Iraq War. He is replacing Lord Warner who retired at the end of 2006 in what was described as a "personal decision". A spokesperson for the Department of Health told GC News that final details of Hunt's portfolio are "still being ironed out", but he will take responsibility for quality and safety, research and development, relationships with the National Institute for Clinical Excellence and the Healthcare Commission. He is likely to lead on workforce issues and Connecting for Health, which were under Warner's brief. . . Hunt's appointment comes at a critical time for NPfIT and its governing agency, Connecting for Health: there have recently been reports of an internal DoH review of the programme's structure. At a hearing of Parliament's influential Public Accounts Committee last summer leaders of NPfIT were accused of failing to consult sufficiently with medical staff and buying the wrong technology."
NHS chief dismisses fresh call for review (6 Feb 2007)
Computer Weekly
"NHS chief executive David Nicholson has rejected a fresh challenge issued by 23 leading computer scientists to commit to an independent review of the £12.4bn National Programme for IT (NPfIT). Nicholson also dismissed a 212-page dossier of the NPfIT's problems, which details the concerns of some consultants and other clinicians over the programme. The dossier was compiled by the 23 academics, who include senior computer experts at leading universities. His rebuff will heighten concerns among some health experts about what they see as complacency among top-tier management at the Department of Health over the state of the NPfIT. Speaking at a one-day event dedicated to the National Programme, Martyn Thomas, visiting professor at Oxford University and a representative of the 23 academics, issued the challenge to Nicholson to commit within two weeks to launching an independent, published review of the programme. But Nicholson, who attended the whole event, repulsed the challenge only hours later. He expressed strong support for programme, while conceding that there were "issues", including a need for the NHS to "pull the programme in its direction". Nicholson said that the NHS did not respond well to being told what to do and there was a need for "more engagement and more ownership" by the NHS of the NPfIT. He added that the programme was "not wildly off course" and there was "no evidence which would lead me to believe there is a need for an independent review of the programme". Issuing his challenge, Thomas told the conference that a primary concern of the academics was whether the NHS's requirements had been correctly identified and agreed with clinicians and patient representatives, as well as being complete, consistent and feasible. "We also have technical concerns about the system architecture, the security policies, the system usability, the clinical coding standards, and other technical aspects," he said. "We believe that the professional way to address these risks is for there to be an independent, constructive review that publishes its findings and recommendations." Nicholson said he was impressed with the way the NPfIT was developing. He said he now wanted the NHS to own, love and understand the programme. . ."
NHS dismisses calls for IT review (6 Feb 2006)
ZDNet UK
http://news.zdnet.co.uk/itmanagement/0,1000000308,39285804,00.htm
"A group of IT academics has failed in its latest request to instigate an independent review into the NHS's National Programme for IT. Last October the group of 23 computer experts claimed urgent action was needed to put the £12bn National Programme for IT (NPfIT) back on track, with their spokesperson, Oxford University visiting professor Martyn Thomas, warning that the project was set to fail. Nothing came of their demands. Now, according to Computer Weekly, their latest attempt to instigate a review has failed. Speaking at an NPfIT event last week, Thomas said the academic group had "technical concerns about the system architecture, the security policies, the system usability, the clinical coding standards, and other technical aspects". The group wants an independent review to be conducted to ensure that the programme remains on track and meets the needs of medical professionals. But the NHS's chief executive David Nicholson turned down the academics' latest challenge, after Thomas called for an independent review within two weeks. Nicholson denied that NPfIT was "wildly off course" and said there was "no evidence which would lead me to believe there is a need for an independent review of the programme". The much-criticised NPfIT programme, which was been through a raft of supplier and budgetary issues, is the largest civilian IT project in the world."
The evidence base for the National Programme (15 Feb 2007)
Department of Health
http://www.connectingforhealth.nhs.uk/about/case/
"Since its inception, the National Programme for IT has evoked a huge amount of interest and debate. We present the evidence for the Programme and how it will support the NHS to provide better, safer care. We look at why it is needed and what people say about it, offering comments and opinions from patients and patient organisations, clinicans, MPs, the media and from the findings of independent reports looking at NHS Connecting for Health and the National Programme for IT."
Connecting for Health pulls speakers from Europe's largest healthcare IT conference at Harrogate (6 Mar 2007)
Computer Weekly - Tony Collins' Blog
http://www.computerweekly.com/blogs/tony_collins/2007/03/connecting-for-health-pulls-sp.html
NHS Connecting for Health, which runs the NHS's National Programme for IT NPfIT], has withdrawn its speakers from Europe's biggest annual IT health conference at Harrogate. The agency, which is part of the Department of Health, is under political pressure to improve its communications and engagement with the health service, which suggests its speakers would want to be at the HC2007 Healthcare computing conference in force. But two weeks before the conference and exhibition, the three speakers from Connecting for Health have been withdrawn. They are Richard Granger, Director General for NHS IT, Richard Jeavons, senior responsible owner for service implementation and Sir Muir Gray, director of clinical knowledge, process and safety for NHS Connecting for Health. . . It is not clear why Connecting for Health has withdrawn its top people at such short notice. There is speculation that some health officials are irritated by the strong links between the British Computer Society and 23 academics who have written an open letter calling for an independent review of the NPfIT. The academics have much information on the NPfiT on their wiki, comprising published and original material. There is also some speculation that health officials are concerned about a paper published by the British Computer Society's Health Informatics Forum Strategic Panel in December 2006. The paper "The Way Forward for NHS Health Informatics" contained much praise for the NPfIT and the work of Connecting for Health. It made it clear that the BCS wants the NPfIT to succeed. The paper also made some points that Connecting for Health may have found unendearing, an assertion for example that political pressure has caused health officials to "deny problems and to defend the indefensible".. . . But the authors ensured their report was balanced. Indeed they concluded that the NPfIT is changing for the better. . ."
