General Warnings and Advice

From Nhs It Info


More Radical Steps (2003) Initiatives (Jul 2003)

BCS Health Informatics Committee

"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

"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

"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

". . . 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

". . . 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)

"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

"[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)


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.

"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

"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

". . . 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

". . . 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

"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

"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

"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

"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.

". . . 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

"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

"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)


'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),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, 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,,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,,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,,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

'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),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)


". . . 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,,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,,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

"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,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

"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),,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'You+can't+sue+unless+we+say+so,'+trusts+told.htm

"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

"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

"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,,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)


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)"

Text of full article

Richard Barker on why the IT programme is never going to come right (13 Nov 2006)

Health Service Journal

"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."

Whitehall warned on IT glitches (17 Nov 2006)

BBC News

"The National Audit Office has outlined ways in which bosses can avoid a repeat of the glitches that have plagued some recent government computer projects. Its findings come after a series of high-profile delays involving public sector IT schemes. These include the £6.2bn upgrading of NHS computer networks, as well as a new IT system for the Child Support Agency. It says public sector bosses need to show more leadership in such projects, but it also points to good examples. . ."

NHS IT disaster (18 Nov 2006)

Daily Telegraph

Letter to the Editor, from Dr John Lockley, The iSOFT GP User Group

"Sir - James Herbert (Letters, November 10), the spokesman for NHS Connecting for Health (CfH), says that it is "unfair" to describe the national programme for IT as disastrous. Our members ' who currently use very advanced GP software ' would disagree. Despite the fact that Britain leads the world in medical IT and that primary care IT in Britain is significantly ahead of hospital computing, CfH initially treated existing GP software as the problem, not the solution. Yet the first GP systems that CfH proposed were so lacking in functionality that they would have resulted in a seven-year step backwards for the more IT-aware practices. . . "

How will IT be paid for? ask doctors (28 Nov 2006)

Computer Weekly

"Sixty-six per cent of doctors believe there are not sufficient funds in their NHS area to properly implement the National Programme for IT (NPfIT), according to the latest Medix survey. Although £6.2bn of IT contracts are being paid for centrally by NHS Connecting for Health, an agency of the Department of Health, the local NHS is still expected to find funding for training, business process re-engineering and some technology upgrades. Of the 1,000 doctors responding to this month's survey by healthcare online research organisation Medix, 28% said they disagree and 38% said they strongly disagree that their NHS organisation would have sufficient funds to enable it to properly implement the NPfIT. The findings come at a time when the government has announced that the NHS is expected to suffer a £94m deficit for 2006/2007, although strategic health authorities are expected to find a contingency of £100m to cover this deficit. . . "

One more year - many more software project failures (Nov 2006)

BCS Review 2007

". . . The NHS programme: Given the size and scale of this programme and the amount of press it has attracted, it feels inappropriate not to discuss it here. The reporting of this programme has largely been negative, which is understandable, but this is one of the largest civilian IT change programmes in existence; why did anyone expect it to run smoothly? The really interesting story behind the headlines is the business of contract structure and the level to which risk has been transferred to the suppliers. The NHS has procured these systems at a fixed price and does not pay until services are proven to have been delivered and working. All very laudable, but this places some very high cash flow demands on each of the suppliers that could lead to some painful future consequences. Only huge corporations can afford to bid for this kind of contract and only a tiny number of the UK-based system integrators (SIs) have the financial strength to run with this kind of deal and the inevitable problems that arise. Contracts of this nature create a 'hard edge' to the relationship between the customer and supplier, often reducing the collaboration between them. When you consider that most project failures have strong roots in poor requirements and that collaboration is key to success in this area, I can't help thinking we are going to see more failures in the future. The interesting thing about failures in this context is that they could have sufficient critical mass to seriously damage or even bring down a supplier, an outcome that will benefit no one. . ." [Andrew Griffiths]

Transformational government: a supplier's view (Nov/Dec 2006)

National Computing Centre

". . . The perceived inability to get departmental systems working is demonstrated time and time again e.g. the tax credit system in the Child Support Agency. The real issue here is the temptation to impose systems on users in support of modernisation and transformation initiatives without full consideration for the needs of the citizen and the front line staff supporting them. Working practices are often dictated from the top down according to the needs of the new systems not vice versa. . . The IT landscape of public sector organisations is a complex mix of systems, people and processes representing years of evolution. To create a strategy that will successfully enable implementation of the Government's transformational agenda requires an understanding and acknowledgement of all these factors and the value each one brings - as well as the cost it incurs. Only then, from this position of understanding, can a strategy that fits the organisation be created. As competition gets tougher there will always be a willingness to take on tougher contracts. Few suppliers will take these on without undergoing significant due diligence and understanding the commercial risk. Tougher contracts [like Richard Granger's NHS NPfIT contracts] however are rarely the reason for failure of the supplier to deliver the project. The contracting body must realise or accept that large-scale modernisation programmes will, by their very nature, change over time and make allowances for change in the contractual terms. Once contracted to, these terms should be honoured by supplier and customer alike. Failure to work to robust, transparent change-control mechanisms will ultimately result in a failed programme or the withdrawal of the supplier. . . Getting true consultation with the frontline users can be difficult. For example, Richard Granger claimed to have consulted 2,000 clinicians in the run-up to the NHS's Choose and Book system. But, from the squeals that were heard from GPs and hospital doctors when the scheme was released, one wonders whether he had consulted the right 2,000, or in sufficient depth. Will suppliers continue to have any appetite to bid for major government business, when they see so many projects fail for reasons not within the suppliers' control, and within the public sector's pervasive blame culture? The withdrawal of Accenture from the NHS NPfIT project is a case in point. Suppliers and civil servants always have to calculate the effect of a change of government. Projects may be cancelled or heavily modified. As an election gets closer, or even a change of Prime Minister, commitment to radical transformation may wane. . ."

The Way Forward for NHS Health Informatics (15 Dec 2006)

British Computer Society

"The changes in direction required: The fundamental goal is to support diverse business processes that recognize local constraints and individual patients' health beliefs and values. . . Instead of the current monolithic systems intended to meet most of the needs of users in a local health community, we need a range and choice of more innovative and agile solutions. These should contribute to a common purpose, encouraged within national standards to deliver functionality in whatever way suits the users and suppliers. This should not be interpreted as ruling out adoption of LSP products where they fit the business requirements. . . Implement at Trust level and below, where most sharing of information is required and where most of the gains are to be had. . . To achieve local implementation, it is necessary to persuade local NHS staff (including management) at Trust level and below that informatics is part of the answer to their problems and not an expensive irritation and preserve of the specialist. . . While acknowledging that some existing systems are no longer fit for purpose and need replacing, the approach should be to build on what presently works and to encourage convergence. This is particularly apt in general practice. . . NPfIT needs to decide what the National Care Record Service is and to communicate this clearly to the NHS. Is it (a) a physical IT concept ' a comprehensive patient record held in its entirety in one or more national databases; or (b) an information concept ' pulled together ephemerally (on demand in real time or by regular extraction processes) from disparate patient record databases and presented for a single instant for a specific user, or (c) a mixture of both? . . . If patients do not feel comfortable with the confidentiality of their data, they will not allow significant information to be recorded or will withhold it, so informed patient consent is paramount. In either case, their care will suffer as a result. On the other hand, care that is appropriate and safe can only be provided if certain types of patient information are shared. . . The NPfIT is ultimately intended to provide vastly increased amounts of patient data for secondary purposes, including NHS management, planning and research. So although the associated confidentiality issues have been with us as long as electronic patient data has been available in significant quantities, the requirement to tackle them is now more urgent than ever. People using patient data for secondary purposes should obtain patient consent to use personally identifiable data or should only be able to use anonymised/pseudo-anonymized data. . . Cost-efficient procurement is necessary but not sufficient. Issues remain with NHS and supplier capacity, capability and affordability (which may be exacerbated by NHS CFH cost-shifting driven by DH central budget cuts). . . Many thousands of patients move between the UK home countries for, or during, treatment every year, and some at least of their patient information needs to accompany them. Any strategy adopted by NHS CFH must be capable of supporting these cross- border treatments. To do this, certain basic informatics elements should be standard across the UK. . . To flourish, NHS CFH and its suppliers must be open to, and acknowledge, the challenges and problems they face. In reality, failure is only complete when we do not learn from it."

BCS Press Release summarising the above report -

Confidential NHS paper on the health of the National Programme for IT (21 Dec 2006)

Computer Weekly - Tony Collins' Blog

"Published exclusively on this blog is a confidential NHS paper on the £12.4bn National Programme for IT [NPfIT]. The paper is important because it is an objective analysis of the strengths and weaknesses of the NPfIT by senior IT executives on the front line. Its authors work for the Leeds Teaching Hospitals NHS Trust, which is the largest NHS trust in the UK. At Computer Weekly's request, the Leeds Teaching Hospitals NHS Trust has kindly allowed this blog to make the paper available. First I have reproduced some excerpts from the paper. Second I comment on some specific parts of it. Then the paper is reproduced in full. . . My comments on specific parts of the paper: I have not seen it stated so clearly in an NHS board paper that there has been shrinkage in the scope of the national electronic patient record. No announcement has been made on scaling back of the original plan. The electronic patient record is the chief objective of the £12.4bn NPfIT programme. Innovative systems are welcome but if such initiatives are under-funded and over-ambitious this suggests they are high risk and may fail, in which case this underlines the need for more accountability and visibility, ideally in the form of an independent, published review. Also I have not seen it stated so clearly before in any trust board paper that the pressure on the budgets of the Department of Health has increased costs to the NHS. If more costs are transferred to the NHS from the centre, this could make the local implementations unaffordable in the medium and long term. Again, it's a cause for concern, and a further reason for an independent review of the programme. . . It is more than four years since the national programme was launched and nearly three years since contracts worth £6.2bn were signed. One would have expected clear plans for an electronic health record to have been finalised long before now. Nobody reading the Leeds paper should continue to have a Panglossian view of the national programme."

Re:Viewing 2006: The year in the public sector (21 Dec 2006)


"Two massive and highly controversial projects have dominated public sector technology news in the last year - ID cards and the NHS IT. In both cases, despite a strong start the year, with the government insisting it has learned the lessons of previous tech disasters, it appears those old habits die hard. . . For the giant £12bn NHS IT project, it's been another mixed year. While there has been progress on an number of fronts - such as digital X-rays - probably the biggest news was Accenture which decided to pull out of two massive contracts. Accenture was awarded the two contracts to be the local service provider (LSP) for the East and North East regions back in 2003 but will now hand over the work to CSC, which is already an LSP for the North West and West Midlands regions. As part of the agreement Accenture will get to keep £110m of the £173m it has been paid by the NHS to date for its work on the CfH contracts, and is due to hand over its delivery obligations to CSC by 8 January 2007. . . It's probably worth noting that the Accenture exec who was responsible for the company's £2bn contracts for the NHS IT programme is the same James Hall who is now head of the government's ID card project. There has been a steady drip-drip of criticism of the project through out the year, including warnings from the British Computer Society for the need to move away from monolithic computer systems, while nurses complained they weren't getting enough training. But few NHS IT projects have created as much controversy as the electronic patient record which will contain information such as patients' current medications, allergies and adverse reactions. Many patients - perhaps spooked by the public sector's track record on IT - have objected to this. As a result, when the trials start of the project start in the spring patients will be allowed to opt out of data sharing if they want to. So as the year draws to a close government IT projects, haunted by fears of past failures, seem to be going out with more of a whimper than a bang. . ."

