General Warnings and Advice
From Nhs It Info
More Radical Steps (2003) Initiatives (Jul 2003)
BCS Health Informatics Committee
http://www.bcs.org/upload/pdf/rsjul03.pdf
"Estimates of four to eight times current planned investment were suggested as necessary to carry out necessary professional training, organisational systems redesign and realignment to support a successful NPfIT. Until any other figure is ratified, the potential for NPfIT to have a substantial impact on care remains at serious risk"
NHS Confederation Briefing (1 Aug 2003)
National Programme for Information Technology in the NHS
http://www.npfit.cambridgeshire.nhs.uk/default.asp?id=24
"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."
The National Programme and Primary Care Informatics (1 Mar 2004)
BCS Health Informatics Committee
http://www.phcsg.org/main/documents/Position%20Paper%20Release%201%20-%20Mar%202004%20.pdf
"The National Programme needs to understand GPs' current high levels of dependence and relative satisfaction with their current systems, and must provide a path to allow GP practices to move to systems that can fully realise the vision of the National Programme in a controlled manner without excessive loss of utility in the process. Critically, the National Programme needs to recognise that there is no hurry to replace current systems before proven alternatives are generally recognised as justifying the disruption."
National programme for information technology (15 May 2004)
BMJ 2004;328:1145-1146, doi:10.1136/bmj.328.7449.1145
"With the national programme for information technology, the NHS in England has set itself an enormous task. A programme of this size has never been attempted in the United Kingdom and, in many respects, elsewhere in the world. But what is the national programme, why is it so important to the government and to the viability of the NHS, and is it on course to succeed? The national programme means an investment of £6.2bn ({euro}9.2bn, $11.1bn) over a 10 year programme of change. It promises to modernise information and communications technology across the NHS and provide the tools to help streamline the healthcare services. It will create a basic health record for all 50 million patients, enabling quick and easy access to the essential information that anyone making health decisions about a patient needs to know. It will connect more than 30 000 general practitioners and 270 acute, community, and mental health trusts in a secure system. It promises to "improve the convenience and quality of care" by having the right information in the right place at the right time. It will sustain the NHS reform programme and support patients' choice. That is the hype, but why does the NHS need such a national programme? For many years the NHS has been flirting with information and communications technology. This has resulted in a multitude of disparate systems many of which are unable to share information. The publication in 2002 of the Wanless report (a review of the long term trends affecting the health service and the resources required over the next 20 years) convinced the Department of Health to commit to a fully integrated national system. The report concluded that "without a major advance in the effective use of information and communications technology, the health service will find it increasingly difficult to deliver the efficient high quality service, which the public will demand." The Department of Health thought that information and communications technology in the NHS needed to be managed and controlled at a national level. The increasing complexity of health care, the need for timely access to quality data and the latest information by healthcare professionals, and the need to reduce clinical errors demanded a revolution in information and communications technology. The term national programme for information technology is misleading because the programme isn't just about technology. Its successful implementation will affect the ways in which people work and services are delivered. . . Will the national programme work? In a recent article in the Financial Times, Nicholas Timmins highlighted some major concerns about the programme. He reports suggestions that Peter Hutton was "frozen out" of the programme after expressing serious concerns. The programme has been criticised as being too secretive, even excluding many NHS employees from its development. Peter Hutton also raised concerns over how uniformity and continuity of care will be achieved across different local service providers, stating that local variations would raise "major safety and training implications." EMIS, the largest supplier of primary care systems in the United Kingdom, announced that it would not sign current contracts with any of the local service providers appointed to deliver the national programme. With so many concerns, and we have looked at just a few, one wonders how the national programme will succeed. However, far too much is at stake for it to fail. The consequences of failure are too ghastly to imagine. . ."
How To Succeed In Health Information Technology (25 May 2004)
Health Affairs
http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.321v1.pdf
". . . The most broadly implemented health IT system in the world today is that of the Veterans Health Administration (VHA). This system, known as VISTA/CPRS, covers more than 1,200 sites of care, including acute care hospitals, ambulatory facilities, skilled nursing facilities, and pharmacies. While the admiring visitor might imagine that he or she is looking at the result of a brilliantly executed, centrally conceived plan, nothing could be further from the truth. The original plan to computerize the VHA was specified and contracted in typical government fashion. It failed spectacularly. The successful system that is apparent today in every VA hospital is the result of the teaming together of physicians, nurses, and other caregivers to develop a system that works in real practice, every day. Naturally, a system as large as that of the VHA requires central management, but management has learned its lesson. The development sites are decentralized and as close as possible to frontline caregivers. . . The most ambitious project of all is on the other side of the Atlantic, that of the English National Health System (NHS), which has contracted with multiple parties to assemble a seamless $10 billion electronic health record to cover its forty million members. In each of those projects, there has been relatively little involvement, beyond some focus groups, of front-line doctors, nurses, and other caregivers. As a professional 'entrepreneur' in health IT, I have learned a consistent lesson, sometimes the hard way. That lesson is that one cannot ever spend too much time talking with the users, showing them prototypes, learning their preferences, and trying things out. . ."
Public Value and e-Health (1 Jul 2004)
Institute for Public Policy Research
http://www.ippr.org.uk/ecomm/files/public_value_ehealth.pdf
". . . although new ICT systems have been procured for the NHS, in order for the anticipated benefits to be delivered there will have to be significant changes to the way the NHS works in order to take full advantage of the greater availability of information. There are two potential barriers to the successful completion of this change management process. First, control over NHS ICT might have moved from being too devolved to too centralised. This could potentially make systems insufficiently flexible to take account of useful variations in local working practices and might also lead to trailblazing NHS organisations being held back. Second there may simply be insufficient capacity within the NHS to cope with the magnitude of change that will be required. Managers, health professionals and specialist health informaticians are all extremely busy and may not have the time to make sure that the change is a success. Inadequate funding, insufficient skilled staff and the competition of other priorities may mean that although ICT systems have been procured, the benefits delivered will not be as great as they might have been."
Transcript of File on Four (19 Oct 2004)
BBC (Interview with Jean Roberts, BCS Health division)
http://news.bbc.co.uk/nol/shared/bsp/hi/pdfs/fileon4_20041019_nhs_it.pdf
"To get these new systems introduced, the people competent to use them and for them to be day-to-day support tools will require somewhere, according to the people in the field, between four and eight times the initial investment."
Doomed from the start: considering development risk (1 Feb 2006)
Reg Developer
http://www.regdeveloper.co.uk/2006/02/01/development_risk/
"[The NPfIT] project does seem to exemplify one with high scores in all the risk categories I'd review before starting a project:
- It's a very large project, and the Government's record with large projects certainly isn't better than anyone else's.
- It involves massive changes to existing systems.
- It cuts across organisational boundaries (hospitals and GP surgeries, and uses outsourced services).
- It has legal/regulatory issues - doctors are responsible for the governance of patient records, and the Data Protection Act applies to much of the information.
- It is a highly visible project, raising considerable press interest.
- Top management (in this case, probably even our Prime Minister) is taking a lively and, possibly, ill-informed interest.
- It has safety-critical aspects.
- Resources are limited and, in theory, tightly controlled.
- It involves new technologies.
- Few of those involved can have much experience with similar projects - US healthcare is very different and the NHS is an unusually large operation, even in a global context."
BCS Response to NAO Investigation of NPfIT (4 Jan 2005)
BCS
http://www.bcs.org/upload/pdf/auditofficejan05.pdf
"Summary:
1. NPfIT is damaging the UK healthcare IT Industry by excluding many small but innovative players. Steps must be taken to make systems more open.
2. NPfIT operates in an unnecessarily secretive manner. Its contracts and other documentation need to be made public to allay suspicion and encourage trust.
3. NPfIT is too top down in its approach. It now needs to be made bottom up: owned, understood and made affordable locally.