On the Evolving NHS IT Strategy (15 Mar 2007)
Health Service Journal - HSJ Intelligence
http://www.shop.hsj.co.uk/pdf/hsj_intelligence150307.pdf
". . . in 2002, the national IT programme was set up to move things along with 'ruthless standardisation' and procurement from a few large firms. But there is now a sense that the programme is coming to an end, and that the agency that runs it, Connecting for Health, will evolve into a standards-setting and infrastructure body. The NHS's latest operating framework makes strategic health authorities, rather than the programme's local service providers, responsible for implementation and benefits realisation. Providers have been told to draw up IT plans that take account of business needs, while showing commitment to the NHS care records service. These changes will be welcomed as they are in line with those demanded by the NHS 23 group of academics (see news in brief), the public accounts committee and various trade bodies. They may also be inevitable, since trusts are increasingly reluctant to take programme systems. . . Few will weep if the arrogant, secretive 'NPfIT' fades. Its successes have been negotiating software deals, setting standards and creating infrastructure, so it seems to make sense for it to focus on them, Its failures lie in not managing to install the systems supposed to make up the 'functionally rich' local end of the NHS Care Records Service and to align IT and reform. The irony is that this is what it was set up to do. . . [Lynn Whitfield]"
On Developing Local Strategies (15 Mar 2007)
Health Service Journal - HSJ Intelligence
http://www.shop.hsj.co.uk/pdf/hsj_intelligence150307.pdf
". . . There are two possible versions of the Department of Health thinking behind recent guidance to the NHS on developing local information technology strategies to 'fully exploit' investments by the national IT programme. Either: 'There you are NHS, the national IT programme has delivered what it was set up to deliver and now it falls to you to put the sophisticated, value-for-money systems they have procured to good use for the benefits of patients.' Or: 'Well, we've made a right mess of that - nothing for it now but to pass the buck back to the NHS and hold local chief executives personally responsible if they don't retrieve the situation.' . . . Doubtless many primary care trust chiefs will feel, in being asked to co-ordinate local IT plans, they have been handed the mother of all poisoned chalices just at the time they have neither the financial or specialist intellectual capacity to cope with the scale of the task. However, those clinicians, managers and IT professionals across the NHS who, despite everything, hope for clinical systems that help to improve care (as distinct from booking appointments, etc.) may see a glimmer at the end of what many feel has been a dark tunnel. They will see that the DoH and the programme now accept that the national project will deliver much less, in terms of sophisticated local functionality to the NHS, than was originally hoped. While this is all disappointing, it does at least provide an opportunity at last for the more visionary local NHS health managers to sit down with clinical colleagues and decide how to build what is eventually provided by the programme into the sophisticated locally integrated health record. It may also offer a chance for the many small- and medium-sized IT suppliers to develop applications that can integrate with the infrastructure provided by the programme and turn it into the clinically rich, fully integrated local system that everyone had hoped for. . . This may well be a way out of the privacy quagmire that surrounds the creation of the national care record database. People worried that their records will be held on a national database may be much happier to see their local organisations commission secure, web-based personal electronic records - which can be made available, where they approve, to support their health wherever it is provided. . . [Frank Burns]"
NHS IT devolution plan goes into action (27 Mar 2007)
Computer Weekly
http://www.computerweekly.com/Articles/2007/03/27/222674/nhs-it-devolution-plan-goes-into-action.htm
"Whitehall officials will start dismantling parts of Connecting for Health next month in a bid to "reinvigorate" the £12.4bn National Programme for IT (NPfIT). Under the plan, which forms part of an audit by NHS chief executive David Nicholson, some staff, job roles, budgets and responsibilities will be transferred from the agency to local and regional organisations. The rethink means that responsibility for meeting key local and national objectives of the NPfIT will be dispersed to more than 150 senior responsible owners at local and regional health service sites. Among these, the regional senior responsible owners - in practice, the chief executives of strategic health authorities - will be expected to commit to ensuring that deployments meet the NHS's contractual commitments to local service providers. Under the contract, the NHS has to place a minimum amount of business with these suppliers each year. The NPfIT Local Ownership Programme is Whitehall's response to a report by the National Audit Office last year that said that a critical factor in the success of the NPfIT would be the local support of doctors and other NHS staff. But so far it is unclear how much freedom local senior responsible owners will have to operate, and whether they would be held responsible for any failure of the NPfIT, which after four years continues to be beset by uncertainty - in particular over electronic health records. . ."
Passing the reins (30 Mar 2007)
The Guardian
http://society.guardian.co.uk/e-public/story/0,,2045822,00.html
"On April 1, much of the responsibility for the £6.2bn NHS National Programme for IT, parts of which are two years late, will pass from NHS Connecting for Health (CfH) to strategic health authorities (SHAs). The National Programme for IT local ownership programme will include the transfer of staff to SHAs from five super-regional "clusters" run by CfH as local delivery arms. According to a document released earlier this month by the North-East SHA, this might include redundancies. Dr Stephen Singleton, the authority's medical director, wrote: "The geographical spread of SHAs is far greater than current CfH clusters. Connecting for Health staff generally appear to be on higher grades than NHS counterparts. The two points above suggest there might be a reasonable risk that redundancies will be necessary (but there is no financial provision)." The SHAs have formed two new groups to deal with the dominant "local service provider" suppliers, according to documents placed online by SHAs, based on the areas covered by these companies. BT supplies London SHA only, but the southern CfH cluster supplied by Fujitsu - covering the South Central, South-East Coast and South-West SHAs - has established a south NHS management board, chaired by Mark Britnell, chief executive of South Central SHA, which first met on January 9. A similar structure has been created for a new "NME" (North, Midlands and East) group for the six SHAs covering the rest of England, which are all served by CSC following Accenture's withdrawal from the national programme in January. The NME NPfIT programme board met for the first time on February 21, according to the North-East SHA document. In what might be an indicator of future problems with these groups, Dr Singleton wrote that his SHA wanted a decentralised approach to CfH staff, whereas other authorities want to centralise. A spokesperson for North-East SHA said it prefers to place staff working across the region within individual trusts, to keep them in touch with frontline work. Richard Popplewell, chief executive of Stockport PCT and chair of the Greater Manchester IM&T programme board, welcomed the localisation, although he estimates it will take one to three months to become effective. . . Murray Bywater, managing director of health IT consultancy Silicon Bridge Research, said the localisation work could run into problems if SHAs and trusts disagree, or if they want to alter the terms of the local service providers' secret contracts. "There will need to be some readjustment of those contracts for [the suppliers] to operate effectively in the new environment," he said. The change comes as CfH launches a £100m tender to find additional software suppliers. Bywater said decisions including this and the localisation work show power shifting from CfH back to the Department of Health, following the national programme's numerous difficulties. "The Department of Health is beginning to reassert itself," he said. "Politically, you can interpret this as CfH having its wings clipped.""