Lessons learned Connecting for Health (22 Dec 2006)

Computer Business Review

"It is over four years since the UK government announced ambitious plans to fundamentally change the way IT is procured, maintained and utilised within the National Health Service (NHS). Despite receiving strong political and financial backing from the government, however, the project, dubbed the National Programme for IT (NPfIT), has been mired in controversy for most of its short life; the result of delays and rumours of ballooning budgetary requirements. Richard Granger, director-general for IT at the NHS and the public face of the NPfIT, has sarcastically described his time at the helm as "four joy-filled years", and regularly jokes that the stress of his job has been the cause of his hair loss. . . Granger is unwilling to accept much of the criticism levelled at the NPfIT, claiming that it is driven by both vested interests in the NHS and by a hostile press. While he can do little about the latter, Granger says that he "should have spent two years benchmarking what was there [in the NHS] before, because those with a vested interest don't want to tell you how bad things are". . . According to the NAO, previous IT procurement and development within the NHS was "haphazard, with individual NHS organisations procuring and maintaining their own systems, leading to thousands of different IT systems and configurations". This resulted in information being kept in silos, which were not shareable even in the event of system compatibility between practices. The NPfIT aimed to change this by introducing a national data spine, to be built by BT, which would hold patient records in a central repository, and by replacing local systems at hospitals and general practitioner practices across the UK with centrally selected software. But the plan is controversial. Information Technology in the NHS: What Next?, an article by Richard Bacon, Conservative MP for South Norfolk, and John Pugh, Liberal Democrat MP for Southport, argues that: "The fundamental error made when setting up the programme was to assume that centralised procurement of single systems across the NHS would be more efficient than local decision-making guided by national standards." . . . One of Granger's first decisions as head of NHS IT was to commission a study by management consultancy McKinsey into the healthcare IT market in the UK. While the report was never published, it is thought to have concluded that no contractor working in the UK healthcare sector at the time had the capacity to become a prime contractor on such a major national programme. As a result, the NPfIT looked to global IT services vendors to head up the project. Granger chose big suppliers such as Accenture and CSC because he believed that, under the old system, patients were forced to bear the risk of IT failure, whereas the new structure would shift that burden on to the IT suppliers themselves. In January 2003, the NPfIT set out its key procurement principles, which made it clear that contractors would be expected to "retain appropriate payment and cost risks related to delivering a service or system that is accepted according to the terms of the contract". Many in IT now believe this approach was flawed. "Transferring risk on to large suppliers never works," says [Lisa Hammond, CEO of IT consultancy Centrix]. "Once they start losing money, it's more effective for them to back out." . . . Many of the problems that have beset the NPfIT during its turbulent life have their roots in the very early stages of the project. Decisions regarding procurement, suppliers and the length and scope of the deals were taken back in 2002 and 2003, yet are directly responsible for the deepening sense of crisis around IT in the NHS. The first few months of any IT contract will define the future of the scheme and clients and suppliers alike should not allow themselves to be swept along by waves of hype and optimism. . ."

Newsletter - British Medical Association's Working Party on NHS IT (Dec 2006)


". . . The BMA's policy is that explicit consent should be obtained before any healthcare information is uploaded onto the spine. Doctors feel that some patients may be unhappy about having their sensitive personal data uploaded onto a central system and a more gradual approach will allow patients to fully consider what information is contained in their records and whether they wish this information to be shared. Confidentiality is central to trust between doctors and patients. The BMA is currently seeking clarification from the GMC, MDU and MPS on how exactly this would affect clinicians in terms of liability. . . Role-Based Access Controls (RBAC) are a technical means for controlling access to computer resources and an integral part of the security process. Following comments by the National Advisory Group and the BMA, CfH is considering how to simplify the system to reduce the number of job roles (currently 350), areas of work (currently 290) and activities (currently 350). The role of sponsors will be crucial in ensuring roles are correctly allocated and updated. This could require extensive training. . . There has been much press about the suppliers for the National Programme for IT. . . Soft has recently been linked with a sale as its debts and troubles mount. The BMA Working Party are keeping a watching brief on what effect this will have on the National Programme but have also expressed concerns that changes in suppliers will add to a lack of confidence in the programme amongst clinicians. . . At the July BMA Annual Representative Meeting (ARM), doctors voted in support of a motion calling on CfH to ensure that patient safety is given much greater consideration and elevated to a core requirement of the programme. . . The BMA has conducted a small survey of doctors' experiences of Choose and Book. Initial responses suggest great discontentment with the system. . . The national email service for NHS staff, including medical students, once known as 'Contact' has been endorsed by the BMA Working Party for the transfer of patient identifiable information. However, the Working Party felt that information governance issues need to be addressed, for example, ensuring that emails are not left in inboxes and making sure that the correct person receives the mail when there are multiple users with the same name. . ."

Lessons from the NHS National Programme for IT (1 Jan 2007)

Australian Health Review

". . . Procuring contracts centrally resulted in vigorous supplier competition and saved about £4.5 billion. However, the speed of procurement meant that the NHS had not prepared key policy areas (eg, information governance), standards (eg, for messaging and clinical coding), and information system architecture (neither enterprise architecture nor detailed technical architecture was ready). Further, the contracts bound suppliers to a vague specification that has cost the NHS around £30 million in legal fees to sort out. . . IT can be a powerful enabler, but if poorly implemented or used, it can result in patient harm. Yet system safety was not written into the initial procurement specifications. Somewhat late in the day, CfH developed a safety accreditation process and appointed a National Clinical Safety Officer. Failure to account for safety also brings commercial risks. . . A significant criticism in the National Audit Office report was that procurement occurred before clinical engagement, perhaps because extensive consultation was thought to slow the process. This has resulted in significant disquiet among some clinicians and the priorities of the program not fully matching those of the clinical community. . . Picking the wrong patient consent model may be a deal breaker. Patients must give consent for their information to be stored electronically and made available to others.10 CfH has chosen an 'opt out' model in which patients by default are included within the system, and make an informed choice to leave it. . . 'Opting out', while technically simpler, may end up being the Achilles heel of the new system should significant examples of breach of confidentiality hit the media. 'Opting in' might eventually prove to be the cheaper model when all costs are considered, not just the technical ones. . . Perhaps history will record that the NHS was not sufficiently prepared to take on such a fast-paced, radical and extensive modernisation program, that it was compromised by workforce shortages in health informatics, and fell into the trap of leading with technology rather than clinical need. . . ."

Review of BBC2's 'Can Gerry Robinson Fix the NHS?' (11 Jan 2007)

Evening Standard

". . . Nowhere is this Stalinist mentality clearer than in the looming disaster of the world's most expensive non-military IT project, to put every NHS patient onto a national database. The costs are out of control, the medical profession hates it, and it will make everyone's medical records available to any half-competent hacker. . ."

NHS £6bn IT system poor value, say experts (22 Jan 2007)

The Guardian,,1995850,00.html

"Leading healthcare IT experts have warned that the NHS's troubled £6.2bn system upgrade is costing taxpayers substantially more than it should. They claim the same functions could be delivered for considerably less outside of the national programme for IT, dogged by delays and software setbacks. Stephen Critchlow, executive chairman of software group Ascribe, said he "could not see where value for money is coming from". There was evidence, he added, to suggest the NPfIT was installing and running systems for several times the going rate. Phil Sissons, a former executive at the software group Torex - now part of iSoft - and an ex-consultant to the NPfIT, said: "Publicity from the national programme was that they got some good deals because of the buying power of the NHS. But I don't believe they reduced the cost at all. There are multiple margins being added to the process each time there is an extra layer of management or another company involved." Doug Pollock, managing director of software supplier Cambio, who has also worked within the national programme, said these multiple margins were sometimes "scandalous". From the outset, NHS bosses promised the centrally organised 10-year IT upgrade programme - covering hospital trusts and GP practices across England - would be £3.6bn cheaper than the cost of upgrading systems on a piecemeal basis. However, the first three years have proved troublesome, with deliveries of patient administration systems (PASs) to acute, primary care, community and mental health trusts falling far short of targets - and, most importantly, without delivering the promised clinical functionality. Cost savings, NHS bosses still insist, remain on track. Meanwhile, the NHS's head of IT, Richard Granger, has been busy compiling a catalogue of alternative suppliers. Industry insiders believe they could help the troubled project - the largest civil IT project in the world - evolve from a national into a local programme. At the same time, the Department of Health continues to make multimillion pound payments to its five lead regional contractors, known as local service providers (LSPs). . . No detailed figures for DoH spending on NPfIT are available since last March, but a number of sources within LSPs have privately confirmed multimillion-pound payments have continued to flow. A number of rogue acute trusts have become so frustrated with the NPfIT that they have opted out, forgoing central government funding in favour of selecting their own IT suppliers."

Why the 'rip and replace' syndrome needs to stop (9 Feb 2007)


". . . The public sector has been committed to offering the public a better service through use of IT systems for decades. So why do so many reports state that technology is the solution, if it is already being used effectively? The problem lies in the fact that when Central Government wants to use IT to achieve greater efficiency or improve processes, more often than not it chooses to 'rip and replace' existing technology with new systems. While this might seem like a good idea initially, the cost of the purchase, resulting downtime, expense and consultancy fees for IT projects that demand huge input and radical overhauls can be huge. There is also the all too real possibility of budget overruns and project delays, and the risk of implementing untried applications. Given this approach it is hardly surprising that in the last 40 years the money spent on IT by the Government is thought to easily be in excess of £25 billion. We have seen numerous examples of Government departments embarking on painful technology implementations. A recent, high-profile case is the £6 billion National Programme for NHS IT (NPfIT), which involves the implementation of new systems and infrastructure. As the media frequently reports, parts of the programme are running into trouble as they rely too heavily on a single supplier's new, untested system. . . While upgrading legacy systems is the key to achieving joined up Government, this should not necessarily mean ripping them out and replacing them with new systems. It would be less expensive, and much less risky, to make the most of existing systems, which are tried, tested and proven. More often than not, the desired aim can be achieved through breathing new life and value into infrastructures already in place. It is possible to use what the Government already has, at the same time as making sure the demands of a joined-up, interactive and collaborative modern society are met. Service orientated architecture (SOA) makes this type of modernisation possible, avoiding the problems of projects going over-budget or taking risks with new systems. SOA is a standards-based approach to IT architecture, which builds business-focused services using 'loosely coupled' links between legacy systems. Used strategically, SOA can modernise existing technologies. It can allow disparate systems to be linked by providing an underlying set of architectural principles and standards to, for example, support the sharing of information across departments securely. Essentially it avoids the cost of ripping out systems and replacing with new expensive upgrades when policies change or business processes have to adapt. This is not a new concept and we have seen a lot of success in the private sector. For example, financial institutions have been using this type of approach for years now. Keeping downtime and expense to a minimum is a priority, so their IT departments are in the habit of taking a step back and reviewing whether modernisation can happen within the existing infrastructure. In many cases objectives have been achieved by enabling interoperability and maximising the utilisation of existing systems, using SOA techniques. . . It is obviously difficult to say whether NPfIT might have been better advised to use legacy modernisation and an SOA approach to systems design on this occasion. But moving forward, it is clear to see the advantages that SOA can bring to the public sector IT programme. The starting point for any new public sector IT project should be to carefully examine what already exists - across government as necessary - and to properly evaluate whether an approach based on legacy modernisation, supplemented by new functionality as necessary, developed in an SOA can provide the project with a head start. . ."