4. Current experience in the UK is not being exploited.
5. There needs to be confidence in the quality of staff developing NPfIT. Qualified informatics staff should be the norm.
6. More staff are required at all levels to implement NPfIT at the pace planned. Education is needed in health informatics to develop a larger pool of skilled workers.
7. Centralised solutions may not perform well enough for clinical use. Consideration should be given to distributed solutions.
8. Patient care is at risk from a loss in functionality. Much current healthcare is built around and depends upon current IT solutions.
9. There are risks to physical security and privacy of content from the NPfIT approach. Rigorous but practical user access controls are essential.
10. Confidentiality constraints must not interfere with patient care by limiting what information is documented and what is available to whom.
11. Without user ownership, NPfIT systems will not be used. Clinicians need to be consulted about integrating IT systems with operational clinical services.
12. NPfIT is primarily about business change, not information technology. There needs to be an extensive education and training initiative."
National Programme for IT: the £30 billion question (1 May 2005)
Br J Gen Pract.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463155
"The National Programme for IT (NPfIT) for health and social services in England has an anticipated cost of around £30 billion. The world's largest ever IT project aims to provide 'Better information for health, where and when it's needed'. The core strategy is 'to take greater central control over the specification, procurement, resource management, performance management and delivery of the information and IT agenda'. . . Virtually every general practice in the UK is now computerised. A rapidly increasing proportion of all practice team members, not just GPs, use computers face to face with patients every day. Arguably, UK general practice leads the way in the use of computers to support patient care. Yet, as evidenced by the medical tabloids, this key stakeholder group has become alienated and marginalised. The explanation for this lies in part with ownership and control. The NHS struggles to throw off its image as a 'command-economy state organisation' but NPfIT, which is run under firm central controls to very tight deadlines, perpetuates that image. Until recently, GPs owned their computer systems. Over more than 20 years these systems have become feature rich in response to user driven innovation. At many sites, electronic information systems and the administrative processes of running a practice have become highly interdependent. Suddenly, ownership has been taken away and procurement of all replacement systems placed in the hands of local service providers. These new people have little or no experience of the general practice domain. They are charged with providing NHS-wide integrated systems to deliver NPfIT priorities. The future of existing general practice systems, upon which GPs are increasingly dependent for delivering care and generating their income, remains unclear. There is little confidence in the quality of replacement systems, partly because what does not yet exist cannot be assessed and partly because there is a widespread perception that knowledge built up through many years of experience is not being harnessed. There is a fear that existing systems will be uprooted at short notice to be replaced with 'new' systems, resulting in severe disruption of vital practice processes. There are further fears that painstakingly collected clinical information will be lost or corrupted during this process, putting continuity of care and patient safety at risk. . . Many of the concerns expressed in this article arise because the people, organisations and technology that deliver health care together make up an unpredictable complex adaptive system. Thus far, NPfIT seems to have adopted a rational and deterministic approach to management. It systematically gathered and analysed facts to produce an output-based specification and then set clear objectives with tight deadlines. This 'well-oiled machine' is now driving IT into the health system. That may be fine to get the technology in place, but much more than just IT is required. The impact on patients and professionals has yet to be seriously addressed. A very different approach is needed to nurture culture change. We will need to feel trusted, to be encouraged to experiment in a system that encourages innovation and learning from mistakes. With powerful 'informating' systems, we should be well equipped to adapt quickly to change and be able to transform the way we work to provide truly patient-centred care. The £30 billion question is not just whether NPfIT will get the technology right but whether it can also win the hearts and minds of the people on whom the NHS depends every day." [John Williams]
Doctor voices concerns over new NHS IT system, UK (6 May 2005)
Medical News Today
http://www.medicalnewstoday.com/medicalnews.php?newsid=23962
"The political drive to implement the NHS's national programme for information technology is failing to take account of professionals' anxieties, argues a GP in this week's BMJ. Dr Nigel de Kare-Silver describes his experience of workshops to introduce the new system to users. 'We were shown screens of a third rate computer program lifted from the existing system of US hospital administrators,' while further meetings produced 'lame presentations by various strategic health authority IT leaders.' He goes on to describe problems with the 'choose and book' system, in which doctors will select from a list of local hospitals and book an appointment while the patient waits. This has a national implementation date of the end of December 2005. 'The application screens are slow, and the computers often fail to pick up the programs. There is no integration with existing clinical systems or with Microsoft Outlook,' he writes. But the 'really frightening module' is the inability of the software to retain advice by either the consultant or the GP, or to integrate it with clinical results. 'This is a major clinical governance issue, he adds. While the ambition of the NHS agenda for IT change should be applauded, it is unfortunate that the contractors show no ability to deliver a system that is an advance on existing services, says the author. 'It is frightening that the political drive to implement the system is failing to take account of professionals' anxieties.' Before allowing its delivery, clinicians from all backgrounds must demand a service that is rigorous in terms of clinical governance, friendly in its user interface, fast, and relevant to the needs of clinicians and patients, he concludes."
Strategic Business Management - Final Stage Examination (14 Jun 2005)
The Chartered Institute of Public Finance and Accountancy
http://www.cipfa.org.uk/students/studylounge/download/pastpapers/jun05/SBMXQ1.pdf
". . . Stories of the incompetence of central agencies ' the Child Support Agency, the schools examination board and NHS drugs procurement in the past month alone ' are the stuff of comment. Yet nobody examines how these matters are conducted to greater public satisfaction abroad. Nobody notes that local democracy runs schools in Sweden, hospitals in Denmark, planning in France and everything in Spain. These countries are not Utopian or naive. They have all experienced centralist drift but, at least since the early 1980s, have fought back and devolved successfully. The only Utopia is the belief of the UK Treasury that every public service can be run more efficiently from Whitehall. The latest madness is its wholly unnecessary £6bn NHS computer system. . ." [Quotation from article in Public Finance]
Masters of the universe give us a billion-pound computer fiasco (26 Jun 2005)
The Sunday Times
http://www.timesonline.co.uk/tol/comment/columnists/simon_jenkins/article537539.ece
". . . As long ago as 1997 Computer Weekly estimated that some £5 billion had been lost by Whitehall on botched computer projects. Consultants had found selling computers to ministers was like giving sweets to children. Labour claimed it would stop all this, but it did the opposite. Ministers traded up from candy to cocaine and are now hooked. The money being wasted subsidising the computer industry far outstrips what used to be wasted on nationalised cars, steel, coal and shipbuilding. Government computers are the new lame ducks. I am told that the NHS project was sold to Tony Blair by a McKinsey team at a meeting in February 2002. The team chief was David Bennett who, intriguingly, was this month appointed Blair's policy chief at an undisclosed 'six-figure salary'. The NHS computer was supposed to list everyone in the country with their various ailments so any doctor or hospital could treat them 'on screen'. Nobody ever asked for this machine, which was supposed to start in 2004. It was a pure top-down sales pitch. The medical establishment pleaded naively that the cost not be met from other health spending. The price soared within a year to £2.3 billion and is now £6.2 billion, with no known delivery date. Every industry expert is screaming at Patricia Hewitt, the health secretary, to cancel it. She has not the guts. It was a 'McKinsey project' and her boss dare not be seen wasting billions on his friends, money that might have gone on patient care. Yet this gullibility is not confined to health. A planned Ministry of Defence computer is budgeted at £4 billion, sold to Geoff Hoon as linking 70,000 desktops in 'real-time decision-making with network-enabled capability'. Hoon also spent £195m on consultancy fees for an unbuilt aircraft carrier, under something ironically called 'smart procurement'. This is a ministry that cannot equip its troops in Iraq with modern kit and claims 'frontline overstretch'. . . The apotheosis of public sector consultancy came last week with McKinsey appointed de facto Purveyor of Policy to Her Majesty's Government. It takes the place of the cabinet, MPs, the civil service and the Labour party. Thus Sir Michael Barber left Downing Street for McKinsey to advise on 'government', while the firm's David Bennett moved the other way to head 'policy'. Bennett's duties reportedly included approving the new head of the civil service, as well as doubtless protecting the NHS computer. With him are McKinsey associates Lord Birt, Nick Lovegrove and Adair Turner. Downing Street claims oddly that they earn no 'public' money. So who pays them? If it is McKinsey, which is paid by government, is this not just salary laundering? Were these jobs or contracts properly tendered? Nobody is saying and nobody seems to know. I can see why McKinsey once boasted in a documentary that its staff were 'masters of the universe', even if none had ever run a whelk stall. It seeks to locate key alumni everywhere that has money to burn. . . Consultancy, as Peter Drucker said, is not a corporate investment but rather a corporate indulgence. It is a perk, a weekend retreat, an executive jet. A boss turns to consultants when he is bored with his colleagues or wants to avoid a simple, tough decision by making it seem complex and intellectual. For Blair, consultants offer flattery and jargon. They promise top-down initiatives that circumvent civil servants, parliament and usually common sense. They are a vain attempt to depoliticise government. This is really about greed, yet another round in the old game of lifting money from the taxpayer by bamboozling ministers and officials. Computerised government is mostly nonsense. The sums leaching from the Home Office, NHS, MoD and Inland Revenue are grotesque. . ."