Minister announces new directions, to overcome resistance to England's NPfIT (19 Apr 2007)
British Journal of Healthcare Computing & Information Management
http://www.bjhc.co.uk/news/1/2007/n704007.htm
"Health minister Lord Hunt announced a drastic switch in priorities for England's National Programme for IT at the HC2007 Conference in Harrogate last month. Delivery of the National Care Records Service is being put on the back burner - in favour of a concentration on projects that are most likely to deliver quick wins, and a transfer of ownership of the NPfIT - from the centre to organisations in the field - becomes a high priority. Both are part of a move by the Department of Health to win the hearts, minds and active support of frontline care providers in using the national IT infrastructure to enhance the quality of patient care. In his speech last month he also conceded that the Government had failed to convince the public that the goals of NPfIT - especially the shared care record - were worthwhile."
NHS computer records project chief quits (15 Jun 2007)
Financial Times
http://www.ft.com/cms/s/5a361d74-1b8a-11dc-bc55-000b5df10621.html
"Richard Granger, the UK's highest-paid civil servant, is to leave as head of the £12bn programme to develop an electronic patient record for the NHS. The 42-year-old head of the IT programme, who is on six months' notice, said on Friday he wanted to go because by October he would have fulfilled the five years he originally said he would devote to the project, and "most of the building blocks are now in place". His decision to go, he said, was also "a very personal one". He wants to spend more time with his three young children in Cumbria, with a break from a job that has been "quite simply relentless". He plans to "move to the next stage of my professional career" next year. He will be taking up "one of a number of approaches that are swirling around". He will go as the state of the programme remains a matter of controversy. Its key goal - a full, detailed, local, interchangeable electronic patient record - is running at least two years late. But Mr Granger can argue the programme is on budget, suppliers only get paid after they deliver, and large amounts of the infrastructure, and a host of other applications, including the wholesale replacement of X-ray film by digital images, are now in place, or being rolled out, and are working. The programme, however, also remains well behind on installing the new patient administration systems that are needed to work with the patient record software that is now due next year. There is, however, now "no doubt about the programme's achievability", Mr Granger said."
Granger to leave in transition by end of 2007 (16 Jun 2007)
e-Health insider
http://www.e-health-insider.com/news/item.cfm?ID=2784
"Connecting for Health chief executive, Richard Granger is to leave the agency responsible for delivering the National Programme for IT to the NHS in England 'during the latter part of this year.' In a personal statement issued today, he said he would "transition" from his full time post at the agency he was largely responsible for setting up. The controversial and outspoken IT boss who joined the NHS from Deloitte Consulting in September 2002 will return to work primarily in the private sector during 2008. The statement says he is currently considering several significant approaches. He said: "My decision should be seen in the context of the changing role of the centre of the NHS and the fact that when I took on this challenge I said I would give this job five years. I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years. There remain a number of challenges ahead, but I firmly believe that the leadership of the programme by Lord Hunt, David Nicholson and my colleagues within CfH will ensure these hurdles are overcome. I want to acknowledge the enduring professional support I have received from my team and colleagues throughout the NHS." The statement said that in due course an announcement regarding the identification of a successor and transitional arrangements will be made by the Department of Health. Health minister Lord Hunt said: "I would like to thank Richard Granger for his hard work and tremendous achievements in delivering the National Programme for IT for the NHS and wish him luck for the future. Richard will continue to lead Connecting for Health during the transition period, which we expect to be the late part of the year, and his decision will not affect the delivery of the NHS IT programme."
Boss of troubled £12bn NHS computer project quits (16 Jun 2007)
The Times
http://www.timesonline.co.uk/tol/news/uk/health/article1942900.ece
"Britain's highest paid civil servant has announced his resignation as head of the £12 billion computer project for the National Health Service. Richard Granger, 42, chief executive of NHS Connecting for Health, was responsible for upgrading information technology (IT) systems and introducing electronic patient records. Although computer systems have been improved in many trusts, the project has been criticised for delays and design flaws. The departure of Granger, who was paid £290,000 a year, will be seen as a further setback for the project. He has been credited with updating hospital IT systems from 'the stone age" and ensuring that private contractors involved in the project were not rewarded for failure. Granger will leave in the next few months and said he was considering offers to return to the private sector. "I passionately believe the programme will deliver ever greater levels of benefit to patients over the coming years," he said. The NHS project, the biggest civilian computer project, was backed by Tony Blair to deliver detailed electronic records for every NHS patient. The electronic record system is now more than two years late and Gordon Brown is expected to review its progress when he becomes prime minister. Tony Collins, executive editor of Computer Weekly, the industry magazine, which has called for an independent inquiry into the project, said: "Without Granger the risk is that this programme will now fall apart. The programme has highlighted the need for proper electronic records in the NHS, but you have to ask what it has achieved that trusts could not have done on their own. It has also not delivered on the main objective of a centralised patient record system." Granger was appointed head of the project in 2002 after successfully managing the introduction of the IT element of the congestion charge in London. Confronted with what he saw as the intransigence of the medical profession and the determination of IT suppliers to make high profits at the taxpayers' expense whatever their performance, Granger tried to introduce a tough competitive climate for the contractors. His metaphor for the project was a sledge being pulled by huskies. Those who fell by the wayside would be "chopped up and fed to the other dogs" to ensure that those who survived worked harder. The former management consultant was respected by many in the industry but others were taken aback by his abrasive and demanding approach. One contemporary once described working with him as a "deeply corrosive experience". Connecting for Health proved to be a huge challenge as NHS staff complained they had not been properly consulted and experts argued it was foolhardy to keep patient records in one central database, warning the system might be vulnerable to unauthorised users. . ."
Anger as best paid civil servant goes (17 Jun 2007)
Sunday Telegraph
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/17/ngranger117.xml
Britain's best-paid civil servant is to quit as the head of NHS information technology, claiming the new, accident-prone computer system is on track. Richard Granger, the chief executive of Connecting for Health, said he would leave the post, and its £290,000-a-year salary, in October. "There is no doubt about the programme's achievability," said Mr Granger, who took up the role in October 2002. "Most of the building blocks are now in place." Karen Jennings, the head of health at Unison, the NHS's biggest trade union, said Mr Granger's optimism was at odds with the views of the "majority of NHS staff". She said: "Technically... things are finally coming together. But lessons must be learned from the way these over-ambitious, big-bang IT projects have been brought in late and so over-budget." Parts of the project are two years behind schedule and it may now cost a total of £20 billion, which would put it £7 billion over budget. Mr Granger can point to some successes. An electronic patient-booking service now arranges 20,000 appointments a day and 250 million X-ray images are now stored electronically. But there have also been breaches of patients' confidential details and what has been called the "biggest computer crash in NHS history", when 80 NHS trusts had no access to patient records for four days. Richard Bacon, a Conservative MP on the Public Accounts Select Committee, said Connecting for Health had caused "anger and resentment among doctors, nurses and hospital managers".