Supplier sets out risks facing NHS IT plan (13 Feb 2007)

Computer Weekly

"A senior executive at services supplier Fujitsu, a primary supplier to the NHS's £12.4bn National Programme for IT (NPfIT), has questioned whether key aspects of the scheme are working - or are going to work. The comments of Andrew Rollerson, healthcare consultancy practice lead at Fujitsu, won general acceptance from a small, diverse group of IT executives at a conference last week entitled "Successful implementation of NPfIT 2007". . . Rollerson, who is responsible for the delivery of Fujitsu's healthcare professional services, said there was a "gradual coming apart of what we are doing on the ground because we are desperate to get something in and make it work, versus what the programme really ought to be trying to achieve". He added, "The more pressure we come under, both as suppliers and on the NHS side, the more we are reverting to a very sort of narrowly focused IT-oriented behaviour. This is not a good sign for the programme." A main aim of the programme - now in its fifth year - is to provide electronic health records for 50 million people that can be shared. This part of the programme is running two years behind schedule, and there are concerns about whether it is possible to achieve fully joined up systems given the size and complexity of the NHS. . . He said, "What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn't working. And it isn't going to work." He added, "Unless we do some serious thinking about that - about the challenges of scale and how you scale up to an appropriate size - then I think we are out on a limb." Rollerson's criticisms were not directed specifically at Connecting for Health, which is running the IT part of the programme, but at what he saw as a lack of vision and focus related to the wider changes within the NHS that are needed to make best use of new technology. . . Rollerson said there was a danger that suppliers would end up delivering "a camel, and not the racehorse that we might try to produce". Fujitsu is one of three companies that are local service providers to the NPfIT. It has an £896m contract to supply systems in the South of England. Responding to Computer Weekly's reporting of Rollerson's speech, Ian Lamb, NHS account director at Fujitsu Services, said, "This is a significant misrepresentation of a presentation made in support of the National Programme. "We refute any inference that has been drawn to the effect that Fujitsu in any way questions the success of the National Programme." A Department of Health spokesman said, "David Nicholson, the chief executive of the NHS, has clearly said that he is fully committed to the National Programme for IT as it is a necessary part of a modern health service, fit for the 21st century. He sees this as one of his key strategic priorities as it is key to the successful delivery of patient-centred care." Connecting for Health declined to comment."

Other Coverage:

The Times: Clear as Mud - The NHS has taken a wrong turn off the information superhighway

Daily Mail: Expert warns £20bn NHS computer programme 'won't work'

Forbes: Fujitsu expert says 12 bln stg public health IT scheme 'will not work'

BBC News: Concerns over NHS IT criticisms

£20bn NHS computer system 'doomed to fail' (13 Feb 2007)

Daily Telegraph

"In pictures: Concerns over NHS computer systems.
Labour's multi-billion- pound project to create the NHS's first ever national computer system "isn't working and isn't going to work", a senior insider has warned. The damning verdict on the ambitious £20 billion plans to store patients' records, and allow people to book hospital appointments, on a central computer network has been delivered by a top executive at one of the system's main suppliers. Andrew Rollerson, the health-care consultancy practice lead at the computer giant Fujitsu, warned that there was a risk that firms involved in the project would end up delivering "a camel and not the racehorse that we might try to produce". His bleak assessment was delivered in a speech on the health service's national programme for IT that he delivered to a conference of computer experts last week and which is reported in today's Computer Weekly magazine. Fujitsu is one of the main firms involved in the project after winning a £896 million contract to deliver systems in the South of England. Mr Rollerson underlined his message with a series of downbeat slides, including one showing a huge oil tanker being hit by a tidal wave, one with the word "Lost?" alongside a picture of a desert island and one with a man walking a tightrope. Another slide declared "visionary leadership is still missing" alongside the famous World War One poster of Lord Kitchener declaring "Your country needs you". His presentation even featured a picture of a huge alligator with the message "We have become obsessed by the alligators nearest the boat." The final slide showed two women mud-wrestling and asked: "Where would you rather be?" In his speech, Mr Rollerson voiced concern at the direction of the NHS programme and the lack of vision on how the health service can make best use of new technology. . . His comments are the latest sign of problems in the ambitious project, which is expected to cost the taxpayer around £7.6 billion more than estimated. Last year it emerged that there had been 110 "major incidents" involving the system in just four months. A letter signed by 23 leading computer scientists urged the Commons health select committee to launch an inquiry to "establish the scale of the risks" facing the project. Stephen O'Brien, the shadow health minister, said: "Even those from inside the programme are now telling the Government that it is coming apart at the seams. "This is another example of the heavy-handed, top-down failing approach of this Labour Government." . . .
[In print edition only]:
Last night Fujitsu said Mr Rollerson was not directly involved in the NHS contract and was not a senior executive at the firm. It said the content of his slides "may have been ill-considered" but insisted that his quotes had been taken out of context and that he supported the programme. Peter Hutchison, managing director, public sector, at Fujitsu Services, added: "We believe the programme will achieve a huge step forward in health care provision in england and we're proud of our part in that.""

The time for NHS honesty (13 Feb 2007)

Computer Weekly

"Years into a major IT project it is understandable that some of those involved will want to talk about the specific things that are going well, and studiously avoid mentioning the bigger things that are going wrong. This is now one of the dangers facing the NHS's National Programme for IT (NPfIT). Andrew Rollerson of Fujitsu, one of the main suppliers to the programme, said at an Eyeforhealthcare conference last week that work on the programme so far had been "fighting fires", and that the approach was "just not working". We applaud his honesty. The key now is for MPs to admit the truth. That is a big step. Neither MPs nor senior civil servants are rewarded in their careers for admitting mistakes. What we have instead are civil servants who say privately that MPs do not want a published, independent review because it could expose mistakes. And MPs do not want to admit mistakes on a £12.4bn programme for fear of the political fall-out. With so much money at stake, this stalemate is increasingly ludicrous, especially when so much needs to be done and so much needs to change. John Reid, former health secretary and now home secretary, said last month, "I believe that, whether in personal, business or political life, acknowledgement of a problem is always the first step in resolving it." We absolutely agree. When health secretary Patricia Hewitt can bring herself to acknowledge the problems on the world's largest civilian IT programme, she will then be in a position to commission a published independent review of the scheme. This will not happen while she and her colleagues remain willing participants in Whitehall's culture of cover-up and denial."

Storm over Fujitsu executive's 'honest' NPfIT remarks (15 Feb 2007)

e-Health Insider

"A senior executive from local service provider to the Southern cluster, Fujitsu, has said that the intense pressure suppliers are under to deliver short-terms risks the wider aims of the NHS National Programme for IT systems, resulting in a danger of it delivering 'a camel", and not the racehorse that we might try to produce.' Andrew Rollerson, healthcare consultancy practice lead at Fujitsu, the prime contractor for the NPfIT project in the South of England was speaking at a conference in London last week where he was delivering a presentation entitled 'Lost?'. Rollinson was quoted by Computer Weekly as warning there was a "Gradual coming apart of what we are doing on the ground because we are desperate to get something in and make it work, versus what the programme really ought to be trying to achieve." His reported remarks were seized upon up by a series of national newspapers as 'proof' of the programme's failings. The public acknowledgement of widespread problems and project drift certainly comes at a delicate stage for the NPfIT programme, with the agency responsible Connecting for Health needing to attract new players into the market. One senior supplier told EHI that such a frank public exposure of NPfIT's difficulties may also not help iSoft's quest for a buyer, who would necessarily have to address many of the issues raised by Rollerson. . . His public warning echoes concerns that key suppliers have repeatedly acknowledged to E-Health Insider in private, about how intense pressure to deliver is working in known problems being let through, a focus on targets and payments rather than quality. Rollerson's comments were accepted by some in the industry as welcome breath of fresh air, providing a necessary and honest account of the state of the NPfIT programme. Benedict Stanberry, managing director of healthcare consulting firm Avienda who also presented at the conference. He told E-Health Insider that Rollerson had simply given an honest opinion of the project. . . Defending Rollerson's comments, Stanberry added: 'A good consultant is always honest with their client and that means they have to be neutral and objective about the challenges involved in achieving the changes the client wants. 'Andrew Rollerson was very much reviewing the IT programme from the point of view of the massive organizational and cultural changes that still need to rake place if the NHS is to realise all the benefits and opportunities that single, shared electronic records and booking systems will create.' Ian Lamb, NHS account director at Fujitsu said: 'We refute any inference that has been drawn to the effect that Fujitsu in any way questions the success of the National Programme.' According to a press report in the Evening Standard, Labour insiders say health secretary Patricia Hewitt has been ordered by Tony Blair to explain how the project has gone wrong."

Tories renew their call for a full review of the NHS's National Programme for IT (27 Feb 2007)

Computer Weekly - IT projects blog

"Senior Tories have had a meeting to discuss their strategy over the NHS's National Programme for IT [NPfIT]. It's understood that among the topics discussed was the question of whether the Tories should take a radical stance, or simply renew their call for a review of the scheme. They decided to renew the call for a review. The Conservative Shadow Minister for Health Stephen O'Brien MP referred to the need for a "zero-based" review. The phrase zero-based means, say the Tories, "from the bottom, in that we would review the design as well". O'Brien said:"The Conservatives promised a zero-based review before the last election. That promise stands. It is time for the Government to swallow their pride and follow our lead. "It is disappointing that the NHS Chief Executive [David Nicholson] has ruled out a review. I welcome the U-turns the Government has already made, but they do not go far enough. The programme must engage front-line professionals, patients and the public, and a zero-based review is fundamental to that". The statement added: "The Government has delivered notable u-turns, for example it is now offering an opt-out from having a summary care record uploaded to the Spine. It is also moving towards the localism and open provision long championed by the Conservatives - for example through GP systems of Choice. . . The Conservatives say they have:

  • Consistently called for the power to be given to local providers to choose the IT most suitable for them - an interoperability rather than uniformity paradigm.
  • Challenged the mission creep of the programme
  • Challenged the soviet tractor production figure style of Connecting for Health's attitude to answering questions."

System Failure! (2 Mar 2007)

Private Eye

A Private Eye special report by Richard Brooks

How this government is blowing £12.4bn on useless IT for the NHS.

'Waste and inefficiency in the NHS is intolerable,' declared Health Secretary Patricia Hewitt one year ago among mounting deficits. 'A penny wasted is a penny stolen from a patient.' This is the story of the theft of 1,240,000,000,000 pennies from patients through an IT project that wasn't wanted and doesn't work. It tells how political vanity, official incompetence and vested interests have wreaked havoc on the health service - and calls for a halt to the ultimate in a long line of New Labour cock-ups before it is too late. . .

The Eye asked a leading IT specialist (who wants to remain anonymous) for his view on what went wrong and what needs to be done.

The fatal flaws of the National Programme for IT:

  • It was launched without any evidence that hundreds of largely autonomous NHS organisations with their own IT would buy into one-size-fits-all systems imposed on them from Whitehall.
  • No evidence has been produced that a nationally available electronic health record will work.
  • Clinicians should have been consulted on what they really wanted from a large spend on NHS IT. Feasibility studies should have been published. If the scheme looked feasible by all independent assessments, only then should the National Programme have been announced. Instead it was conceived in secret and announced as a fait accompli - the worst possible way to engage clinicians.
  • Assessments of the programme, such as gateway reviews by the Office of Government Commerce, have not been published. Some practitioners think that this is because they show the programme to be deeply flawed.
  • There has been no admission by any minister of the seriousness of the problems while the gap between optimistic ministerial statements on the programme and the reality, as perceived by NHS managers and clinicians is widening - turning even the programme's enthusiasts into sceptics.
  • Those running the programme talk only about the specifics of what is going well, and what can be delivered. Nobody mentions the big things that are going wrong, such as the reasons for the delayed core software. And nobody in authority wants to ask the question: will it ever work as originally conceived?

What should happen now?

  • A ministerial admission that the programme is mired in delay, and doubts over costs and technical feasibility. A problem that is not admitted cannot readily be tackled.
  • Nobody yet knows that the idea of a nationally available electronic health record system will work in the way it has been configured. So an independent published review is a must.
  • Trusts and GPs should have the authority to make their own choice of IT systems and suppliers as long as they meet nationally agreed standards. That way they'll want what they install rather than having it foisted on them.
  • Money given to trusts for upgrading IT should be ring-fenced - earmarked only for specific IT projects. There would then be no need for a huge central bureaucracy which monitors what trusts and suppliers are doing."

Private Eye special report on NHS IT programme (6 Mar 2007)

Computer Weekly - Tony Collins' IT projects blog

"An executive who has IT responsibilities for several large hospitals has phoned to enthuse over the Private Eye special report on the National Programme for IT [NPfiT]. He described it as very well informed. Not everyone connected with the NPfIT who reads the report will be quite so enthusiastic. Whatever your reaction to the report there is one thing in particular that should be mentioned. In the Spring of 2002 when the NPfIT was announced by ministers either they or their officials deceived Parliament, taxpayers, and the NHS. This deception has never been explained by the Department of Health. Its lack of interest in the matter could give the impression that such deceptions are the norm. This deception was significant because it involved a document that launched the world's largest civilian IT programme, and it also triggered a public consultation over the scheme. There were two versions of the document. Both were called Delivering 21st Century IT Support for the NHS. The published document had an risk-assessment appendix missing. It wasn't simply removed. It was carefully cut out. The remaining appendices were then renumbered and the text of the main document which referenced the excised appendix was altered. . ."