Exploiting the potential of the NPfIT: a local design approach (Jul 2005)
British Journal of Healthcare Information Management
http://www.bjhc.co.uk/issues/v22-7/v22-7eason.htm
"ABSTRACT: England's National Programme for IT in the NHS can be characterised as using a 'push' strategy to implement standardised systems across the NHS. Evidence from similar implementations in other organisations suggests that, because of local variations in healthcare requirements, this will lead to: implementation failures and delays; partial use; and inefficient workarounds. To avoid these outcomes local user communities need to develop 'pull' strategies in which they examine how they can exploit the new technical systems to improve local healthcare practices in ways that are important in their context. A user-centred, local design approach is proposed for this purpose based on six principles: studying the local 'sociotechnical' system; understanding local ambitions; establishing local planning teams; reviewing the implications of incoming NPfIT systems; designing local systems; and implementing systems using action research to review user experiences. [Ken Eason, Br J Healthcare Comput Info Manage 2005; 22(7): 14'16]"
NHS IT ' now time to get on with the job (Oct 2005)
Silicon Bridge Research
http://www.siliconbridge.co.uk/art_nhs_it.html
"After three years of activity, we now have a much clearer picture of the practical implications of the National Programme for IT (NPfIT). Publication of the latest business plan by Connecting for Health (CfH) has finally removed some of the wraps from this high profile Government driven project. The road to a full National Care Records Service (NCRS) turns out to be at least as long and winding as many experienced healthcare IT professionals had predicted. In reality, the original timescales of 'two years and nine months' have stretched to a decade or more. In addition to its many undoubted strategic and technical merits, NPfIT also has a strong political dimension. The original idea was first conceived in 2002, three years before the 2005 General Election, as a means of gaining strategic advantage and mitigating political risks commonly associated with high profile NHS IT projects. Now that the election is past and NPfIT has started to become a practical reality, current political priorities are rather different. The next General Election will probably take place in 2009, with build-up starting in 2008. Even under currently projected timescales, NPfIT will still be deep in the transition phase, particularly in terms of rollout by NHS Trusts. The most likely areas for political gain will therefore be in national infrastructure and application projects, most of which are already well under way. These national projects are fully capable of completion within the next three years, at least in terms of available functionality, even if take-up may be less than 100% at local implementation level. In addition to the £6billion committed by CfH (of which less than half has been spent to date), considerably more will be required to achieve successful completion. Emphasis has already switched to NHS Trusts to provide more IT resources and funding for themselves. This comes at a time when Trusts are under unprecedented pressure to balance their budgets and may find the choice between increasing IT spend and cutting back clinical services difficult to make. This will result in a softening of the hard edges of NPfIT and will allow more room for choice and diversity in local IT implementation projects. However, some difficult questions still remain to be answered in relation to NPfIT and its implications for the UK market:
- What exactly is the scope of new products being rolled out?
- How will the transition from current systems be handled?
- How will suppliers secure engagement with clinical users?
- Where will necessary implementation resources come from?
- Who will be winners and losers in the emerging market?
- What now are the future prospects for NHS IT? . . ."
Re-configuring the health supplier market: Changing relationships in the primary care supplier market in England (9 Mar 2006)
Integrated Health Records - Practice and Technology, National eScience Centre
http://www.nesc.ac.uk/talks/648/Papers/sugden.pdf
"The NPfIT 'top down' approach has been criticised for appearing to ignore the complexity and diversity of local requirements and developing a 'one size fits all' solution. Whilst the NPfIT goals of information sharing and interoperability across the NHS are laudable, its centralised planning approach has resulted in a shift of the locus of control to management consultants, rather than users or suppliers."
NHS plan is evolving but one-size-fits-all is a fundamental flaw, says hospital chief (14 Mar 2006)
Computer Weekly
"Jonathan Michael, a top NHS executive, had some good words to say about Connecting for Health, an agency that is running one of the world's largest civil IT programmes. After pointing to a fundamental flaw in the NHS's IT-driven modernisation, he told a healthcare symposium at London's City University, "If that seems somewhat critical of Connecting for Health, what we have to recognise is that CfH is evolving. It is in a process of refreshing its view and approach. But it is listening and it is evolving." The flaw Michael sees in the national programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising. The chief executive of Guy's and St Thomas' NHS Foundation Trust, Michael wants IT support for the specific ways people work in particular parts of his organisation, such as the accident and emergency department. "There is a fundamental flaw in terms of the business," he said. "We are running a business in an increasingly decentralised competitive healthcare market, rather than a centrally managed healthcare market." A rigidly standard approach "is not practical in a competitive healthcare market where we may want to look at the business processes within our organisation, be it in accident and emergency or other areas, and to use our IT support systems to help us improve efficiency". Michael said the reality of the one-size-fits-all approach is that it doesn't fit, or if it does, it constrains managers' ability to run the business flexibly. "The idea that the requirements for all hospitals are the same is, I think, simplistic. Flexibility is designed out of solutions and out of the implementation process. So standardisation of IT systems effectively dictates the standardisation of the business model," he said. Michael's speech about the NPfIT commanded the rapt attention of his audience not simply because he is running one of the largest NHS trusts in the UK but because it is rare for any senior health service executive, especially one of Michael's standing, to criticise openly the NPfIT."