Personal statement regarding Richard Granger (18 Jun 2007)
Connecting for Health
http://www.connectingforhealth.nhs.uk/newsroom/news-stories/personal
"Richard Granger has announced that he will transition from his full-time post as the Chief Executive of NHS Connecting for Health. Granger will leave NHS Connecting for Health, the Department of Health Agency responsible for delivering the National Programme for IT to the NHS in England, later this year. He will return to work primarily in the private sector during 2008. He is currently considering several significant approaches. Granger said: "My decision should be seen in the context of the changing role of the centre of the NHS and the fact that when I took on this challenge I said I would give this job five years. "I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years. "There remains a number of challenges ahead, but I firmly believe that the leadership of the programme by Lord Hunt, David Nicholson and my colleagues within NHS CFH will ensure these hurdles are overcome. "I want to acknowledge the enduring professional support I have received from my team and colleagues throughout the NHS." An announcement regarding the identification of a successor and transitional arrangements will be made by the Department of Health in due course."
NHS director general of IT quits after repeated system delays (18 Jun 2007)
The Guardian
http://business.guardian.co.uk/story/0,,2105353,00.html
"Britain's highest paid civil servant, the man in charge of the NHS's delayed £12.4bn IT upgrade programme, has resigned amid calls from politicians and academics for a wholesale review of the project. Richard Granger, the NHS director general of IT, is to wind down his role and leave the health service by the end of the year. "I am proud of what has been achieved by the team I established in 2002," he said. But there is concern that the National Programme for IT (NPfIT) is in trouble. Designed to update the NHS's paper-based records in England over 10 years, it is the largest non-military IT project attempted in the world. Four years in, repeated delays, concern about the suitability of core software and the withdrawal of a number of suppliers have left many hospital trusts and clinicians disillusioned with the project. Last year Accenture, a lead contractor, walked away from two £1bn contracts, writing off hundreds of millions of pounds relating to work on the project. Mr Granger has argued that his insistence on not paying for work on the programme until it has been delivered has meant the taxpayer has not had to bear the extra cost as suppliers work round the clock to keep the project on track. He pointed out the NHS had spent £1.5bn on delayed contracts by April last year, instead of the £2.3bn it would have cost had the work been delivered as contracted. Mr Granger last week dismissed much of the debate around the IT programme as "complete tosh". Speaking at an IT conference, he said: "We would not have got to this point without our dedicated ring-fenced funding. I think that with a bit less whingeing and more support ... we might have even got the programme done quicker." But David Nicholson, who took over as chief executive of the NHS in England last September, has been under pressure from hospital trusts to decentralise the troubled IT programme and open out elements of the healthcare IT market to wider competition."
Richard Granger's NHS IT legacy (18 Jun 2007)
Silicon.com
http://www.silicon.com/publicsector/0,3800010403,39167548,00.htm
"Will the £12.4bn project be viewed as a success or a failure? After five years in charge of the biggest IT project in the world NHS IT director-general Richard Granger has announced he is to step down later this year. The former Andersen and Deloitte management consultant came to the NHS IT post on the back of his successful stint delivering the London Congestion Charge scheme, becoming the UK's highest-paid civil servant - a silicon.com Freedom of Information request last year revealed he earns around £280,000. It has undoubtedly been a turbulent five years and opinion is strongly divided on whether his time in charge of the £12.4bn NHS computerisation programme - also known as Connecting for Health - has been a success. While Granger's hard-headed and no-nonsense approach meant tough new contracts for suppliers, which would only get paid for systems they actually delivered, it also led to accusations of a project being imposed on the NHS with little input from the doctors, nurses and patients who would be using it. . ."
Fulsome praise for departing CfH boss (18 Jun 2007)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2788
"The news that Richard Granger is to leave Connecting for Health and the helm of the NHS IT Programme later this year has elicited a clutch of glowing tributes from some of the most senior industry and NHS executives he has worked with over the past five years. Over the weekend Granger received effusive praise and statements of regret about his departure from NHS and industry leaders, forwarded to EHI by Connecting for Health's communications team. EHI readers commenting on site have also been sharing their thoughts, some pointing out that despite undoubted achievements on infrastructure, PACS and introduction of systems like Choose and Book the core NPfIT objective of delivering integrated shared electronic patient records remains unrealised. . ."
Ailing project at heart of NHS (19 Jun 2007)
The Guardian
http://politics.guardian.co.uk/publicservices/story/0,,2106234,00.html
"The government's ambitious vision for a single, standardised IT programme that would drag NHS creaking paper records systems into the 21st century was always going to be a challenge. The largest non-military IT project ever attempted - forecast to cost £12.4bn, or enough to pay 650,000 nurses for a year - it has been under strain almost since its inception four years ago. Repeated delays and lingering concern about the suitability of core software, particularly that of iSoft and the US firm Cerner, has hampered progress, as has the withdrawal of a number of important suppliers. Worse still, the 10-year National Programme for IT (NPfIT) quickly fell out of favour with clinicians and hospital trust executives, many of whom felt such a centralised project was at odds with the federal structure of the NHS in England, where trusts were used to making decisions for themselves. To date, however, these festering problems have been kept at bay, largely thanks to the determination and drive of Richard Granger, the NHS's director general of IT and one of NPfIT's most zealous advocates, who quickly gained a reputation as a ruthless enforcer. "I cannot exaggerate the value of Richard to this programme and the likelihood of its success," the government's then medical adviser, Professor Sir John Pattison, told MPs five years ago. This week, though, Mr Granger, the UK's highest-paid civil servant, said he was quitting. The former Deloitte consultant, who introduced London's congestion charge IT system, is to wind down his NHS role and quit by the end of the year after a successor is found. There has been a mixed reaction to the shock move. A controversial figure from the start, Mr Granger was never afraid to upset those who challenged his vision of a ruthlessly standardised NHS care records system. . . Speaking at an IT conference in London last week, Mr Granger said: "I think with a bit less whingeing and more support we might have got the programme done quicker." In truth, however, Mr Granger's centralised NPfIT project has been unravelling for some months. Faced with widespread disaffection, David Nicholson, chief executive of the NHS, has taken steps to appease trusts, in part by offering them greater control of IT decision-making. He has also begun to open out parts of the IT healthcare market to increased competition. Low-profile and modest in scale, these measures have quickly won the enthusiastic support of many clinicians and hospital executives, as well as scores of smaller IT groups with a long record of working with the NHS. With Mr Granger's departure, they hope NPfIT will continue to evolve away from a monolithic, centrally co-ordinated solution into a network of "inter-operable" systems, all plugged into an electronic "spine" and accessible to trusts across the country. In public, the health minister Lord Hunt insists Mr Granger's departure "will not affect the delivery of the NHS IT programme" but behind the scenes even NHS officials are busy drawing up plans for further IT devolution. . . Five core multibillion-pound regional contracts, linked to iSoft and Cerner, could ultimately prove Mr Granger's most controversial legacy. The lead contractors CSC, Fujitsu and BT have refused to write down the value of their NHS work, signalling that they firmly believe the contracts will provide them with a commercial return. But with growing enthusiasm for devolution and choice within NHS IT, the future of the five regional deals looks uncertain. What is clear, however, is that at some point someone, somewhere, is going to have to pick up a colossal tab for an over-ambitious and unpopular IT project."