Labour has replaced heart of NHS with a computer, says Cameron (19 Mar 2007)


"Conservative leader David Cameron criticises reforms to health services, including the Modernising Medical Careers program. The Labour government has "ripped the heart out of our NHS and replaced it with a computer," said Conservative leader David Cameron in a speech yesterday. During his keynote speech at the Conservative Spring Forum, the opposition leader criticised the Labour government's reforms, calling them a "mind-blowing waste in the name of modernisation and efficiency". The National Health Service (NHS) is currently undergoing a multi-billion pound, ten-year IT overhaul, which will see patients bar-coded, records digitised and the system modernised. Cameron said a Conservative government would return the "heart and soul" to the NHS by putting people back at the centre of the system and cutting back on management consultants. The Labour party have "turned the NHS into a vast, inhuman machine, a pen-pusher's paradise at the mercy of the management consultants' latest wheeze," he said. . ."

Cayton says legacy systems could have offered more (11 Apr 2007)

e-Health Insider

"England's NHS National Programme for Information Technology will lead to better patient care but greater emphasis on building on existing systems could potentially have delivered results faster and cheaper, according to the Department of Health's national director for patients and the public, Harry Cayton. The patients' 'tsar' who is also chair of the Care Record Development Board said that in his personal opinion more could have been achieved, sooner and at lower cost by building on existing legacy systems. Speaking at the World Health Care Congress in Barcelona, Cayton strongly backed the programme saying that will ultimately deliver better patient care to the 52m patients in England and will be of huge benefit to 1.3m NHS staff and over 36,000 GPs. However, he also pointed out that the NHS was already making extensive use of IT before the advent of NPfIT. 'The NHS was and still is digitally enabled and, in my opinion, we could have thought more about using existing legacy systems, rather than spending all this time building new systems. It would have been faster, cheaper and possibly have been received with a better reception.' Questioned about advice he would give to other European nations looking to invest in eHealth, the DH's director for patients and the public said: 'In my opinion, it is necessary to engage with clinicians, both sceptics and enthusiasts, from the very beginning.' He also said it was important to ensure that new developments included a careful balance between things clinicians want, and the systems they may be less keen on but which are needed to better manage and administer the health service. He suggested Connecting for Health should have gone down the same route as the Veterans Administration in the US, which used the technique of deploying bundles of developments that doctors wanted with those they were not so keen to adopt. 'So for example, if we brought in systems at the same time as Payments by Results ' which acts as an incentive for staff - then it is possible the two would have come in together without disruption. Maybe you should think about mixing the two.' . . . Public acceptance of the proposals for the use, security and confidentiality of shared electronic records was an issue that must be addressed as quickly as possible, Cayton said. 'Acceptance is enormously important, hence we updated the Care Record Guarantee. It was important we cold prove that we were able to protect the confidentiality and security of patient records and were working within the guidelines of the Data Protection Act and the Human Rights Act.' Cayton said that it was necessary for all patients to have an electronic record, and not stay with paper records. . ."

Lib Dems demand rethink on NHS IT project (16 Apr 2007)


"The Liberal Democrats today called for an immediate moratorium on all further spending on the NHS's £12.4bn IT programme in England pending an independent inquiry into a mounting catalogue of errors and delays. Norman Lamb, the party's health spokesman, said the government was in a state of denial about the technical, financial and political deficiencies of Connecting for Health, the agency responsible for the scheme, which is the world's biggest ever non-military IT project. A straw poll of hospital IT chiefs conducted by Liberal Democrat researchers last week found most were sceptical about the benefits of the national programme and concerned about delays in delivering equipment. . . Mr Lamb said the government rejected a proposal from a group of 23 computer academics who in April last year called for an independent technical assessment of the project. They said: "The programme appears to be building systems that may not work adequately and - even if they worked - may not meet the needs of many health trusts." Since the academics' intervention, Connecting for Health has experienced a series of setbacks including the disruption of NHS business at 80 trusts in the West Midlands and north-west after a fire in a data centre run by one of the agency's contractors. Mr Lamb said: "Targets for progress have been repeatedly broken. Connecting for Health at one stage announced that 155 out of 176 acute hospital trusts would have electronic patient record systems operating by the end of 2006/7. However, only 16 got there." Patient groups also had serious concerns about the civil liberties implications of plans to store the medical records of 50 million patients on a national electronic database, known as the Spine. Mr Lamb said: "There can be no doubt that the government's plans have gone badly wrong. Any discussion with people working in the NHS leaves one with the overwhelming sense of loss of confidence in the project." An independent inquiry should assess whether it is still possible to achieve the programme's original objectives or better to adapt it to deliver what GPs and hospitals say they need, he said. Simon Eccles, Connecting for Health's linkman in dealings with hospital doctors, said an independent inquiry would help nobody. "If we spent even more time answering questions on what we are doing and why, we would risk further delay in the programme. We are not encountering widespread opposition among clinicians. They want us to get on and deliver useful projects as soon as possible." By the end of 2008 there would be visible proof of the programme's success, with equipment deployed across the health service. "At this point we are in a state of invisible near-success, when the full benefits are not yet obvious to everyone," Dr Eccles added."

Seven in 10 government IT projects fail (17 May 2007)

ZDNet UK,1000000308,39287110,00.htm

"Seven in 10 government IT projects have failed, according to the chief information officer of the Department for Work and Pensions. Joe Harley called for projects to be completed at a lower cost to the taxpayer, and said the government wanted to reduce the number of project failures to just one in 10. Speaking at the Government IT Summit this week, Harley said: "Today, only 30 percent of government IT projects and programmes are successful. We want 90 percent by 2010/11. We want to achieve a 20 percent overall reduction on IT spend in government, including reducing the total cost of a government laptop by 40 percent [in the same timescale]." Harley said that the criteria for success of a project included whether it was delivered on time, to cost, and to the quality promised. While private sector IT projects had a similar failure rate, government IT projects needed to be more efficient both in terms of cost and delivery, Harley said. "The government spends £14bn per year on IT in the UK. It's not sustainable as a government to continue to spend at these levels. We need to up the quality while reducing the spend," Harley added. One government project that has been heavily criticised in terms of missed deadlines and inflated costs is the troubled NHS National Programme for IT (NPfIT), which is overseen by Connecting for Health (CfH). Andy Burn, head of information management and technology planning for CfH, said that, while the project had achieved some successes, taken as a whole, it had failed so far. "The programme still has three wheels still on. It's not in hand in some respects, but it is in others. At a local level, progress has been made over the years. At an organisational level, less [progress has been made]. The challenge is joining up services ' we've been struggling with that for quite some time." Burn added that it would take a lot of work to put NPfIT back on track. "Inevitably, with the size of the programme, we're bound to be up against the wall [for the next year]. For the next decade, not for the next year."

Whitehall's shameful secrets (30 May 2007)


"I am staggered that the government is trying to overturn a ruling that the gateway reviews of public sector projects should be published. This is not some esoteric argument about freedom of information: basic principles of public and professional accountability are at stake. It is not only that billions of pounds of taxpayers' money is spent on public sector IT each year, much of it wisely and effectively, but too much of it disastrously. It is about learning lessons, about spreading best practice and about not blaming IT for failures of politicians' making. The Office of Government Commerce is fronting an appeal for the government over an order to publish information from the gateway reviews of the ID card scheme. It says disclosure would fundamentally undermine the review process because those involved would not be as frank in expressing their views and commercial organisations might not wish to be involved. I have been approached by IT staff at organisations where a gateway review was being carried out. They talked about team members being coached in what to say and what not to say. They described how the more Bolshie members of the team were sent on leave or on courses just to keep them out of the way. I have talked to gateway reviewers who, though keen to maintain some confidentiality in the process, would shake their heads in despair at the crude efforts to manage or manipulate the information they were presented with about public projects. I have also talked to IT staff and reviewers who have found the whole gateway review process invaluable as a sanity check on projects. Meanwhile, Intellect, the IT suppliers' organisation, has made plain that its members would like to see some of the information from gateway reviews published. Intellect might be too refined to say it, but some of its members working in the public sector feel they are getting a bum rap when projects are reviewed. If anyone wants to know just how much help public sector IT projects require, they need only look at the ongoing National Programme for IT in the NHS. The latest incident, where CSC is preventing the takeover of troubled supplier iSoft, is another example of just how problematic large scale public sector projects can be So who benefits from public sector secrecy? And who is protecting who with this appeal? If the OGC appeal succeeds, bad politically motivated decisions about IT projects and bad project management will be hidden from view. If writing to your MP to complain made any difference, I would recommend it." [Mike Simons]

Civil servants told to destroy reports on risky IT projects (1 Jun 2007)

Computer Weekly

"Treasury officials are ordering the immediate destruction of "Gateway" internal reports into risky government IT schemes to prevent information on the projects being leaked. Their action, a response to the Freedom of Information Act, comes even though the Treasury's Office of Government Commerce (OGC) has lost two appeals to keep Gateway reports secret. Managed by the OGC, Gateway reviews are independent assessments of high and medium-risk IT-based and other projects at various stages in their lifecycle: projects such as the £5.3bn ID cards scheme and the NHS's £12.4bn National Programme for IT. Liberal Democrat Shadow Chancellor Vincent Cable described the policy as 'shockingly arrogant behaviour by those who should know they are accountable for public money'. He said that those involved in projects, as well as parliament and taxpayers, had a right to see the Gateway review reports. The OGC paper on the Gateway review, seen by Computer Weekly, tells its teams, 'You must securely dispose of the [final Gateway] report and all supporting documents immediately after delivery of the final report - which should be no later than seven days after the review." The OGC wants to cut the risk of leaks - only two people will have copies, the OGC and a department's 'senior responsible owner'. Nobody else has any automatic right to see the reviews. So a department or agency's internal audit committee, MPs, the department's IT team, computer suppliers and potential end-users may be denied access to the final report. . . Civil servants who undertake Gateway reviews told Computer Weekly they thought it unnecessary to destroy the final reports. They said the documents usually contained important recommendations which may not be carried out properly if people in the department or agency do not know what they are. One Gateway reviewer said the order to destroy the final reports was 'odd and a little sinister'. . . More than 2,000 Gateway reviews have been carried out ' but the OGC has published none of them. The order for the destruction of final reports will fuel suspicion that they identify fundamental flaws in some major government IT-based projects. . ."