NPfIT and the NHS healthcare IT market: an assessment at year four (Apr 2006)
Silicon Bridge Research
http://www.siliconbridge.co.uk/art_nhs_it.html
"Information and communications technology is evolving so rapidly that we cannot realistically plan systems implementation more than 24 months ahead. Maybe this was the thinking behind the magic figure of two years and nine months originally announced at HC2002 as the timescale for the implementation of what is now known as the National Programme for IT in the NHS in England (NPfIT)? In practice, timescales have stretched progressively from five to eight or even 10 years, depending on how one chooses to read the Connecting for Health (CfH) media releases. So how did this happen, and what are the implications? More importantly, who will pick up the pieces? . . . From the outset, CfH made it clear that specialist UK healthcare suppliers had seriously let down NHS customers with inadequate existing or 'legacy' systems. . . Anyway, as the putative NPfIT pounds rack up relentlessly from thousands to millions to billions, who is now to say the NHS has not been getting value for money from its long-serving existing systems? . . . But it would be a great mistake to dismiss the NPfIT as a totally worthless concept. There is much to be admired, particularly in the approach to central infrastructure support. . . Realisation of local NPfIT business objectives will now depend on continuing support and development of the much-maligned existing systems. This has already been recognised for GP systems and a similar situation is now emerging for hospital systems. The idea of a clean sweep with standard NHS PAS-replacement systems was never going to work in practice, and new systems will have to coexist with old for some time to come. Pending availability of a full National Care Records Service (whatever this turns out to be), GPs and hospitals must either implement their own local electronic patient record (EPR) systems or continue to operate with manual paper records. This situation will become increasingly difficult to support without using interim local document-management systems. . . Using large-scale service suppliers as prime contractors is an effective way to channel more skilled resources into the NHS market; this is how the USA market has operated for the past 20 years. The big mistake was to force LSPs to adopt limited-choice solutions selected by CfH with little reference to user needs at operating level. Even worse was the decision to demand major modifications to standard product specifications in the mistaken belief that CfH knows more about healthcare-IT system needs than major suppliers. Worst of all was the mistaken assumption that the choice agenda does not extend to individual NHS trusts in their selection of strategic IT systems. . . The priority for CfH must now be to manage expectations for the NPfIT in such a way as to secure effective completion of the essential basic infrastructure components as originally conceived by the NHS Information Authority ' without throwing the baby out with the bath water. At the same time, local NHS organisations need all the help they can get from LSPs to manage the long and difficult transition from paper-based systems to electronic healthcare records. For all the NHS users and commercial suppliers involved, the risks of failure are too great to contemplate."
Should Connecting for Health be Reviewed? (24 May 2006)
Presentation at the BCS Primary Health Care Specialist Group Spring Conference, 23rd ' 24th May 2006 by Dr Glyn Hayes, Chairman ' BCS Health Informatics Forum. http://www.phcsg.org/main/pastconf/heythrop06/Wed/GHayes1520.ppt
". . . What is Wrong with NPfIT? - Everything is late; Confidentiality is still an issue; Data Migration/Quality still not worked through; Centralised versus distributed systems; The scale of the NHS still causes problems; Hosted Systems. What are the Dangers of a Review Now? - Damaging political resolve; Things are beginning to happen; Many parts of the NHS are gearing up for delivery; Any further delays are unacceptable; If there is to be a Review it must not hold things up; To be meaningful it must be done by those who understand health informatics"
US conference gets a reality check on NPfIT (26 May 2006)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=1909
"Former National Programme for IT industry liaison manager, Phil Sissons, delivered a transatlantic reality check this week, exposing some of the warts in the £6.2 billion programme to an American audience, US correspondent Neil Versel reports from the 22nd annual Towards an Electronic Patient Record (TEPR) conference in Baltimore. In a keynote address this week, Sissons, now an ICT consultant said that there was a lot of truth in the negative reports about Connecting for Health (CfH), the agency running the National Programme for IT (NPfIT), despite the frequent denials by NHS officials. A prime example of CfH failure, according to Sissons, is Choose and Book. "Of the 80,000 appointments that have been made, I can count probably about six that have actually been made using the system. The rest are been made by phone. And yet, Choose and Book is seen as a major step forward," he said. Similarly, the data Spine that is to make patient records portable throughout England, has 80,000 people registered to use it, but neither hospital nor surgical information systems feed information to it yet."
The NHS and IT: A failure to connect (15 Jun 2006)
The Economist
"A gulf of mistrust between Mr Granger's team and the GPs threatens the success of the project. Part of the blame lies with CfH for making a poor job of selling itself. But blame attaches to the GPs too. Their status as independent contractors to the NHS too often blinds Britain's doctors to the wider picture."
EHRs: Electronic Health Records or Exceptional Hidden Risks? (Jun 2006)
Comunications of the ACM, vol. 49, no. 6 (Jun 2006) p.120.
". . . Over the past decade, several countries such as Australia, the U.K. and the U.S. have started IT initiatives aimed at stemming rising health care costs. Central to each of these initiatives is the creation of electronic health record (EHR) systems that enable a patient's EHR to be accessed by an attending healthcare professional from anywhere in the country. . . However, the attempts at creating national EHR systems have been encountering difficulties. In Australia, the implementation cost has risen from an estimated AU$5OOM in 2000 to AU$2B today. In the U.K., the implementation costs have risen from an estimated £2.6B in 2002 to at least £15B today. In the U.S., the "working estimate" for a national EHR system runs between $100B and $150B in implementation costs with $50B per year in operating costs. The UK Connecting for Health initiative calls for everyone in the UK to have EHRs by 2008. However, there have been ongoing problems with its implementation that spurred 23 leading UK computer scientists to write an open letter to the Parliament's Health Select Committee in April, recommending an independent assessment of the basic technical viability. In their letter, they ask whether there is a technical architecture, a project plan, a detailed design, assessments of data volumes and traffic loads, adequate resiliency in the design, as well as conformance with data and privacy laws, and so on. The US. approach to creating a national EHR system differs from the U.K. approach. . . Instead of funding the building of a single, integrated networked system with a central EHR database as in the U.K., the U.S. government is facilitating the definition of standards to allow the interoperability of commercially available EHR systems as well as interoperability certification standards. . . As the UK is discovering, focusing on the technology of electronic medical records without considering the myriad socioeconomic consequences is a big mistake. . ."
MP says NHS IT should be flushed (8 Aug 2006)
The Register
http://www.theregister.co.uk/2006/08/08/nhsit_flush/
"A conservative MP has called for the £12.5bn National Programme for IT (NPfIT) to be scrapped after he saw a leaked report that said the NHS was better off without the computer system. On Sunday, The Observer reported the contents of a leaked report by David Kwo, who had been in charge of implementing the scheme in London. Kwo, it said, had written that "the NHS would most likely have been better off without the national programme". Richard Bacon, MP for South Norfolk, who received the leaked report, called for the NPfIT to be scrapped. "The billions of pounds already spent could have been used to run 10 district general hospitals for a year," he told the Observer. "Now it is clear that patient safety and public health could be at risk. It is time to halt this programme before things get worse." Kwo's report described how hospitals were being "forced" to implement old software, just so it looked like NPfIT was delivering something. The Observer reported that just 12 of 176 major English hospitals had implemented the most basic version of software produced by NPfIT. GPs were implementing their own systems, according to Kwo. He said while NPfIT was meant to join all the NHS's disparate systems together, they were instead "fragmenting further". The National Care Record, the keystone of a conjoined NHS IT system, is also running about two years late, having originally been expected this year. It is being reconsidered, but some means of sharing patient information around the country would have been required whether NPfIT was implemented or not. Connecting for Health, the government body running NPfIT, said in a statement its systems would "ultimately" improve patient care by giving NHS organisations around the country access to all patient information. "Currently, with most existing systems, information stays on the computer where it was originated and can't be accessed by other doctors and nurses to treat patients," it said. It also said GPs were pleased with the systems they were getting under NPfIT and it knew of none who had chosen to implement their own."
Toughest tests still lie ahead for NHS IT: Two core problems threaten the progress of the national programme for health service technology (17 Aug 2006)
Computing
http://www.vnunet.com/computing/analysis/2162411/toughest-tests-lie-ahead-nhs
'Having made it through the Public Accounts Committee hearing relatively unscathed, the £6bn National Programme for NHS IT (NPfIT) faces tests with far greater implications. The data centre failure that knocked out patient admin systems in 80 hospitals this month raises serious questions, not least because backup systems also failed. But they are only ripples on the surface; two far deeper currents are stirring. The first is the doctors. Progress is already being delayed by disputes with the government over reform plans, with the Connecting for Health (CfH) agency running NPfIT over lack of consultation, and between different clinical groups over who owns what data. While discussions are cloaked by concerns such as confidentiality and security, there is more than a hint of politics, and of a turf war over who is the first and final arbiter of the relationship with the patient. The second vital area will be the suppliers. CfH director general Richard Granger was specifically hired from the private sector to broker hard-nosed, commercial deals. He did a good job. The NPfIT contracts pay only on delivery of working systems, and include punitive fines for under-performance and the scope to swap out the weak at any time. . . An optimist might say the suppliers' financial issues are evidence that the contracts are working. But private sector pockets are not bottomless, and only a fantasist would say that implementation delays ' and therefore payment delays ' will catch up in the coming year.'