NHS and IT suppliers say Granger's departure 'won't change contracts' (20 Jun 2007)
ComputerworldUK
http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=3612
"The NHS and trade body Intellect have both dismissed suggestions that key suppliers to the health service's £12.4bn National Programme for IT (NPfIT) might seek contract changes or compensation when NHS IT chief Richard Granger leaves. Granger is to quit his post as director general of NHS Connecting for Health, which runs NPfIT, by the end of the year. The combative NHS IT chief claimed in an interview with the Financial Times that there was a 'significant' risk of lead NPfIT suppliers CSC, Fujitsu and BT seeking contract changes or compensation because his departure would amount to a variation on their contracts. But a Connecting for Health spokesperson poured cold water on the idea. 'Contractors cannot make a claim on the basis that Richard Granger has resigned,' he said. He added: 'We are currently in a transitional period. An announcement about the identification of a successor to Richard Granger and also transitional arrangements will be made by the Department of Health Shortly.' Eddy Peers, vice-chair of the healthcare group at IT suppliers' body Intellect, said: 'I'm surprised at the interpretation that a contract of that magnitude would be tied to a person. I would be extremely surprised if it happened.' He added: 'For the vast majority of major contracts, key people will change.' Peers said there had been 'a lot of renegotiation' of the NPfIT contracts recently ' a move linked to the devolution of the programme's ownership to the NHS's strategic health authorities as some of the focus of NPfIT shifts towards implementing its systems in local hospitals. 'Contractual arrangements and the way implementation takes place, responsibility and so on have been reframed on the ground in the light of experience, as you would expect in a major project,' he said. Peers noted that there was 'a lot of excitement in the supplier marketplace' about Granger's departure and the possibility of change 'because a lot of suppliers have been put onto the margin' by the NPfIT contracts, which are structured around the three lead suppliers. . ."
NHS IT will never be the same again (21 Jun 2007)
Computing
http://www.vnunet.com/computing/news/2192474/nhs-never
"As Richard Granger prepares to step down, NHS IT programme focuses on implementation. No other public sector technology programme, however controversial, has generated quite the same furore as the £12bn National Programme for NHS IT (NPfIT). The project is held up as a paragon of tight contracting, technical vision and world-leading innovation. But it is also used as an exemplar of the worst excesses of disastrous government IT: autocratic, unworkable and a spectacular waste of money. Richard Granger's combative stewardship of the programme for the past five years has created almost as much controversy. And his departure in a few months, announced this week, will have a significant impact. Electronic X-ray systems and the high-speed N3 broadband networks are both widely acknowledged as successful. But there are still problems with the hospital software needed to make the most of the electronic bookings, prescriptions and patient records schemes. And although pilots of summary care records are about to begin, and corporate issues with key subcontractor iSoft may be nearing resolution, both remain significant challenges for the new director general. Reaction to the news of Granger's resignation veer from eulogy to condemnation. But, personalities aside, his resignation is part of wider changes for the programme. Critics of NPfIT have two major complaints. First, they say it was designed and run as a monolithic dictatorship that took no account of the diversity of the NHS. Second, they say it did not engage sufficiently with clinicians. . ."
'The NHS programme is like a Hummer, it will drive through anything' (21 Jun 2007)
Computing
http://www.vnunet.com/computing/news/2192472/nhs-programme-hummer-drive
"What the experts say about the departure of NHS IT chief Richard Granger.