The foundations of an NHS IT system are in place: now start building (14 Jun 2007)

The Guardian,,2101825,00.html

"No doubt Gordon Brown's inbox is already creaking with suggestions about what he should do with the NHS national programme for IT. No doubt, too, some of these suggestions involve inserting the programme up the anatomy of certain senior civil servants. In the five years since the government published its blueprint Delivering 21st Century IT Support for the NHS, the world's largest civil IT programme has amassed an impressive array of enemies: doctors, politicians, academics and privacy groups. Despite all this, the new prime minister should resist calls to scrap the programme or radically change its governance structure. Either course would set back by decades the hope of computerising the NHS - a project surely worth trying. But while euthanasia is a bad idea, some urgent therapy is indicated. It needn't be painful. Here are three simple steps for reviving enthusiasm for the programme. Step one: immediately abandon the pigheaded stance that patients should be assumed to have given consent for their electronic records to be shared across the NHS unless they say otherwise. Insistence on "opt out" rather than "opt in" may upset only a minority of patients, but it is at odds with the spirit of patient empowerment that is supposed to be driving NHS policy. Step two: admit defeat in the footslogging and wasteful campaign to replace basic hospital administrative systems with standard packages procured nationally through the infamous billion-pound "local service provider" contracts. This timetable is horrendously behind schedule because many trusts, rightly, see little point in going through the pain of changing to a standard system which in many parts of the country is an interim solution amounting to a step back from technology already in place. Moves are already afoot to allow hospitals to procure from a wider catalogue of systems that are compatible with the national "spine"; this should be speeded up. This would also rescue what remains of Britain's home-grown healthcare informatics industry from the industrial slaughter arising from ideological attachment to offerings from overseas. Step three: find islands of excellence and build on them. Because, alongside (and in some cases despite) the national programme, the NHS has some brilliant local initiatives in which IT is transforming the whole practice of healthcare. Surgeons at Birmingham Heartlands hospital are ensuring that patients get the right operations by tracking them with RFID tags. Nurses at Queen Alexandra hospital, Portsmouth, are entering patients' vital signs on handheld personal digital assistants. GP members of the Records Access Collaborative are in the process of recruiting 100 practices to engage patients in their healthcare by showing them their electronic records - a home-grown technology in which the UK was a leader well before the national programme. Rather than trying to move the whole NHS convoy at the speed of the slowest ship, Connecting for Health, the NHS IT agency, should be identifying such grassroots initiatives and helping them spread. Ideally, the outcome would be a handful of exemplar all-electronic NHS communities where clinicians would clamour to work and patients clamour to be treated. If a few million more quid is needed for the purpose, that is money well spent. Contrary to some commentators' opinions, the NHS national programme has quite a lot to show for five years' work. But most of what it has done is to put in place the basic components of a computerised NHS. It has quarried the stone; in some cases created useful building blocks. From the ground upwards, it's time to start building the cathedrals."

NHS chief attacks computer project (15 Jun 2007)

Liverpool Daily Post

"THE outgoing chief executive of Wirral Hospital Trust has condemned the troubled £12bn scheme to create electronic patient records, warning many doctors are 'beginning to despair'. Frank Burns, who carried a previous investigation into improving NHS computer systems, said the programme was losing the support of clinicians as it fell years behind schedule. The chief executive said National Programme for IT (NPfIT) was wrongly focused on linking up records nationwide, instead of connecting hospitals and local GP surgeries. Most remarkably, he said Wirral trust had rejected introducing the first version because it was inferior to the IT system it had set up way back in 1990. Mr Burns, who leaves his post next month, said: 'What is eventually produced by NPfIT won't be as sophisticated as the system we introduced 17 years ago. 'That is why we took the decision we did at my trust, on the grounds of possible safety. It would have been a possible danger.' NPfIT, the largest non-military IT project in history, is designed to drag patients' clinical records, many of which are still paper-based, into the 21st century. . . Giving evidence to the Commons health select committee yesterday, Mr Burns said attempting to set up a national system was 'putting the cart before the horse'. In contrast, the Wirral IT system, for example, automatically alerted the hospital's chest clinic if a radiologist in a different department 'reported something sinister on an X-ray'. Mr Burns said: 'The technology is slow in coming forward. In many parts of the country, people are beginning to despair if it will ever arrive. 'What's important are good local care records, because most people attend their local hospital if they have an emergency. 'The occasions when any of us fall over in some distant town and need emergency care are not that frequent.' Mr Burns's criticisms are significant because he carried out a 1998 study, Information For Health, which called for local implementation of better IT systems. But the proposals were not funded by the Government and were overtaken by the NPfIT, which was launched in 2002. Mr Burns was appointed as general manager of Arrowe Park Hospital in 1989 and became chief executive of Wirral Hospital NHS Trust when it was created two years later. The trust has since become one of the most successful in the country."

Are we nearly there yet? (Jun 2007)

BCS Health Informatics Now

"'Are we nearly there yet?' is the question often asked by the smaller passengers on the back seat of the car. They probably have only a vague idea of the intended destination and had no (or very limited) input to its choice. They were probably given no option as to whether they wanted to go on the journey and may even have had other things that they would have preferred to do. However, based on past experience, they probably have confidence in the driver that he/she knows where they are going and how to get there. They may have concerns that the driver does not usually welcome advice (or even stop to re-visit the map) when lost. Do you see any similarities in respect of the current plans for IT in the NHS in England? Do we hear clinicians (and some managers) asking the question 'Are we nearly there, yet?' What about their confidence based on past experience? Many of us who were working in NHS computing 20 years ago thought then that we were nearly there. Most hospitals had some computer systems working and nearly all GP surgeries were computerised. The only thing needed - we thought - was for these systems to communicate with each other. Once that had been achieved, a number of other things would be possible, including changes to the way healthcare was delivered and where it was provided. The 'C' was to be the most important letter in ICT. Where did we get it wrong? A few of you may remember that in the late 1980s, the NHS had 14 regional health authorities (RHA) in England. Each RHA had a regional computing unit (RCU) with at least 100 staff ' some had more than 200. Each RCU had a capability to write, run and install computer applications - such as PAS, pathology, child health and financial systems. Furthermore, some regions wrote and even ran applications for other regions. We worked as though there was a 'national' health service. We even worked closely with our colleagues in Wales, Scotland and Northern Ireland and with those employed by the Department of Health. Our shared wisdom at the time ' based on some successes (and a few failures) ' had reached several conclusions. Here, in no particular order, are 12 of them:

  • The most important issue is implementation since it involves many, already over-worked individuals from a number of different professions (and possibly) different organisations).
  • The rate of implementation roll-out is more dependent on the health authority's willingness and capability than to any capital budget constraints.
  • Maintaining the interest and enthusiasm of users is vital for a successful implementation.
  • It is essential to involve users at all stages - specification of requirements, procurement (if a purchase is necessary), implementation, live running and subsequent modification/updating.
  • Both user and management expectations should be managed.
  • Delivery of an application or a usable sub-set should, ideally, be within six months - otherwise the users loose interest.
  • It is extremely difficult and usually very costly to anglicise an application written for the American market.
  • When offered a 'working' system, insist on trying it yourself - demonstrations are easy to fake.
  • The importance of the procurement process is often overrated. Many health authorities got good results from poor systems and some got poor results from good systems. The local implementation is the most important factor.
  • Most staff at the Department of Health have a very limited knowledge of how the NHS is managed and how healthcare is delivered.
  • The power of the medical mafia(s) should not be underestimated. There is often more than one and each has its own agenda.
  • If it ain't broke, don't try to fix it. . ."

The MTAS failure is no ripple in a teacup (9 Jul 2007)

Health Service Journal

"The cuts in funding for junior doctors' pay and study leave were very bad management and smacked of panic measures when they were announced half-way through the financial year. . . Then came the introduction of the medical training application service. I fought this through every due process from 19 September 2006, and by December 2006 had to admit defeat and prepare my junior and senior colleagues for disaster, crossing my fingers that disaster would not happen. The disaster hit on 26 February. Again I involved local MPs well before going to the media. I also fought for months on the patient safety issues around the national IT programme care records system, taking matters right up to Whitehall before turning to the media. We are meant to have an open culture for whistle-blowing on imminent disasters. This process does not seem to operate above local trust level. Our trust management has always taken seriously what I have had to say, listened and taken action. Higher up above the trust, the attitude to my raising concerns seems mainly to have been a pretence of listening, no understanding and a denial of impending problems. . . Doctors are professional and do not rush to the media. The number of doctors breaking ranks from loyalty to the NHS and the profession to speak out in the media is a sure sign of major problems in the philosophy and implementation of central management in the NHS. [NHS chief executive David] Nicholson would do well to consider this to be an early warning of issues that could be deeply damaging to the NHS, and take steps to ensure that sober, prudent professionals are heard and understood, before they feel that they have to turn to Joe Public for support through the media." [Dr Gordon Caldwell is a consultant physician at Worthing Hospital.]

NHS IT project needs a comprehensive review - Lamb (11 Jul 2007)

Liberal Democrats

The man who was behind the NHS IT system has admitted that some of the work by contractors has been "appalling". Richard Granger is quoted in an interview as saying "Sometimes we put stuff in that I'm just ashamed of." Commenting, Liberal Democrat Shadow Health Secretary, Norman Lamb MP said: "What is "appalling" is that Richard Granger repeatedly defended the disaster prone NHS IT system when he was responsible for its delivery. Now that he has stepped down, he is more candid with the truth. How soon will it be before another technical glitch puts patients' lives at risk? Any discussion with people working in the NHS leaves an overwhelming sense of loss of confidence in the project. The Government cannot continue to charge ahead with the system, blind to ever more stark warnings. We must have a thorough independent review with no more uncommitted spending until that review is complete."

Senior Responsible Owner - a good idea subverted (24 Aug 2007)

Computer Weekly - Tony Collins' Blog

"In 2000 the then Cabinet Office minister Ian McCartney, with the help of Intellect, the suppliers' association, published a worthy guide on how to avoid IT-related failures. The guide - successful IT - recommended that one accountable individual should supervise a project. That person should be called the Senior Responsible Owner. It was a good idea, a corrective to flawed custom. Too often senior civil servants retired or were moved off projects as they began to understand its complexities. A senior responsible owner would see a project through from the time it was conceived to the point that the benefits became tangible. The McCartney report said that reviews of successful IT projects in Singapore had found that in every case the scheme was sponsored by a senior manager, who was held accountable for its success. But the McCartney recommendations have become, in the main, a tick-box exercise. . . The NHS's National Programme for IT [NPfIT] has had a variety of senior responsible owners. Sir John Pattison was on the point of retirement when he was appointed as senior responsible owner. Since then, 2002, there have been multiple senior responsible owners of the NPfIT: Professor Aidan Halligan, John Bacon, Sir Ian Carruthers, Richard Jeavons, Richard Granger and David Nicholson to name only a few. The Department of Health has this year appointed more than 100 senior responsible owners for parts of the NPfIT. . . I suggest that reality makes nonsense of some of the best recommendations in the McCartney report, at least those on the all-important role of the senior responsible owner.

There was no squalor when sister ran the ward (15 Oct 2007)

Daily Telegraph

". . . Back in the mid 1970s when I was a junior doctor at the 1,000-bed Whipps Cross Hospital in east London - one of the biggest and busiest in Europe - the "management" consisted of just six people. . . In the late 1980s, the Conservatives turned on the middle class professions and their high-minded values of public service, portraying them as untrustworthy and inefficient. They disparaged claims to independence, dismissing self-regulation as merely a means to protecting self interest. The Tories' radical solution was to create the "internal market", with all the different elements of the NHS in competition with each other. As Kenneth Clarke, the Health secretary of the time, put it, the intention was to provide "choice, competition and a measurement of quality to be found in private industries". But now every management function had to be replicated by "purchasers" and "providers" . . . The 510 senior managers who had run the unreformed NHS swelled over three years to 13,000. . . Wave after wave of policy directives and guidelines swept over the health service. . . Most recently, the Government has changed tack again, re-introducing features of the supposedly discredited internal market, although now to be controlled by supposedly independent regulators monitoring quality and standards. Not surprisingly, given all this, the number of senior managers has expanded faster than any other category of NHS staff, and they now number nearly 40,000 - 80 times as many as two decades ago. To that figure must be added a further 250,000 "administrative and clerical" personnel that now constitute a fifth of all NHS employees. . . When family doctors need to refer to a specialist for an opinion, they would in the past have written a letter that might take a couple of minutes. Today we have "Choose and Book". Oldham GP Dr Anita Sharma explains some of the process: "To make an appointment, I have to first open the system, making sure patient demographics are copied, search for a clinic near the physician's name or speciality, and then choose between a range of dates. This whole process can take between 10 and 20 minutes, and that means angry, groaning patients in the reception area." . . ."