The good of IT in healthcare: Let's not forget the benefits in spite of poor execution (17 Aug 2006)
silicon.com
http://www.silicon.com/publicsector/0,3800010403,39161603,00.htm
'The NHS IT modernisation programme has received its fair share of criticism. Much of which, granted, might well be warranted - with costs likely exceeding £12bn, a series of rollout delays and scepticism from some doctors who wonder if it's "the biggest government IT disaster yet". But ironically at a Northern Ireland hospital trust outside the remit of the NHS Connecting for Health (CfH) programme, silicon.com has seen just how beneficial IT can be to doctors and patients. The Royal Hospitals Trust in Belfast has rolled out a new wireless network which will be used to share X-rays easily among doctors and to speed up drug dispensing. The trust is even handing out Star Trek-style wireless communicators to staff to facilitate finding and communicating with doctors and nurses when they're needed. . . Of course execution is the big issue and that's where the CfH scheme appears to be stumbling. This publication would never argue that the scheme's organisers not be held accountable for missteps. But let's not get too jaded and forget the good that can come from this - or perhaps this just underscores how essential it is for the NHS to get its IT overhaul right, and the magnitude of the consequences if it does not.'
NHS computer chaos deepens: MP brands electronic link for hospitals and surgeries 'a hopeless mess' as costs rise to £15bn (20 Aug 2006)
The Observer
http://observer.guardian.co.uk/uk_news/story/0,,1854311,00.html
'A multi-billion pound plan by the government to link the computer systems of every hospital and GPs' surgery is unlikely to be delivered on time and may fall short of the NHS's requirements, according to a confidential review leaked to The Observer. . . The government has consistently claimed the project will be fully operational by the spring of 2008. But the review of the software that powers the system, conducted five months ago, suggests this is now in doubt. It notes that there has been 'slippage' in the rollout of the software, provided by Isoft, of '300 per cent'. The troubled firm is providing the software for three of the five regional 'hubs' of the national Connecting for Health IT system. The review, conducted by consultancy firms Accenture and CSC, who were awarded multi-million-pound contracts to oversee the implementation of the Connecting for Health system, notes: 'Critical elements of the plan seem significantly underestimated,' and warns that dates for the roll-out of the software are likely to be 'highly optimistic'. . . The review breaks the project down into 39 parts, each of which is given a colour grading. 'Red' requires immediate work, 'amber' suggests there is a potential risk and 'green' indicates there is no problem. Of the 39, 13 are classified red, 21 amber and only five green. The review identifies the issue of clinical safety under the current Isoft system as a 'red' problem. It notes the firm has appointed a director of clinical safety in response to the concerns, but that he could not 'articulate the time frames for establishing a clinical safety team given the current financial climate within Isoft' - a reference to the company's financial problems which have caused its share price to collapse. The report is extremely critical of Isoft's ability to build a system to meet the NHS's needs. It notes that 'programme planning... is based on unrealistic assumptions that drive unachievable plans that ultimately fail to deliver on time'.'
What price the NHS computer upgrade from hell? (27 Aug 2006)
The Observer
http://observer.guardian.co.uk/business/story/0,,1859032,00.html
"What are the lessons to be learned from the unfolding fiasco engulfing the £12bn NHS computer upgrade? It is a large and complex programme designed to hold the records of 30 million patients, one of the biggest projects of its kind, so it needed to be thought through properly. And the users - the consultants and clinicians - should have been widely consulted. Neither seems to have happened, demonstrating the propensity of government to throw taxpayers' money down the tubes. If everything was going smoothly, why would Accenture, one of the key suppliers, have written off $450m because of delays and glitches that have left its executives seething? Within the NHS, there are stirrings of discontent as fears grow that hospitals may be signing up to something they don't want. The Sheffield Teaching Hospitals NHS Foundation Trust, for example, recently announced it was abandoning one leg of the programme. The troubles at financially stretched iSoft, which is providing some of the software, illustrate what can happen when one firm's fortunes are so closely tied to a single client. They also highlight the need for careful project management, sadly lacking in this instance. It is difficult to escape the feeling that this project is being rushed with unrealistic deadlines (no one seriously believes that it can be completed by 2008) and that targets set for suppliers are too tough to meet. Perhaps the writing was on the wall at the start when IBM pulled out of the bidding - wary, no doubt, about the ability of government to execute such an ambitious task. If IBM, or 'big blue' as it is known in the US, was alarmed about the intricacies of the programme, perhaps others should have drawn their own conclusions. If Accenture decides to quit, as is widely expected, we should be concerned: this is a company which generates tens of millions of pounds from government contracts - and would bend over backwards not to upset one of its most important customers. The NHS computer programme, championed by the Prime Minister, is a wonderful idea in theory. It allows electronic access to patient histories around Britain, making it simpler for people to choose where they have treatment and easier to treat those who fall sick miles from where they live. But with forecasters now saying that the true cost of the upgrade could top £30bn, the question has to be asked: at what price?'
IT deals are failing public services (29 Aug 2006)
The Guardian
http://politics.guardian.co.uk/publicservices/story/0,,1860168,00.html
"As someone who was involved in NHS computer system design for nearly 20 years, the latest news, although sad, comes as no surprise (Ex-CBI boss caught up in NHS fiasco, August 26). We were told in 2003 that the contracts for the local and national suppliers were "so tight that the suppliers couldn't wriggle out of them". My response at the time was that if that was the case, the directors would walk off with pocketfuls of money while leaving the companies to founder and their staff searching for new jobs as soon as the going got tough. However, even I am slightly surprised at the amounts these directors have creamed off. My colleagues and I attended many meetings in which the cream of consultants from the supplier companies and their advisers dismissed the painstaking and thorough analytical work that had gone on within the NHS for many years as "science fiction" and "over-complex", before going on to adopt simplistic solutions which were under-researched, had no meaningful clinical input, and were based on naive assumptions which may be adequate in a commercial environment but were totally inappropriate to the multi-layered, multi-disciplinary and culturally disparate environment which is the NHS. We are now seeing the inevitable results of that inept design, which is unable to meet even the most minimal requirements of patient confidentiality and is so fragile that a simple power failure creates days of chaos for many hospitals. I take no pleasure in these failures, but my main concern is that no one is learning from them and we seem doomed to continue with the same flawed model of procurement. Meanwhile, those systems which were built in and by the NHS many years ago continue to reliably provide the basic IT infrastructure which keeps the whole thing running.' [Ian Soady, Former chair, NHS Information Authority]
MPs urge rethink of NHS records project (31 Aug 2006)
The Independent
http://news.independent.co.uk/business/news/article1222861.ece
'The controversial programme to upgrade the National Health Service's IT systems has suffered another blow after two MPs called for an overhaul of the project yesterday. Richard Bacon, the Conservative MP for South Norfolk, and John Pugh, the Liberal Democrat MP for Southport, argued that the programme should be reformed to allow hospital trusts to purchase systems locally that can then be linked into the national network. Both MPs are members of the Commons Public Accounts Committee that reviewed the programme in June. The pair said that the project's "fundamental error" was to centralise the procurement of single systems across the NHS. "The Government is convincing no one that the situation is under control. The national programme for IT in the NHS is currently sleepwalking towards disaster ... This programme is costing taxpayers a king's ransom, but is descending into chaos," they said. A Department of Health spokeswoman rejected their claims. . . '
Brampton Factor: NHS IT - can this project be saved? The prognosis looks poor... (19 Sep 2006)
silicon.com
http://www.silicon.com/publicsector/0,3800010403,39162536,00.htm
". . . what are the main reasons for pessimism with regard to NHS IT? The most damning evidence is the failure of the project to maintain the confidence of those who will use it in their daily lives. Their view has increasingly been that the project is driven from the centre and will not deliver what is needed. Surveys of NHS staff are showing decreasing buy-in and senior doctors have been publicly critical. The National Audit Office has been driven to comment on the lack of staff commitment. . . Another crucial area that is too readily dismissed by sponsors of the project is security, and in particular the interests of individual patients. Most people probably still think of their relationship with doctors as one of strict confidentiality. That is how most doctors would like it to be. A number of changes have seriously undermined that position. Changes to greater reliance on electronic systems have shifted the ownership of data away from doctors towards administrators, who are much less constrained by ethical commitments. With ever increasing centralisation, data becomes the property of faceless bureaucrats. . . Recently doubts have been cast on whether patients will be permitted any kind of opt-out from this all-embracing approach to personal data. Of course plenty of bland assurances are given about how information will be kept secure. But with leaks from banking or criminal records systems commonplace, it is highly unlikely those promises can be met. Another problem is the accuracy of records, notably illustrated by the case of Helen Wilkinson who had to go to parliament to get a potentially damaging slur in her records removed. What, then, of the financial issues? . . . A delayed and over budget project is doubly damaging - the excess costs are painful but the delay in the benefits makes the situation far worse. . . So what do we learn from all this? Unfortunately very little that is new. Imposing sweeping change on a large and complex organisation from the centre has a poor likelihood of success - especially where large numbers of professional staff are involved. Excessively centralised systems are brittle and fail easily. Consultants do not deliver value unless they are exceptionally well managed. Senior management frequently fails to understand how organisations really work. The NHS is not a business, and it is a nonsense to treat it as one. Government cares little for the security of personal data. What kind of solutions are available? We would be much better off with more diverse provision of IT services to the NHS, which actually has many varied needs. Efficiency gains would be achieved more readily by the setting of standards for data exchange rather than the imposition of all-embracing systems. Incremental improvement is a more reliable way to achieve gains than a big bang. And open source solutions, as used effectively by the US Veterans Health Administration, have huge potential for gain - both through cost cutting and also through opening up developments to greater diversity and innovation. Will any of this happen? With the current posturing by leading politicians, and numerous signs of blame-passing around NHS IT, the prospects are poor."