- Granger has not been ashamed to get on with things and at no point has he tried to cover his arse, which is refreshing in the public sector. But we have to step back and do things the NHS way rather than dictating from the centre. That was a mistake from the beginning - A senior supplier
- The NHS IT community had never had any professional leadership before. Many commentators think Richard Granger is ruthless and uncompromising. And no doubt sometimes he is. But he is also a man of huge personal integrity and he has earned loyalty and respect - Andrew Haw, IT director, University Hospital Birmingham NHS Trust
- The National Programme is like a Hummer: it is not subtle, it will drive through anything and will survive a few bomb blasts. But if you want to do anything with finesse, it is not the right vehicle. Now we need to change to something a bit more attractive, that people actually want to drive - A senior NHS source
- Granger did what he needed to do to please his political masters. He decided that his reputation and his relationship with the industry could be sacrificed to deliver what the political climate demanded - A senior industry source
- Richard Granger's focus and drive transformed the multitude of healthcare principalities, dukedoms and feudal states into a single NHS information state. 'Ruthless standardisation' has allowed freedom of communication for the benefit of patients, whose care was previously fragmented between these isolated entities - Professor Sir Muir Gray, Oxford University
- Granger was always a dealmaker, not an implementer - A senior NHS source
- When [his vision] is fulfilled, millions of patients should be reaping benefits for years to come - Barbara Greggains, formerly of the Council of the Royal College of Radiologists"
Richard Granger's departure may jeopardise NHS IT programme (26 Jun 2007)
Computer Weekly
"It is a pity Richard Granger, director general of NHS IT, is to leave as head of Connecting for Health, the agency that is running the National Programme for IT (NPfIT). The decision was his - he was not asked to leave. Indeed, officials at the Department of Health may soon recognise that they are losing the NPfIT's most valuable asset. Without Granger the NPfIT is at risk of falling apart, for he has given the programme a credibility it would not otherwise have had. Long before he joined the Department of Health as director general of NHS IT, the future of the NPfIT was to a large extent sealed. By then a key lesson from the failures of three separate IT-related programmes - Wessex Regional Health Authority's Regional Information Systems Plan (1992), the Read Codes version three (1998), and the Hospital Information Support Systems initiative (1996) - should have been learned. And that was that large, centralised IT schemes imposed on semi-autonomous NHS sites rarely work. They engender a scepticism among doctors that becomes impossible to overcome. Instead of avoiding this mistake, officials at the Department of Health and Downing Street made it the central ingredient of a new scheme of unprecedented scale and boundless complexity. Ministers further deepened scepticism among clinicians by conceiving the national programme in secret and announcing it as a fait accompli. Later, when Granger joined the programme in autumn 2002, he gave it a credibility based on a conviction that it was needed. And he was right. Reliable electronic health records are needed urgently. Paper notes go missing, and are not generally available after hours. So there is no disagreement on the need for easily accessible electronic medical records. But local patient record systems were already being installed successfully before the NPfIT was born. It was just happening slowly. So it is understandable that ministers wanted progress to be accelerated. The answer was for national standards to be set, money put aside for modernisation, teams from successful sites deployed as troubleshooters within the NHS, and incentives paid to GPs, IT specialists and chief executives for successful implementations in which benefits for patients were measurable. Instead, the Department of Health wanted in early 2002 to put itself at the centre of everything that happened. Bureaucracies love complexity. And so an amorphous national programme without a simple, clear objective grew around the sound idea of electronic records for everyone in England. Later, Granger joined the programme. And he and his team have achieved much. IT is now a high priority for NHS trust boards and he has broken new ground in his firm dealings with suppliers. The NPfIT has also done much to force trusts into identifying duplicate and inaccurate patient records, and some trusts have had antiquated IT replaced with more modern systems. Connecting for Health has also delivered a number of useful systems that most people have never heard of, including the Secondary Uses Service (a healthcare planning, clinical audit and research tool), the Personal Demographics Service (a database of names, addresses, dates of birth and NHS numbers), and the Quality Management and Analysis System (a means of assessing the work of GPs). Though successful, these systems may, for the NPfIT as a programme, represent "scope creep" in that they were not among the original four main NPfIT systems. . . [Arguably] the biggest weakness in the NPfIT: ministers have politicised it. In the private sector the project would have been reviewed independently. If there were parts that did not work, and it was thought unlikely they would ever work, they would be scrapped. Money and people would instead have been directed into installing systems that yielded measurable patient benefits at an affordable price. But in politics, changing direction can be seen as a weakness, or even, dare we say it, a mistake. So changes must be made below the radar, without anyone really noticing, while transient ministers declare that all is well. Unannounced changes are indeed being made to the NPfIT. Local NHS trusts are installing standalone systems that are being adapted to national standards. These may be integrated in years to come when, for example, there is agreement among clinicians on how records can be shared. But with Granger's departure, the programme is losing a rock. About a dozen ministers with overall responsibility for the programme have come and gone, and the health minister Lord Hunt has gone and come back again. But Granger has for years remained as senior responsible owner for the IT parts of the scheme. So we are disappointed that he is leaving. And it is surprising the Department of Health is not doing more to keep him. A figure as charismatic and demanding will prove difficult to replace. We are by no means sure the programme can be held together without him."
Review of NHS could impact IT (4 Jul 2007)
Computer Weekly
http://www.computerweekly.com/Articles/2007/07/04/225348/review-of-nhs-could-impact-it.htm
"The new health secretary has announced a review of the NHS that could affect the direction and funding of the £12.4bn National Programme for IT at a time of cost pressures. Alan Johnson today announced an independent review of the NHS, which will help inform the Treasury when it sets the funding for the health service as part of the 2007 Comprehensive Spending Review. The review will be led by practicing surgeon Sir Ara Darzi, and it will not be "controlled from above", said Johnson. He added that one aim of the review was to ensure the NHS is "clinically led, patient-centered and locally accountable". It will draw on the views of NHS staff, patients and the public. It will look among other things at ensuring that "clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery". Johnson also emphasised that money spent on the health service needed to be invested wisely. This review could be an opportunity for the government to revisit the £12.4bn National Programme for IT [NPfIT]. Many in the NHS want NHS trusts to have more discretion over what they buy, provided it meets national standards. If this happens as a result of the review, it is unclear how the programme's main suppliers, the so-called Local Service Providers, would make enough money from their NPfIT contracts to justify the investments they have made in national systems. . ."
Brown moves Lord Hunt, a ministerial head of the NHS IT plan (4 Jul 2007)
Computer Weekly
"Gordon Brown's ministerial shuffle has seen ardent supporters of the NHS IT programme moved on ' which could indicate a lower profile for the project in the lead up to a possible early general election. Lord Hunt, the health minister most closely associated with the launch of the NHS's National Programme for IT (NPfIT) in 2002, has left the Department of Health as part of Brown's shuffling of ministerial posts. Another vocal and passionate ministerial spokesperson on the NPfIT, Caroline Flint, has also been moved. . . In Gordon Brown's shuffling of ministers, Lord Hunt has joined the Ministry of Justice. Patricia Hewitt, who was Secretary of State for Health, and was another ardent supporter of the NPfIT, has been replaced by Alan Johnson."
DH denies report that NPfIT is to be shelved (9 Jul 2007)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2851
"Suggestions in a weekend newspaper that the NHS is to shelve the National Programme for IT (NPfIT) have been strongly denied by the Department of Health (DH) today. According to the News of the World, NHS chiefs have agreed to shelve the programme after admitting it was an expensive failure. The report claims: 'Hospitals have been secretly told to buy in their own systems, with money that could have gone on looking after patients.' The article quotes an unnamed source as saying: 'It doesn't work and it's never going to.' However, the DH told E-Health Insider that it 'had no plans to shelve the national programme.' No official comment has been made regarding the authenticity of the claims that trusts are being told not to wait for an NPfIT system. The DH told EHI that they are awaiting information from Connecting for Health (CfH) to see if any guidance had been issue to trusts by the NHS body responsible for the NHS IT modernisation in England. CfH told EHI they were investigating the article and would issue a statement later in the day. The DH is working on a response to the newspaper and said that the article had come as a surprise as the newspaper had not asked about the IT programme in a previous briefing. The spokesperson acknowledged that aspects of the programme were open to scrutiny due to the ongoing delays, but said that systems such as the N3 network and PACS have demonstrated the programme's benefits in bringing the NHS into the 21st century. An official rebuttal from the DH is due later today, a press spokesperson told EHI."