NHS IT time-frame 'ludicrously tight' (25 Oct 2007)


"The NHS National Programme for IT is the largest non-military project in the world and aims to revolutionise healthcare. But the budget for the massive project was never properly explained and it was given a "ludicrously tight" time-frame a new BBC Radio 4 investigation reveals. In 2002, Sir John Pattison at the Department of Health and colleagues were invited to a seminar on IT at Downing Street. They were given 10 minutes to explain their vision for a computerised NHS. The initial plan was for a dependable electronic network connecting all parts of the NHS containing three elements - electronic patient records, booking of appointments and prescriptions. "I suggested it would take three years," says Sir John, but admits: "We did not get across that the initial time-frame of three years and budget of £2.4bn was just the first phase, and this is possibly where the concern for delayed implementation has come from". This initial timescale was "ludicrously tight" according to Dr Paul Cundy, chairman of the BMA's IT committee. "If you'd asked anyone with any sort of feet on the ground anywhere near any sort of IT project, they'd have said no it's not possible." Now the project has a 10-year plan with an estimated budget of £12.4bn. The director of the project, Richard Granger, resigned in June this year. During his tenure, he had coped with accusations of delays, problems with contractors, including one of its software suppliers - iSoft - being investigated for alleged accounting irregularities. . . in June 2006, the National Audit Office published a report assessing the NHS IT programme, which had allegedly been completed in draft form a year earlier. The editor of trade magazine Computer Weekly, Tony Collins, saw a draft version of the report which he alleges was radically different to the final one and believes it was exploited by the Department of Health and turned into "the most gushing report". . . Despite the optimistic tone of the National Audit Office report, within three months two more suppliers - IDX and Accenture - withdrew from the project and there was also a new NHS chief executive, David Nicholson, to oversee the National Programme for IT. Earlier this year he rejected fresh calls by the 23 academics for an independent review but he later announced the National Local Ownership Programme - a move away from Granger's original vision of a centralised IT delivery - to the regions - something many critics have called for in the past. The change of direction followed consultation with health professionals and trusts about their needs and has been welcomed by Dr Paul Cundy at the BMA who was so critical of the project's initial timescale and vision. . ."

Who lost our data expertise? (29 Nov 2007)

The Guardian

"The sound of two dropped CDs is still echoing around the government's £14bn-a-year IT programme. And the effects are already being felt: last week the NHS IT agency Connecting for Health warned hospitals not to post discs containing unencrypted personal data to the central NHS Tracing Service, run by a private contractor in the Midlands. Media not meeting security standards "will be destroyed upon receipt", it warned. And on Tuesday ministers announced a five-month delay to ContactPoint, a database with details about every child in the UK. . . Data sharing between departments about individuals can have benefits; what is needed is a culture within government where both the power and the responsibility for implementing those benefits is understood throughout. Right now, however, the first priority for IT chiefs is to comply with the prime minister's request for an analysis of "systems and procedures" by December 10. The reports will feed in to a review by Robert Hannigan, the government's intelligence chief. Yet all these efforts make one big assumption: that so long as "systems and procedures" are properly followed, everything can continue as before. There is an alternative, more worrying analysis of the situation: that the child benefit data fiasco was the result of a government overwhelmed by the scale of what it is trying to do with IT. "It's indicative of a lack of expertise," says Helen Margetts, professor of society and the internet at Oxford Internet Institute and the co-author of a study that is devastatingly critical of the government's IT programme. Published last year by Margetts with her colleague, Patrick Dunleavy of the London School of Economics, the study of IT projects in seven leading countries found that governments that place big IT contracts in the hands of a few big contractors are the ones most likely to experience failures. The UK was unique in the extent to which it outsourced projects so that large IT companies had the government over a barrel. The study found that the UK had "the most concentrated government IT market in the world, with a near-monopolistic lead supplier (Electronic Data Systems, or EDS), huge contract sizes, poorly understood use of private finance initiative (PFI) contracts for inappropriate IT projects and virtually no in-house capacity to manage (let alone develop) IT systems." . . . In theory, the government has been trying to raise its game for more than two years. One of the three central aims of the Transformational Government Strategy, published in November 2005, was to create a new "IT profession in government". Part of this process is to hire people with IT qualifications for the civil service fast stream, where they can expect to rise to the top. Six fast-streamers were hired last year; 15 will shortly be selected for entry next year. In the context of the government's IT programme, this is like opening a hospital before you have put the staff through medical school. . ."

Ready, steady, scrap - the big and bloated Olympics are just a start (2 Dec 2007)

Sunday Times

". . . Gordon Brown should announce forthwith that he is putting his three wildest white elephants out to grass: identity cards, the National Health Service computer and the plan to locate the 2012 Olympics in Stratford. All have budgets out of control. Such is this centralist squandermongering that Brown could take 2p off income tax for a decade or give every school, hospital and library in Britain a Christmas bonus of £1m. The first two projects could vanish with no shock to the system but the impoverishment of a few consultants. The ID computer is seriously sick. A review last year led to a supposed scaling back from some £10 billion to £5.4 billion. The £10 billion was reckoned by outsiders to be a gross underestimate and the new figure has been rising by 5% each six months. A figure of £20 billion remains plausible. As for the theory that the, as yet unworkable, ID computer will "help catch criminals", most computer commentators say: tell that to the marines. Criminals will revel in it. Every month we have evidence that such giant systems are porous both to hacking and to human error. British people will not accept being interrogated by the state so that their personal details can be available to every agency in Europe and every hacker in the world. The NHS computer is, if anything, sicker. Nobody can now recall a reason for it. Lord Warner recently admitted that its cost had risen to £20 billion. Choose-and-book, already in place, is simply not required by general practice. The government is weakening in its demand that patients must opt out of, rather than opt into, making their medical records open to the world. But if they must opt in, who will bother? In the latest survey, 85% of doctors want "an inquiry" into whether the project should proceed. . ."

Not fit for purpose: £2bn cost of government's IT blunders (5 Jan 2008)

The Guardian

"The cost to the taxpayer of abandoned Whitehall computer projects since 2000 has reached almost £2bn - not including the bill for an online crime reporting site that was cancelled this week, a survey by the Guardian reveals. The failure of the multimillion pound police site marks the latest chapter in the government's litany of botched IT projects, with several costly schemes biting the dust. Major blunders overseen by Downing Street have included the Child Support Agency's much-derided £486m computer upgrade - which collapsed and forced a £1bn claims write-off - and an adult learning programme that was subjected to extensive fraud. Top of the ministries for wasting public money is the Department for Work and Pensions, which squandered more than £1.6bn by abandoning three major schemes - a new benefit card which was based on outdated technology; the upgrade to the CSA's computer which could not handle 1.2m existing claims; and £140m on a streamlined benefit payment system that never worked properly. The Guardian's survey of abandoned projects is not exhaustive and the total of £1.865bn is likely to be a considerable underestimate of the actual cost to taxpayers because neither Whitehall nor the National Audit Office, parliament's financial watchdog, keep definitive lists of which schemes go wrong. Neither does it include the major modifications required to fix new systems that have failed to perform as required. One example is the pilot work done on the new £12bn NHS computer system - where outdated technology was installed at Bexley Hospital in south London, and has had to be replaced after it was found to be "unfit for purpose". Another is the huge modification required to the new computerised single payments system for farmers run by Defra's Rural Payments Agency, where the government has had to set aside some £300m to meet possible EU fines for wrong payments to thousands of farmers. . ."

Cameron slams NHS IT programme (7 Jan 2008)

Computer Weekly

"David Cameron has blasted the government's £12.4bn NHS National Programme for IT (NPfIT), saying that ministers have fallen for the sales pitch of IT suppliers and consultants who have cut corners. "I have said before that in their drive to 'modernise' the NHS, Labour have not improved it, so much as ripped out its heart and installed a malfunctioning computer instead," said the Conservative Party leader, at a speech at Trafford General Hospital. "It is one of the most shameful and disgraceful aspects of Labour's record: the way they fall for the sales patter of the management consultants and the big IT firms, who make them think they can cut corners to success." He said that the NHS is suffering from shoddy jargon-ridden schemes served up on Microsoft Powerpoint and swallowed whole by the people who are supposed to be custodians of the health service and custodians of taxpayers' money. He also criticised the Government's proposal for a vast, centralised, NHS database saying that recent events have shown how dangerous government IT systems can be if mis-managed. "Of course we need different NHS professionals to be able to access medical records. But those records should be owned by the patient, and stored locally, under the control and protection of his GP. We need local servers with interoperability," said Cameron."

The NHS's £12.4bn National Programme for IT - Experts give their views (9 Jan 2008)

Computer Weekly

Videoed interview
"Leslie Willcocks, Professor in Information Systems at the London School of Economics, says of the NHS's National Programme for IT [NPfIT] that it is at the "outer reaches of known territory". But is it right for the government to use public money to take such immense risks with public money - not to mention patient safety? Leslie Willcocks makes the point that there's a natural tendency on huge projects for civil servants and ministers to downplay their full cost for fear of frightening off the funders. In this video he talks about the strengths and weaknesses of the NPfIT, the lessons to be learned, and refers to a series of expert views on the programme that are published in the Journal of Information Technology."

The best virtues of British medicine are in grave peril (11 Jan 2008)

The Herald

"As I approach a milestone birthday later this year, I have been reflecting on the career changes I have experienced as a rural general practitioner. . . The English NHS is set to dismantle the very basis of personal care by doctors serving a defined list of patients on the grounds of fashionable competition and privatisation. The key vehicle for this change is dilution of the confidentiality of the personal medical record, recklessly allowing its details to be automatically sucked from practice computers on to what is known as "the spine" - an electronic database to be available to anyone within the NHS "family". Connecting for Health, the latest massively expensive governmental IT disaster, is promoted as essential for the emergency care of any patient who turns up unannounced at a hospital, but the dangers of information incontinence within the NHS, the largest single employer in Europe, is conveniently forgotten. Already there are instances of illicit access to the records of celebrity patients. The real reason for this dangerous innovation, of course, is not patient care, but so that the English Department of Health can offer general practice contracts to alternative providers - commercial companies that propose to offer primary care through the same supermarkets and high street outlets that seem to have captured the imagination of the spotty adolescents who populate the No 10 Policy Unit. General practice has changed over 30 years, and most of us recognise that as welcome and appropriate in a maturing society. What must not change, however, are those enduring principles that have served the NHS and its patients so well since 1948. A personal service, provided by well-trained doctors and their teams, based locally and on families and one where there is trust that what is said confidentially in a consulting room on a Monday will not be on a government database on Tuesday. A service where there is recognition that historically one could never phone for instant advice out of hours for the least discomfort, but one where there was always help in an emergency. . ."

Experiences of 'Connecting for Health' (22 Jan 2008)

Technology and Social Change

Abstract: The national NHS 'Connecting for Health' strategy has shifted the centre of gravity around ICT to big Corporations determined to impose national contractual obligations on Primary Care Trusts often with solutions that are not specified according to local service requirements. Unsurprisingly, outsourcing by stealth has been an inevitable consequence of this process as these corporations offer economies of scale. Secondly it has developed solutions around running the NHS as a business in a market environment as opposed to solutions for front line clinicians that support operational needs. Consequently the role of NHS IT in accelerating the comodification of the NHS has been a major challenge to us all as we seek to maintain 'in house' developments aligned to service needs and not just the national Connecting for Health programme. One consequence is that national systems innovation has now been conflated with management requirements as opposed to patient benefits and this feeds into a bigger political mistrust of government intentions - not least around privacy of information and the potential (mis)uses of data. In this seminar Neil will discuss his experiences of running such programmes at 'the frontline' through a number of case studies that illustrate some of these issues. [Notice of a seminar to be given by Neil Serougi (Director of ICT at Solihull Care Trust)]

NPfIT 'pushed the NHS into disarray' say Lib Dems (23 Jan 2008)

e-Health insider

The Liberal Democrats have labelled the National Programme for IT (NPfIT) as a waste of money which 'has pushed the NHS into disarray'. Setting out his vision for the NHS, in policy paper, 'Empowerment, Fairness and Quality in Healthcare', Liberal Democrat leader, Nick Clegg, says that NPfIT and the Medical Training Application Service (MTAS) have been over-budget messes by the Labour government. "The NHS IT system is running behind schedule and billions of pounds over the original budget; the grossly mishandled doctors' contracts with costs running hundreds of millions of pounds over budget; the new centralised computer system for doctors' recruitment MTAS introduced without proper piloting which caused chaos. These are all examples of where the government has rushed headlong into new projects and in the process has wasted money and pushed the NHS into disarray," the paper says. The paper also accuses the Conservatives of "almost criminal neglect" of the NHS during the party's periods in office. The Liberal Democrats say they will introduce compulsory technology appraisals, to ensure local trusts take full responsibility of the systems they install. "The Liberal Democrats would initiate regular and thorough reviews of the implementation of technology appraisals, and would publish information on which health trusts were failing to meet their legal responsibilities in order that trusts could be held democratically accountable for their decisions. "We will look at ways of allowing technology appraisals not only to make mandatory, legally enforceable recommendations, in high priority areas, but also to make some non-mandatory recommendations. Trusts would be regularly assessed by the Healthcare Commission on their compliance," the party proposes. . . The policy paper will be discussed at the Liberal Democrat Spring Conference in March."