openEHR and HL7 ' some thoughts on the current discontents (21 Sep 2006)
openEHR
http://www.openehr.org/about_openehr/t_21_sep2006_DI_commentary.htm
". . . Unfulfilled aspiration for health IT has created a poker game of ever increasing stakes of ambition, resource and emotion, drawing in an ever wider range of stakeholders, to the top policy levels. Just look at the Commonwealth Fund web site in the States or view on the web the recent Public Accounts Committee hearing on CfH, in the UK. I've been around the debate a long time and have learned that the three things that matter, as I've said before, are implementation, implementation and implementation! The problem with standardising, top down, before doing, is that one tends never to have time to do, and learn well through doing. The problem with doing, bottom up, before learning how to standardise, is that one tends to spend a lot too much time and money, creating eventual ultimate havoc of incompatible legacy. This complexity can only be reduced to tractable levels through starting again, while problems of integration remain elusive. I see the waste and despair that creates in the healthcare workforce. It's a Catch 22; I can chart five reinventions of a national programme for IT, within the NHS, in my career. At its heart, all of this is a debate about emerging discipline, notably in medicine and computer science and at their interface. It's hard because that discipline has been sorely lacking on all sides and in their intersections. No one's fault, really, but shameful, all the same, that through diverse confusions and confabulations, the protection of the multi-billions that are now spent on not serving well the information needs of healthcare, end up with money mainly directed, largely unwittingly, and not in any sense by stupid people, in ways that have still failed to reach or be allowed near the heart of the matter. That is where considerations of quality, information and governance intersect in providing health services that people trust and value. In such circumstances, there are problems best approached through simplifying and withdrawing resource; Fred Brooks and his concept of the mythical man-month is salutary. . . There is a log jam in health IT. A memorable paper claims that sorting out health care data is an $80billion per annum problem for the US economy. In some sense, we believe that it needs to be transformed to a problem perhaps an order of magnitude less than that in monetary terms. . ."
Government must learn to curb its enthusiasm (27 Sep 2006)
The Guardian
http://society.guardian.co.uk/serviceofthefuture/story/0,,1881490,00.html
". . . Tony Blair has been keen on electronic government, or "e-government". He promised to make all services available electronically by 2005, a target the Cabinet Office said earlier this year was met by 96% of central government services: the likes of burial at sea were deemed unsuitable for "e-enabling". But along the way, it has developed a reputation for botching IT projects. . . Critics say the scale of contracts can put the government at the mercy of the handful of companies big enough to compete for them. The English NHS National Programme for IT tackled this by offering several contracts, both national and regional, worth more than £6bn in total, although NHS trusts are expected to spend billions more. This provides Connecting for Health, the managing organisation, with some power over suppliers - a few have been replaced - and it is also paying by results, which has contributed towards financial difficulties at suppliers including UK software firm iSoft. "The government's learning from its mistakes on this one," says John O'Brien. But the National Programme, which faces two-year delays on some projects and is about to be re-examined by the National Audit Office, has other problems, particularly in creating electronic patient records for everyone in England. The government is increasingly advancing big databases containing the personal information of millions as a solution to problems. These include the Identity Card Act's National Identity Register, holding dozens of pieces of information on every adult, and an index of children in England, which will allow practitioners to share abuse concerns. Building these may be challenging, but the real test could come over the next few years as such databases go live. Last May, the Information Commissioner detailed the lucrative trade in personal information, where employees are bribed or tricked into providing data to criminals who sell it to insurers, creditors, other criminals and journalists. Following that report, the government is consulting on imposing prison sentences for this crime, but with thousands of staff having access to each new database, security may be a headache. "You can't have security, functionality and scale from one IT system," Dr Brian Gladman, formerly of the Ministry of Defence and Nato, told a conference in August. "One of them has to go." The dangers, as well the opportunities, could be amplified by government proposals for greater sharing of personal data within the state-sector, to enable joinedup administration. Again, the government is blazing its own trail: many other European countries are wary of such sharing, given the terrible ways they have seen this abused within living memory. Tony Blair has been a cheerleader for IT without being an expert. "Like many people of my generation in positions of leadership, I rarely use a computer and when I do, I usually need help," he said in 1999, adding that he planned to take a computing course. . ."
Increased risk may put companies off public IT projects (3 Oct 2006)
The Times
http://business.timesonline.co.uk/article/0,,9068-2385376.html
"FAILINGS in the £14.5 billion market for public sector IT projects are to be examined in a new study that comes after the controversial exit of Accenture from the NHS super- modernisation programme. Next year, the Office of Government Commerce (OGC) is to research the issues and constraints that could have an adverse effect on the delivery of IT projects in the public sector. Its decision comes after the publication of a joint pilot study by the OGC and the Cabinet Office, which concluded that increased risk, combined with onerous terms and conditions for suppliers, could stop companies tendering for work. Companies questioned for the study included all four key suppliers on the Government's £12.4 billion NHS IT modernisation project ' BT, Fujitsu, Computer Science Corporation and Accenture. Last week Accenture quit the project, which has been hampered by delays, glitches and political wrangling. The company transferred the bulk of its contracts to a rival after making a £240 million provision against potential losses. The pilot report will give further ammunition to critics of the NHS project, who argue that its problems stem from the determination of Richard Granger, who heads the project as chief executive of Connecting for Health, to avoid the problems that beset previous government IT projects by shifting much of the risk on to service providers. Critics say that this strategy makes the work financially impossible for suppliers. . ."