Health department to put record straight on NPfIT (10 Jul 2007)
Computer Weekly
"The Department of Health is seeking corrections to the official records of parliament after two ministers attributed to the National Audit Office positive statements on the NHS's £12.4bn IT plan (NPfIT) that auditors did not make. The corrections being sought by the department, which follow an investigation by Computer Weekly, are likely to add to scepticism within the IT industry about the extent to which ministerial statements on the progress of major technology projects can be relied upon. The Department of Health has conceded to Computer Weekly that it gave unclear briefing notes to ministers in advance of a Commons debate on the NPfIT. In the debate on 6 June 2007, two ministers, Caroline Flint and Ivan Lewis, attributed to public spending watchdog the National Audit Office positive statements on the NPfIT that auditors did not actually make. The separate ministerial statements gave the impression that the National Audit Office had, in its report on the NPfIT, given unequivocal backing to the programme: to the way it was being managed, the excellence of contracts with suppliers, adherence to budgets, and to major savings having been achieved. But the National Audit Office report in June 2006 contained none of the specific statements attributed to it by ministers, except one ' that substantial progress had been made. . . The Department of Health said it accepts that in its briefing notes to ministers about the National Audit Office report on the NPfIT there was 'lack of clarity on what was direct quote and what was reported speech'. The spokesman added, 'We will be contacting Hansard [which keeps the official record of parliamentary proceedings] to check their transcription and set this straight.'
End of the search for a cure (18 Jul 2007)
Information Age
http://www.information-age.com/article/2007/july_2007/last_word_july
"Richard Granger's decision to quit as the head of the UK government agency Connecting for Health was not the most high profile resignation in the month of June. Two of his political bosses, Tony Blair and Patricia Hewitt, both left office, leaving their own bitter-sweet legacy among the workers in the National Health Service. Among technology suppliers, and public sector IT and medical staff, however, Granger has been just as influential as his political masters, and the debates over his legacy, certainly among CIOs and IT suppliers, have been just as lively. It wasn't just that Granger presided over the roll out of the £12.4 billion National Programme for IT (NPfIT), the largest civil IT project in the world, that made his name so widely known, even outside the UK. His personal style, tough and uncompromising on certain issues, made him infamous. Within months of taking up his £280,000 a year appointment in 2002, he had become a highly controversial figure, inciting the worst kind of criticism and the best kind of praise. From the outset, Granger set out to change the way that public organisations buy and manage their IT. As a thousand headlines and half a dozen reports from the Public Accounts Committee (Parliament's spending watchdog) have shown over the years, public sector IT has been a disaster zone in the UK for two if not three decades. Granger recognised that in most cases, suppliers made large profits regardless of the catastrophic failure of the project. He decided to make them accountable every step of the way. That strategy created a huge amount of trouble in the supplier community. Some big suppliers, such as IBM and EDS, stayed out altogether. Others such as Accenture, pulled out half way through. One small but critical supplier, iSoft, begged for help when it ran into trouble, but while it got some help, it wasn't bailed out. As a result, Granger can say that while the project might have overrun, it is not over-budget. In this, Granger should have had the media and, indeed, the entire medical profession on his side. But his willingness to talk tough with suppliers also extended to those who criticised the programme or his decisions. One of the first skills of the modern leader is to listen ' to hold a genuine dialogue with all the stakeholders affected by the introduction of a new technology. But Granger seemed to epitomise the Labour government's belief that the big decisions were best taken at the start, by those with the power and the mandate. One of the key reasons why the fate of the National Programme for IT still hangs in the balance is that consultation has been treated as a means of securing acceptance, not as a co-operative process aimed at reaching the best solution. This is not a throw-away criticism, but a central one. Among the organisations that have articulated concerns about the lack of consultation or the imposition of inappropriate solutions are the British Medical Association; the Royal College of Surgeons; the Royal College of Physicians; the British Medical Journal; the Royal College of Nursing; London School of Hygiene and Tropical Medicine; and the Renal Association. In a survey by The Guardian, GPs also severely criticised aspects of the system and the lack of consultation, while many regional health trusts have also attacked several aspects of the system. . ."
Confidential briefing to Tony Blair on the NHS's National Programme for IT (31 Jul 2007)
Computer Weekly - Tony Collins Blog
http://www.computerweekly.com/blogs/tony_collins/2007/07/confidential-briefing-to-tony.html#more
"NHS Connecting for Health has published on its website one slide from a 'confidential' briefing presentation to the former Prime Minister Tony Blair on the NHS's £12.4bn National Programme for IT [NPfIT], following inquiries by Computer Weekly. Other slides in the presentation to Blair, which Connecting for Health hasn't published, give an insight into how officials wish to counter criticism of the programme. The PowerPoint presentation to Blair was dated 19 February 2007. On NHS Connecting for Health's website is a slide from the presentation that depicts parts of the NPfIT as having been completed. Following our inquiries, NHS Connecting for Health has also published on its website the mathematical workings to explain the slide, though these calculations were not in the presentation to Blair. What struck me as particularly interesting were some of the slides that NHS Connecting for Health did not publish from the presentation. They sought to marginalise critics and criticism, although listening hard to constructive criticism may be of critical importance when managing a large and complex IT-based project. One of the slides marginalised the 23 leading academics, many of them professors in computer-related sciences, who have called for an independent review of the NPfIT. The slide said: 'The largely negative media has shaped public opinion by persistent criticism. An opposition campaign is being well orchestrated. The 'evidence' by the 23 academic critics is almost wholly based on media coverage, hostile submissions to the Public Accounts Committee and Select Committee and Parliamentary questions.' However some of the most pertinent criticism of aspects of the NPfIT has come from the apolitical British Computer Society and a variety of independent voices within the medical and IT communities. . . What none of the slides suggested was tacking criticism by improving, modifying or removing aspects of the programme that were being criticised, or providing good arguments on why things should carry on as they are."