Frank Burns on IT policy in the NHS (23 Jan 2008)

Health Service Journal

"Anyone interested in how high-profile national policy is developed will have enjoyed the revelation, on Radio 4's Wiring the NHS programme, that in 2002 then NHS IT director Sir John Pattison was given only 10 minutes to pitch the creation of the national IT programme to prime minister Tony Blair. . . The national IT programme is the ultimate example of political impatience for results. It arose from frustration at the centre with the slow progress in local implementation of the 1998 strategy Information for Health. The creation of the programme represented a victory for those who had always favoured a top-down approach and who assumed clinical IT systems could be purchased centrally and delivered in the back of a van to NHS organisations. John Pattison's 10-minute pitch to the prime minister must have been mesmerising. It resulted in the replacement of the Information for Health approach with a diametrically opposite philosophy and a target to deliver key systems to NHS organisations in just three years. It was a confident and brave change of direction that was backed up with undreamed-of levels of resource. It was a bid for a quick win on a monumental scale. Regrettably, after allowing for the success in delivering the picture archiving and communications system (PACS), the shortcut to integrated clinical records that was the key driver for the creation of the IT programme seems to have turned into a dead end. The reasons for this are well known and are well documented in the recent report of the health select committee. Though the government came to power in 1997 with an intention that wiring the NHS would be a flagship modernisation policy, in its 11th year of office and six years after the creation of the IT programme, only a minority of NHS clinicians have sophisticated clinical IT support. A grand total of 45,000 people (in Bolton) have the beginnings of a shared clinical record which, in reality, contains only two potentially useful items of clinical information. Even the high priority Choose and Book programme is a long way from being fully implemented and supported. Whatever the true nature of any high-level discussions about the future of the IT programme that are rumoured to be under way, we can only hope that NHS leaders and politicians have finally come to appreciate that wiring the NHS is difficult, complex, frustrating and in the end far too important for 10-minute, off the cuff decision-making. We must also hope that in the interests of expediency they do not choose to abandon the more complex, clinically related components of the project, as these are the only elements of the programme that remotely justify the billions of pounds committed to it."

Large-scale Health IT is a risky business (25 Mar 2008)

Computerworld NZ

". . . Almost everywhere that health executives or authorities have pursued the goal of integrated electronic healthcare the dream has fallen well short of reality - and usually cost a bucket of money along the way. Most prominently right now, there is the UK National Health Service's NPfIT (National Programme for IT) project, which has redefined the term 'project failure'. So many things have gone wrong with this project that it is hard to enumerate them quickly, but, like our 1990s Police INCIS project, it was based on the wrong technology, and that's never a good place to start. NPfIT was based on a technology that hadn't been fully developed, iSoft's elusive Lorenzo, while INCIS was based on one - IBM's OS2 - that was shortly to be discontinued, despite IBM's insistence to the contrary . . ."

Cameron pledges end to "hubristic" IT (4 Apr 2008)

IT Pro

"The Conservative leader has said his party would create modular IT projects, rather than massive ones like the NHS IT upgrade. Conservative opposition leader David Cameron has said his party - if elected - would stop massive IT projects, splitting them into modular components. Giving a speech at the National Endowment for Science, Technology and Arts in London, Cameron came out against large-scale projects such as the £12 billion NHS national programme for IT (NPfIT). "Never again could there be projects like Labour's hubristic NHS supercomputer," he said. He praised open-source development, and said the government should look to such methods to overcome difficulties with large-scale projects. "The basic reason for these problems is Labour's addiction to the mainframe model - large, centralised systems for the management of information," he said. He added: "From the NHS computer to the new Child Support Agency, they rely on 'closed' IT systems that reduce competitive pressures and lead to higher risks and higher costs." Cameron said he would make it possible for smaller open source firms to win government contracts. "We will create a level playing field for open source software in IT procurement and open up the procurement system to small and innovative companies," he said."

Cameron attacks NHS computers (4 April 2008)

Kable's Government Computing

Conservative Party leader David Cameron has questioned the role of IT in the National Health Service In a posting on his blog, published on the party website on 3 April, Cameron used the phrase "No more NHS computers". This followed a speech he gave to the National Endowment for Science, Technology and the Arts (Nesta) in which he spoke about a "hubristic NHS supercomputer" and advocated "open standards that enable IT contracts to be split up into modular components". He also accused the government of being addicted to large, centralised IT systems for the management of information, and that the "NHS computer" relies on "closed IT systems that reduce competitive pressures and lead to higher risks and higher costs". A spokesperson for the Conservative Party told GC News that, despite the comment on his blog, Cameron was not advocating that the NHS should work without computers, or that the government should abandon the NHS National Programme for IT. "He's saying we should make existing systems more efficient," she said, stating that there have been errors in the programme and that "we want the systems to be more scrutinised."

HC2008: learning lessons from the National Programme for IT NHS IT (23 Apr 2008)

Computer Weekly

". . . IT-related progress in the NHS moves so slowly that the eye can barely perceive it. The National Programme for IT [NPfIT] in the NHS was supposed to change that. Ministers wanted action, and quickly. Cynics would say that what ministers wanted quickly was their comments in innumerable media articles and broadcasts on how New Labour was using IT to modernise the NHS. . . Now, six years on from the announcement of a national programme, some NHS staff and those working for the suppliers say significant IT-related change has become slow and tentative, and at some trusts has all but stopped. They depict the NPfIT as a behemoth that nobody knows what to do with. In some ways things are worse than they were before the NPfIT. Hospitals were able to buy what they needed. Several trusts were combining for consolidated purchases of electronic record systems, which could have been mature products today - had they been allowed to go ahead. They were cancelled because of the NPfIT. Computer Weekly has recently reported on some of the trusts that have put major IT plans on hold. Trusts receive money from Whitehall for buying patient administration and other core systems under the national programme. But if those systems do not arrive - and patient record systems are running three years late - what are trusts to do? If they bypass the NPfIT, and some of them are doing just that, they have to fund major IT systems with hospital money and risk becoming outsiders to the national programme. . . Some in the NHS argue that there should be no national programme in the sense of centrally controlled IT that is imposed on trusts. That goes too for a national programme in a guise of a local one - the so-called National-Local Programme for IT. There should instead be a choice for trusts of IT systems that should ideally, but not over ridingly, meet technical standards that are set nationally. Some independently minded NHS executives have long thought that the NPfIT should cease to be an amorphous programme under which integrated systems throughout the country deliver all that IT should and could. Better, they say, to have reliable electronic patient records within local boundaries to replace paper records that frequently are lost than a grand, risky, controversial scheme for national records that exists only in ministerial statements of intent. Yet ministers continue to hope that two main products - Cerner's Millennium system and IBA Health's "Lorenzo" in the North will give the NHS much of what it needs. But some see this strategy as a single circular railway around England that drops people off a long way from where they want to be. How did the NHS end up like this, in such a mess? Some Whitehall officials see this as a pointless question. They want to decide where to go now. But others say it is important to learn from history to avoid making the same mistakes again."

A whole new way of losing the election (20 May 2008)$1223538.htm

"Gordon Brown has staked his reputation on the economy, but it may be his handling of the civil liberties-counterterrorism balance which ruins his premiership. Across the government the prime minister has tasked ministers with implementing his much-needed fightback. Come up with a raft of new measures. Show the world we still have energy and momentum. Aha, Home Office officials say. We have just the thing: a new database. This one is needed because of the telecommunications revolution, they explain. The internet and growth of mobile technology is changing the way criminals and terrorists communicate. If those responsible for keeping Britain safe are to keep up, they need to be able to monitor the situation. Being able to access records of phone calls would be just what the counter-terrorism official ordered. Unfortunately, anyone who has been even vaguely politically aware over the last ten years will realise the horrendously fraught dangers the word 'database' possesses. They just aren't cool. Look at the fate of Connecting for Health's patient records database which has just been delayed by four or five years. How about the furore over data security? A swathe of embarrassing admissions over the winter hasn't helped the government's reputation for competence. This government needs another database like the Titanic needed another hole. . ."

Frank Burns on Lost Opportunities (18 Sep 2008)

Health Service Journal Supplement>

"I've been writing this column now for two years or so and I fear this might be my last piece - not because I want to give up this marvellous platform to peddle my personal passion for clinical IT, but because I'm beginning to wonder if my difficulties in understanding what is going on with the IT strategy in the health service disqualifies me from having this national platform. Notwithstanding the publication of the Health Informatics Review, I am none the wiser about whether the national IT programme is still expected to deliver clinical information systems to service providers or whether the encouragement to pursue interim solutions is the beginning of the end. My confusion might simply arise from my failure to grasp the subtleties of the "biggest IT project in the world" adapting to inevitable changes. On the other hand, it could signal that with the loss of another local service provider, the Department of Health is hoping the programme will die of natural causes (terminal exhaustion) and in the meantime a policy of "mess and muddle" is the best that can be offered. More worryingly, having read the review, I'm still not convinced the authors fully appreciate that the goal of improving the flow of timely, reliable information for decision making, service development and individual patient choice is fundamentally dependent on the universal availability of functionally rich clinical management systems. . . . The most frustrating thing about the review is the fact that 10 years after the publication of Information for Health (yes, I did write it and, no, it wasn't a complete success), the stakeholder engagement process has come up with exactly the same analysis of what the service requires by way of health informatics. Surely an inevitable outcome - the NHS hasn't been complaining about the goals of the national programme but about the process to achieve these goals and the snail's pace progress in delivery. Despite this, I detect absolutely no sense of urgency in the review. The nearest it comes to a sense of urgency is the statement that "local informatics plans should identify the roadmap that achieves these 'clinical 5' as soon as possible". Well, it hasn't been possible over the last 10 years and the requirement for local funding presages the same fate for this initiative as befell Information for Health, so we may be in for another 10-year wait. . .

NHS e-records project has 'ground to a halt' (28 Oct 2008)

Daily Telegraph

The NHS's £12 billion computer programme designed to give doctors instant access to patients' records has "ground to a halt". Connecting for Health, originally launched 2002, has faced a series of problems including reports it is running four years late. Just one of the acute care hospitals due to install the system has done so - Royal Free NHS Trust in London - and that is experiencing difficulties getting it to operate properly. Jon Hoeksma, editor of the e-health insider website which is tracking CfH's progress, said other parts of the project were continuing to make progress. He told The Financial Times: "This key part seems to be simply stuck. It has ground to a halt. And that is not just affecting deployments that should be happening now. It will have a knock-on effect on those that are meant to be going live two or three years down the line." Hospital chief executives, he said, did not want to take a new system "until they have seen it put in pretty flawlessly elsewhere". Fujitsu, the contractor originally hired to build the record system for the whole of the south of England, is now no longer involved. NHS Trusts in the south have been given a choice of working with BT, London's supplier, or CSC, the supplier for the north, but nothing has yet to be agreed. The first installation of patient record software in the north of England was due to go forward at Morecambe Bay in northwest England in June, but the system has still not gone live. Frances Blunden, the IT policy specialist at the NHS Confederation, the body that represents NHS Trusts, said: "It is a little bit too early to pronounce the programme dead." She added that "to say everyone is walking away from it is a bit premature, probably". A spokesman for Connecting for Health said it was more important to get the quality of installations right rather than set a particular date for installation, while talks were underway to ensure "a smooth transition" following Fujitsu's departure.