NHS IT project is force for good and worth the pain so hush the critics (24 Oct 2006)
Computer Weekly
http://www.computerweekly.com/articles/article.aspx?liArticleID=219292
"The media has been full of comment on the "problems" at the NHS IT project as Accenture ducked out. Yet again, the comment portrayed the project as a "disaster" - indeed as "yet another public sector IT disaster". . . I have yet to meet anybody who opposes the overall objective of the NHS IT project. When it is fully implemented it will be a major force for good. It will save lives. I have little doubt that it will be looked upon throughout the world as a model to be followed. Achieving that objective will cause pain. Anybody who has ever been involved in any project - big or small - knows that. . . I have written many articles over many years against the concept of what I dubbed "one-sourcing" - ie. putting all your eggs in one supplier's basket. Indeed I would stake a claim on being one of the first to advocate "multi-sourcing". NHS IT is the most advanced example of just that. Accenture failing and CSC picking up the pieces is an example of the benefits of the approach, not of its failure. How many times have you read of public sector contracts failing and us, the taxpayers, picking up the costs of that failure? How many times have "one-source" suppliers been able to extract huge extra sums from the government to correct their own failures? Granger went out of his way to avoid, or at best minimise, this possible eventuality on the NHS IT project. Why doesn't that major advantage (or indeed any of the other advantages) ever get highlighted by the media? . . . Of course, I too can write much about the mistakes made in this project. I have long criticised the lack of early involvement and commitment from the medical profession something which the project was far too slow to address. The plan to sweep out all the existing systems and suppliers was also misguided. . . The government too must accept criticism. It was naive to believe or announce that the only costs of the project were those related to its procurement. Training and implementation has cost much more than the initial procurement costs in every IT system I have ever been associated with. The timescales imposed on this project, as ever, were initially for political expediency rather than having any relationship to common sense." [Richard Holway, Director, Ovum]
NHS IT project should not be at the expense of patients or of the media's independence (24 Oct 2006)
Computer Weekly
"Computer Weekly agrees with several of the points made by Richard Holway - for example, that health officials should be applauded for trying to stop suppliers from ripping off the NHS and taxpayers. And there are other advantages of the National Programme for IT (NPfIT). Hospitals that had cumbersome, unreliable and old green-screen technology are having it replaced under the NPfIT. A new broadband network has been installed, x-ray systems are being rolled out - though this was happening before the advent of the NPfIT. . . But the main purpose of the £12.4bn spend on the NPfIT is not to show how well suppliers can be managed, or to put new technology into ambulances, whatever the undoubted benefits. A key objective of the programme was to deliver an electronic health record for 50 million people, accessible by any authorised user across England. At a meeting last week of health IT experts, the audience was asked whether the chief objective of the NPfIT should still be the delivery of a national electronic health record. No hands went up. Some thought it better to work towards a less ambitious scheme, to deliver a reliable and easily accessible local electronic medical record rather than a national care records system which may not materialise. This brings to the fore one of the main concerns about the NPfIT: that nobody has any real idea whether it will meet its original objectives, or whether some of those objectives are now obsolete. An independent review could ascertain whether the NPfIT will deliver what the NHS needs. But Caroline Flint, minister for public health, has rejected the call by 23 leading academics for an independent review in part because she says there have already been many internal assessments of the NPfIT. She has refused to publish all of the reports, which raises suspicions that much is being hidden - or worse, that there is much to hide possibly the fact that the programme as originally configured by the government in early 2002 was fundamentally flawed. . . We are also concerned at suggestions that the NPfIT is Richard Granger. Without Granger's impressive drive and conviction the programme is more likely to disintegrate but the programme was conceived many months before he joined, on the flawed basis it would cost £5bn and take less than three years. The NPfIT is a programme involving ministers, officials and thousands of NHS sites and people. It does not belong to one man."
Chris Patten: Politicians have no grasp of technology (26 Oct 2006)
ZDNet UK
http://news.zdnet.co.uk/internet/security/0,39020375,39284350,00.htm
"The former governor of Hong Kong has waded into the debate around lack of tech knowledge amongst politicians and its effect on government IT projects. Former Tory politician Chris Patten has said that a fundamental lack of understanding in government is to blame for a rash of ill-thought-out technology projects and related legislation in recent years. Lord Patten of Barnes was especially critical of the government's ID card scheme, which is heavily reliant on technology. Speaking at the RSA Conference Europe on Wednesday, Patten said the scheme would not achieve one of its possible objectives of making borders more secure. "I don't think ID cards make citizens more secure, or frontiers more secure. People would still have been blown up on the Tube last July if they'd had ID cards," he said. He also criticised the support given to ID cards in 2003 by the then Home Secretary David Blunkett, calling the scheme a "populist Pavlovian Blunkett twitch". Blunkett resigned from the cabinet in 2005 over his involvement in political scandals. Patten, a former EU Commissioner, was speaking at the three-day conference in Nice, France, on European business and technology. Many politicians don't understand the technology issues that could affect government IT schemes, he said. . . Privacy campaigner Simon Davies, chairman of No2ID, agreed politicians aren't in touch with the issues underlying the technology issues they legislate on, and criticised the conditions in government that have allowed the situation to come into effect. "Prime ministers and home secretaries are notorious for grandstanding on technology issues, while at the same time having difficulty setting their video recorders at home," said Davies. "The NHS programme for IT and the ID cards scheme both stand as a testament to the government's complete failure at forward planning [in technology schemes], and its inability to understand technology in the real world," Davies added. . ."
Government IT: What happened to our £25bn? (30 Oct 2006)
Computer Weekly
http://www.computerweekly.com/Articles/2006/10/30/219476/government-it-what-happened-to-our-25bn.htm
"In 1969 the UK civil service began experimenting with large and complex schemes to use computers to standardise the running of central departments - the results are still keenly awaited. Learning few of the lessons from the 1970s and 1980s, namely keep IT simple, ministers and civil servants have continued to launch ambitious and subsequently notorious schemes to help manage payments of child support, tax credits and farming subsidies, the issuing of passports, collating intelligence for the Ministry of Defence, and the handling of police suspects. Market researcher Kable said that £15bn a year is spent on public sector IT, £2.6bn of it by central government in 2005/2006. Over the 40 years since central government has used computers in earnest, the money spent on IT is thought to be far in excess of £25bn - about £400 for every man, woman and child in the UK. This huge spend has served a few major suppliers well. . . However, suppliers have not always had their own way. The Department of Health in 2002 appointed Richard Granger as director general of NHS IT, and he has managed to stop suppliers beaming all the way to the bank whether they delivered or not. There are other positive developments in the way civil servants have managed projects in central government over the past four decades. . . But the innumerable, unsung successes are dwarfed by Whitehall's taste for the dark side of computing: the overly large and complex projects which have limited support from potential end-users, and which trudge on for years without hope of justifying their cost. . . In 1984, MPs were concerned about a proposed project called the Operational Strategy, the objective of which was to bring new advanced levels of automation to the payment of welfare benefits. . . MPs were sceptical that Opstrat, as the Operational Strategy was called, would ever work or stay within budget. Camelot, a previous benefits project, had failed at a cost of £12m. . . But the lesson of not being too ambitious was not then fully understood. Camelot cost £12m and Opstrat would cost about 60 times as much - about £700m. . . . One would like to think that the mistakes of the past few decades would have made ministers and mandarins paranoid about launching any more overambitious IT schemes. The opposite has happened. . . The Department of Health has launched the world's biggest non-military IT-based programme, the £12.4bn National Programme for IT. It has been marred by shortages of skilled staff, an underestimation of total costs and over-optimistic statements by ministers on when systems would be delivered. Officially it is already a success. The private sector has its disasters - but over the decades one can see that corporate victims tend not to repeat major failures. If anything a large-scale failure encourages boards to think small next time. It is unlikely that ministers and mandarins will ever enjoy thinking small when it comes to IT, not while a significant part of the IT industry depends so heavily on the public sector's love of high stakes gambling."