Brown government rejects calls for independent review of NPfIT (9 Aug 2007)
Computer Weekly
"The government under Gordon Brown has rejected a call by an all-party group of MPs for an independent review of the business case for the NHS's National Programme for IT [NPfIT], in the light of progress and experience to date. It has also rejected a call by the Public Accounts Committee for an urgent independent review of the performance of local service providers to the NPfIT, against the obligations of their contracts, which are worth £6.2bn. The rejections are part of a formal response by the government of a highly critical report on the NPfIT which was published by the committee in March 2007. Ministers have accepted some parts of the committee's report - but none of the recommendations that called for independent assessments of aspects of the NPfIT. The government had been due to publish its response to the committee's report by 26 May 2007. But it did not do so until 25 July, the day before Parliament broke up for the summer recess. . ."
Government says no to NHS IT review (9 Aug 2007)
ComputerWorldUK
The government has buried its response to a damning report by MPs on the NHS's £12.4bn National Programme for IT (NPfIT) in a set of Treasury minutes. The document, slipped out just before the parliamentary recess, includes a pledge to produce a first annual statement of the costs and benefits of the huge computer project later this year. In April, the powerful Commons Public Accounts Committee warned that NPfIT was unlikely to deliver significant benefits to the treatment of patients by the end of its 10-year contract without a fundamental change in the rate of progress on the project. Responses to Parliamentary Select Committee reports are usually published on the committee's web page. But at the time of writing the document was not available through this channel and spokespeople for the Department of Health and NHS Connecting for Health - the agency that runs NPfIT - could not confirm whether it had been published. The Public Accounts Committee warned that the Department of Health was 'unlikely to complete the programme anywhere near its original schedule', noting that, four years in, there was still uncertainty about the costs and benefits of the scheme. If the project fails, 'it could set back IT developments in the NHS for years, and divert money and staff time from front line patient services', the committee report said. But the government has rejected the MPs' call for an independent assessment of the business case for NPfIT in the light of progress and experience made so far. The response says: 'The intention is to include details of both the financial and non-financial benefits within the annual statement of benefits realised.' The government 'does not consider there are grounds for an independent review of the business case at this stage'. The response says the government 'accepts the general principle' of a recommendation to set out which elements of functionality originally contracted for under NPfIT would be available for implementation by the end of the 10-year period and to prioritise deployment of the systems that benefit the NHS most. 'Work is underway with the NHS to determine its priorities. The results will be provided to the Local Service Providers and plans will be adjusted as required,' it says. But ministers have rejected the MPs' calls - sparked by concerns that NPfIT suppliers such as the troubled iSoft were running late in delivering key components of the scheme - to modify the procurement process to let NHS trusts select from a wider range of patient administration and clinical systems. The response says: 'Centralised procurement, through a small number of suppliers, was a key feature of the procurement process so as to avoid the disadvantages, and the expense, of the haphazard approach of the past.' Although there are just two suppliers of the crucial acute patient administration systems, 'many more suppliers are contracted across the programme as a whole', it adds. A procurement exercise to increase the number of potential suppliers has brought expressions of interest from 221 suppliers, with 111 of these 'longlisted' so far. 'The intention is to award a series of framework contracts to selected suppliers who can then compete for subsequent business if the need arises,' the government response says. The framework contracts would be 'complementary to the existing suite of Programme contracts and provide contingency'. Ministers rejected the call for an independent review of the performance of NPfIT's lead contractors. 'It is better to target reviews at individual problems,' the response document says."
NHS National Programme for IT faces a hazy future (10 Aug 2007)
Computer Weekly
"The National Programme for IT in the NHS seems to be destined to be dissipated, in part, into general health IT in England. There are signs the programme is in flight from ruthless standardisation; Whitehall has dropped plans to give NHS Connecting for Health, the agency set up to run the programme, the status and independence of an executive agency; officials are struggling to find money for plans to localise the scheme; and a more diffuse leadership may be poised to subsume the departing Richard Granger's role as director general of NHS IT. At a government IT summit in May in London, a senior health official gave an assurance - of sorts - about the future of the NHS's £12.4bn National Programme for IT (NPfIT). "It has three wheels still on, and it is still moving. But things are in hand to a certain degree. They are not in other respects but we are going to get there," said Andy Burn, head of IM&T planning at NHS Connecting for Health, which runs much of the NPfIT. Not all trust IT directors share Burn's confidence about the future of the programme. A comprehensive assessment of the programme by Birmingham and Solihull NHS Trust raised a question about whether the NPfIT would achieve its objectives. It said, "The NPfIT is an ambitious programme that has experienced delays, with current system migrations running two years late, and there are concerns over its achievability." The paper was referring in part to a plan to give 50 million people in England a reliable and useful medical record - called the NHS Care Records Service - which is running at least two years late. Some trusts are now buying essential systems outside of the NPfIT. The paper said, "In priority situations, full EU procurements are being undertaken for systems outside the local or national product portfolio. "The financial impact on national contracts has yet to be resolved, but some trusts may need to pay financial penalties for operating systems outside of the national contracts." Birmingham and Solihull NHS Trust is not the only trust to make such an assessment of the NPfIT. Given the problems with the programme, including concerns in the NHS over the quality and reliability of some NPfIT products installed so far, what is the government of Gordon Brown to do about its future? Several developments indicate that the government, advised by Whitehall officials, has decided to blend the NPfIT more into NHS IT in general. Thus the scheme may not have such a distinctive - and controversial - character. This would make it more difficult for observers of the programme in the NHS, parliament and the media to delineate what is and what is not a success. In the run-up to a possible early general election, ministers would welcome a reduction in the number of articles that cast the NPfIT in a grim light. . . NHS Connecting for Health is expected to continue refusing calls by Computer Weekly, academics and other independent voices for a new high-level, published, independent review of the programme. So there will continue to be no independent verification of the government's claims for the success of the scheme. . . All of which may help to explain why the NPfIT - after a series of ministerial announcements about the programme during its early years of the programme - is hardly mentioned in the latest annual report of David Nicholson, the chief executive of the NHS. But if, as seems the case, some politicians and officials want the programme to head slowly towards obscurity - at least until the next general election - they may be disappointed, especially if suppliers start levying fines on NHS trusts over a lack of NPfIT orders."
Granger's successor remains a mystery (5 Sep 2007)
e-Health Insider