The importance of our right to know (30 Oct 2006)
MediaGuardian.co.uk
http://media.guardian.co.uk/mediaguardian/story/0,,1934601,00.html
"Freedom of Information has many uses. One of the most important is that it shows where public services are broken and need fixing. A sensible government would focus on these problems and set about fi xing them. A bad government would prevent people from uncovering problems in the first place, ignore problems when they come out, and persecute anyone with the gumption to talk about the problems publicly. Bad government is ruled by secrecy and that's what we've had in the UK for decades. Decisions made in secret do not lead to good value for money or good public services. A stream of disasters from the BSE crisis and the Marchioness ferry sinking to the Millennium Dome and Child Support Agency all attest to the costs of secrecy both in terms of human life and public money. All that was meant to change with the introduction of the Freedom of Information Act. Sadly, it didn't take long for New Labour politicians to renege on their promise to empower the citizen. The act was watered down and passage delayed for fi ve years. Nonetheless, for almost two years we have had a weak right, weakly enforced to ask questions of our public officials. To a government obsessed with spin, however, any information not "managed" is considered dangerous. And so the Lord Chancellor has announced the results of a consultation into open government that took place in secrecy. Not surprisingly he wants to make it harder for people to ask questions. Of course, politicians can't come out and say that, so the killer kick to democracy is couched in terms of cost, claiming it's too expensive to answer FOI requests. Politicians instead prefer to spend taxpayers' money on propaganda to convince us that something that is obviously broken works perfectly. The Home Office is a good example. Or the NHS IT programme. Or costings for identity cards. If as much energy was spent solving problems as attempting to spin them away, then these problems probably wouldn't exist. . ."
You can't sue unless we say so,' trusts told (31 Oct 2006)
Computer Weekly
"NHS trusts hit by delayed or troubled implementations under the £12.4bn National Programme for IT (NPfIT) have begun seeking compensation. But they have been told they cannot seek legal redress from suppliers without the government's specific consent. Computer Weekly has also learned that some boards of trusts that have sought compensation have received none so far. As part of the NPfIT, participating trusts are expected to spend at least £3.4bn locally on implementing systems bought by Whitehall. Trust executives operating outside the programme can turn to their contracts with suppliers to seek legal redress for poor systems or software. But for systems bought under the NPfIT, trusts are only third parties to the main NPfIT contracts, which are between the government and the principal suppliers - BT, CSC, Fujitsu and Accenture. To sue suppliers, trust officers have learnt that they need the specific consent of the secretary of state for health, who holds the contracts with the NPfIT's main suppliers. . ."
Agency in charge of NHS computers may be scrapped (8 Nov 2006)
Daily Telegraph
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/11/08/nit08.xml
"The Government has admitted that Connecting for Health, the Department of Health agency in charge of its disastrous NHS IT programme, could be scrapped. The admission comes amid growing alarm in the Government at the spiralling cost of the programme which is likely to end up at £20 billion ' £7.6 billion more than its original budget. . . Connecting for Health is under increasing pressure. John Yard, a respected former head of IT at the Inland Revenue, has been parachuted in by the Office of Government Commerce, a unit of the Treasury, as an adviser. It is understood that in recent weeks senior policy advisers at 10 Downing Street have suggested that IT contractors should bypass Connecting for Health and deal directly with the hospital trusts. Sources close to the programme said ministers were desperate to get a grip on the programme. . ."
IT project accused of bullying (9 Nov 2006)
Health Service Journal
http://www.hsj.co.uk/healthservicejournal/Search.do?dispatch=showPage&pageId=7482&page=0
"Managers have attacked the Connecting for Health IT project for 'bullying' people into talking down problems on the ground. West Herts primary care trust IM&T service manager Roz Foad was among speakers at an IT conference who criticised the scheme to create an NHS-wide clinical computer system. She told HSJ: 'There is a bullying aspect to Connecting for Health.' Local staff felt unable to voice their concerns, she added. 'We are not allowed to put out anything that is not spin, but the only real progress that is being made is with existing systems.' Ms Foad told the audience of managers and IT contractors that CFH was disrupting the work of GPs and PCTs at a time when trusts were already under huge pressure due to mergers and redundancies. Barnsley PCT chief executive Ailsa Claire said the project was focusing on the wrong issues. 'The largest users of our services are elderly people who need integrated health and social care records but that is very far down the agenda.' NHS modernisation aimed to provide patient-centred care, she believes, but CfH did not follow that ethos. 'These systems are designed to be efficient for businesses to talk to each other, not for clients to control their own care,' she said. . ."
Health service IT boss 'failed computer studies' (12 Nov 2006)
The Observer
http://observer.guardian.co.uk/uk_news/story/0,,1946060,00.html
"Mother of NHS computer chief casts doubt on her son's credentials. The expert in charge of the government's ailing £12bn computer modernisation programme for the NHS might expect to face criticism from IT experts, disgruntled doctors and even political opponents. But this weekend, it was his own mother who revealed he failed his university computer studies course. Richard Granger, the tough 42-year-old management consultant who runs the government's Connecting for Health project, initially failed his computer studies course at Bristol University - and took a year off as a result. He was only allowed to resit the exam after she appealed on his behalf, and he went on to gain a 2:2 in geology. His mother, Mary Granger, spoke to The Observer about her surprise at her son's role in the ambitious initiative that was supposed to transform the NHS's computers and allow patient records to be kept electronically. She hasn't spoken to her son for 10 years after a family row, but she is now campaigning to save the local hospital in Huddersfield, West Yorkshire, which is losing some services to another local trust, and believes the computer modernisation plans are a gross waste of money. . ."
Prescription for an I.T. Disaster? (13 Nov 2006)
Baseline
http://www.baselinemag.com/article2/0,1540,2058194,00.asp
A very extensive account, from an an American source. Contents: "A Bold Vision: Lifelong Electronic Patient Records; In the Beginning, Bill Gates Pitches Tony Blair; Selecting Suitable Vendors; What's Ailing the Project?; Waiting for Lorenzo: Software Needs Major Surgery; Health-Care Executives Under Fire; The Players Under the Microscope; Calculating Costs of a Runaway-Project Recovery; Technologies That Promise a Cure; A Time Line of the Project's Progress (and Lack of It)"
Richard Barker on why the IT programme is never going to come right (13 Nov 2006)
Health Service Journal
http://www.hsj.co.uk/healthservicejournal/AdvancedSearch.do?dispatch=showPage&pageId=7521&page=
"Just who is going to accept responsibility for the fiasco that is the national programme for IT? The government's much-vaunted technology led overhaul of the NHS is in chaos, with Accenture, the biggest and most successful lead contractor, responsible for two of the five regional programmes having recently withdrawn from the project. Deadlines have been repeatedly missed and projects undelivered. Yet prime minister Tony Blair has now announced that further funding, on top of the recent revelation by the National Audit Office that the expected cost had doubled to £12.4bn, will be made available if necessary to get NPfIT back on track. In the meantime, leading academics and industry commentators continue to predict that escalating project costs will see the final figure anywhere between £20bn and £40bn. NPfIT will never get back on track; it was never on track in the first place. It breaks every rule of project management - from scoping to delivery - and is patently failing to take into account the actual requirements of clinicians across the NHS. . . The manifest failure of NPfIT to have any impact on the problems facing those at the front line of patient delivery is a disgrace. For five years the NHS has endured a technology moratorium as those tasked with NPfIT have thrown money at over-complex network infrastructures yet failed to address the pressing issues facing clinicians. . . The NPfIT concept may have been created with the best intentions, but before more valuable investment is thrown at organisations that have yet to prove their competency in this area, isn't it time for some answers?
Richard Barker is managing director of Sovereign the software provider to the NHS before the introduction of the NPfIT. Sovereign was too small to bid for NpfIT contracts, but was among those to whom the successful contractors outsourced their roles."