NPfIT 'misconceived': O'Brien (30 Oct 2008)

e-Health Insider

"Shadow health minister Stephen O'Brien has launched a stinging attack on the National Programme for IT in the NHS at Healthcare Interoperability in Birmingham. Mr O'Brien said he had been surprised to see a "flurry" of stories claiming the programme was "grinding to a halt" in this week's press, since there had been no obvious "hook" for them. But he argued they reflected the "perceptible lack of progress" that it is now making. In his keynote speech to the conference, he then went further and argued that the programme had always been misconceived. He noted that one of the triggers for it had been Sir Derek Wanless' 2002 review of the likely future spending needs of the NHS for the Treasury, which argued the health service needed to raise spending on IT to business levels. "He [Wanless] felt that ICT was an important condition for a more efficient health service. The government felt it was a sufficient condition," O'Brien said. Once major IT suppliers had become involved, he added, this had translated into a programme that aimed to "drive" rather than support change in the health service. "The government was seduced by a dream of IT, instead of seeing it as an enabler of a better health service," he said. The irony, O'Brien went on, was that the Wanless report had outlined an alternative: standards based, interoperable systems focused on delivering better quality care to patients. Although O'Brien was reluctant to pre-empt the findings of the independent review of NHS IT that the Conservatives have set up under Dr Glyn Hayes, he indicated strongly that he felt this was the way that healthcare IT should go in the future. . ."

Michael White on IT in the NHS (6 Nov 2008)

Health Service Journal

". . . The word on the health street is that, whatever they cautiously say for public consumption, ministers and senior officials are seriously worried about their ambitious NHS Connecting for Health IT plans. . . Outside Westminster a well informed source tells me he hears it's "in real trouble" - not just in the South either - not least because the technology has moved on. That translates as meaning that software to allow previously incompatible systems to talk to each other now exists to render the centralised CfH vision unnecessary. But, as so often in such chats, my source adds "I don't understand the technology." Few do. The official position from the Department of Health, the NHS Confederation and CfH seems to be that - as with Wembley stadium - it is better to be late and right than on time and wrong like Heathrow's Terminal 5. There is stock-taking, a hiatus, assorted problems, but it ain't dead yet, they all say. I'm sure that's true, but when in doubt talk to smart backbenchers who do IT. Derek Wyatt, Labour MP for Sittingbourne and Sheppey (majority 79), who has blown hot and cold on the practicalities of CfH in chats with me over the years, still insists it's a good thing, albeit over-centralised. "The big change is that we've all gone mobile [as in phones]", he notes. More cautious than Mr Clegg, whose call to scrap the scheme was dismissed by the Tories as "barking mad", Liberal Democrat health spokesman Norman Lamb is calling for "a thorough review of the work in progress and how to proceed". It is when I ring shadow health secretary Andrew Lansley's deputy, Stephen O'Brien, that I get a serious blast. After Tony Blair shot his mouth off on TV in 2000 about creating the best health IT system in the world (he couldn't use email at the time) Labour rushed to make the leader's words a reality of sorts. "A typical New Labour, one-size, top-down and fits-all solution in which only lip service was paid to consulting the professions," is Mr O'Brien's view. The focus from the start should have been on the needs of the patient and the better outcomes which IT could deliver if staff consultation had been a priority. Mr O'Brien is not against the principle of a national IT network. He can see what doctors have done in Cheshire (he is MP for Eddisbury) in terms of efficiency and patient choice. But local schemes like that were urged to hang fire by Whitehall: "We're going to give you a solution that will allow you to speak across the country." It is rare, of course, that a GP has to do that. Even patients going into distant hospitals are usually conscious for interview. But ministers - generally ignorant of IT - were wooed by the big boy suppliers with their overambitious plans. "Ministers were warned that the whole design was designed for failure," says Mr O'Brien, whose complaints are echoed by other smart IT-minded Tory MPs like Richard Bacon. Of course, "low-hanging fruit" - like radiography - works well. That was the easy bit. What to do? With ministers citing commercial confidentiality to avoid debate and accountability Mr O'Brien has raised some private funding to conduct an independent review, chaired by Glyn Hayes, ex-chair of the British Computing Society. Their goal: to rescue the project. But everyone agrees that a recession-hit Treasury in search of savings may even now be casting a beady eye on CfH's billions."

U.K.'s Project Runaway (7 Nov 2008)

Government Health IT

"The United Kingdom's ambitious plan to introduce a nationwide health information technology system has reached a turning point. The $22 billion program has scored some notable successes, including the launch of medical imaging and appointment management services. But it has also come under criticism from those who say it is spiraling out of control. Recent reports have blamed the Labour government of Prime Minister Gordon Brown for unrealistic goals and timetables that have led to major delays in the National Programme for IT (NPFIT). Meanwhile, leaders of opposition parties have targeted the program for increasing scrutiny ahead of a general election that must be held in the next two years. The 10-year program began in 2002, but deadlines have slipped by at least four years. Every National Health Service (NHS) patient was supposed to have an electronic health record by 2010, a goal that now seems unlikely. . . In a report published in May, the National Audit Office (NAO) - the equivalent of the U.S. Government Accountability Office - said some elements of NPFIT are fully deployed and some have even been delivered ahead of schedule. N3, NHS' broadband network for incorporating voice and data services, has been deployed. Other critical systems - such as Choose and Book, an online patient appointment service, and a system for storing and sharing digital images of X-rays and other tests - also met their deadlines. However, delays in other parts of the system, including the Care Records Service and the Summary Care Record (SCR), have held back the overall timetable for NPFIT, the NAO report states. The Care Records Service offers detailed health records and systems that let patients choose what information their records contain. SCRs will include basic patient information, such as current medications and allergies. The final release of the care record software is expected in 2014. Bowen said the delay is because of the software's technical complexity and the need to develop the Care Record Guarantee "to meet the concerns that patients may otherwise have felt about the confidentiality of their records." An independent evaluation of SCR's early-adopter program by University College London detailed the objections that general practitioners and health care organizations had to the first iteration of the SCR software. Those objections included an aggressive approach by Connecting for Health to meeting SCR implementation deadlines, concerns over patient confidentiality, SCR's clunky appearance, its poor ability to interface with other systems, and the need for more training for frontline employees. Another concern was that Connecting for Health was putting too much emphasis on SCR's technology needs. . . Bowen said the Department of Health is now considering how to move forward in light of the report's findings. It's also unclear how the loss of Fujitsu, one of the key vendors on the project, will affect NPFIT. Connecting for Health dropped the company after contract renegotiations broke down in May. Fujitsu is the second vendor to depart from NPFIT in the past two years: Accenture left in 2006 because officials said the company wasn't making any money on the program. Seceding from NPFIT Despite the progress that NPFIT has made in some areas, its continuing delays are starting to take a toll. Last month, the Newcastle Upon Tyne Hospitals NHS Foundation Trust, a local health provider, opted not to go with NPFIT and instead said it would create its own electronic medical record system. Other providers are reportedly considering similar moves. Meanwhile, the program has become a target for the Labour Party's political rivals. The Liberal Democrats have taken an especially hard line. . ."

ASSIST says idea NHS like a bank 'fundamentally flawed' (8 Oct 2008)

e-Health Insider

"NHS informatics professional body ASSIST has published a paper saying the original NHS National Programme for IT plan based on a one size fits all "does not work". The paper says attempting to treat the NHS as if it were a bank failed to understand the structure and characteristics of the health service. ASSIST says there has been too much focus on standardisation of systems rather than standards. The paper says both national and local systems have a role to play but cannot succeed if they are imposed. The ASSIST document says a revised strategy must reflect the shift to a pluralistic, federated model of care delivery, in which information follows the patient. The paper calls for changes to NPfIT to take account of the changed policy environment, for mistakes to be acknowledged and lessons learned. ASSIST, which is affiliated to the British Computer Society, says the standardised systems approach of the original NPfIT strategy, emerged from a "misguided attempt" to see the health service as analogous to a big business. . . The paper has been produced as ASSIST's evidence submitted to the independent review of NHS IT being undertaken to inform Conservative party policy. The document says priority should now be given to getting the IT basics sorted first, with a focus on deploying clinical systems based on common standards. Counted among the notable successes are: primary care computing, electronic records transfers and prescribing, picture archiving and communications (PACS), digital patient monitoring and the secure NHS broadband network. The paper says other important parts of NPfIT have failed. "It is generally accepted that deployment of ICT in acute hospitals through the national programme has not gone well for a variety of reasons." "We observe that IT-imposed solutions have always tended to failure, while IT-enabling solutions have tended to be more successful." As a result of the NPfIT ASSIST says there has been a "radical" change in the supplier marketplace. "There has been a shift from a very wide range of small to medium sized suppliers, to one where there are a few very large suppliers with relatively constrained supply chains." . . . The document calls for pragmatic flexibility on systems: "The experience of the members of the group suggest that simple systems, which offer flexibility to be configured to meet local processes and circumstances, can achieve greater success than more sophisticated systems which bring rigidity." . . ."

Personal touch lost in 'pass-the-patient' (21 Jan 2009)

BCS News Channel (Health Column by John Black, President of the Royal College of Surgeons)

"No matter how routine the operation, learning that you need surgery is an unsettling and pivotal moment in anyone's life and requires confidence in the abilities of those caring for you. A much underestimated and unmeasured factor in healthcare in this country is the importance of the rapport that develops between doctor and patient. This trust is now being eroded by a system that has reduced healthcare to a factory production line where over-reliance on numerical targets and computerisation has broken down care into a series of procedures. I believe this is driving a wedge between patients and doctors in a way that is becoming detrimental to patient care. Until recently, your GP would refer you to a single consultant who would then see you through the whole process of your care, from initial consultation to final discharge. GPs needed to maintain direct professional relationships with local hospital doctors to be able to select the right consultant for each patient, based not just on the type of operation and technical competence, but also on personalities. However, this cord between GPs and surgeons has been cut by the computerised "choose & book" system, which purports to offer greater patient choice but which has had the opposite effect. You may now select the hospital based on sets of centrally gathered statistical measurements, rather than the right doctor for you with professional advice and support from your GP. How many patients know enough about the health service to make a really informed choice? I believe that patients genuinely welcome advice and input from their family doctor on which specialist may be right for them as an individual - a proper complex person not a statistic. Because of the target culture, continuity of care has been severely compromised. You might be seen initially by Consultant A, come back for your results to see Consultant B, go on to a common waiting list and then have your actual operation done by Consultant C, whom you might meet for the first time on the morning of your operation. You may well be sent home the following day by Consultant D and if you are fortunate enough to have a follow up consultation, you may be seen by consultant E. It should again be the norm that patients are referred to an individual consultant who will be responsible for their care. This provides numerous opportunities for mistakes to be made, and it is deeply unsettling for the patient to be handed over time and again at every stage to a new doctor. This is also demoralising for clinicians. For me, and other surgeons, the great joy of the job is in seeing a real positive difference to someone's life. When you are only part of a production line, it becomes ever harder for the healthcare professional to deal with patients as human beings. Surgeons losing control of their waiting lists has also taken away the flexibility to make appropriate professional judgements about which patients are in greatest need and should be dealt with sooner. Another factor is that surgeons gauge their own ability on the outcomes achieved for their patients. If you never see them again, how can you know how you are doing? It should again be the norm that patients are referred to an individual consultant who will be responsible for their care throughout the clinical episode. Using the latest technology to increase the efficiency of the health service and measure how patients' lives are improved is vital. But this must be sensitive to the individual patient and must retain personal professional judgement. The current system in the NHS is forcing patients and doctors apart and I believe the delivery of care is poorer without those personal relationships."

NHS Confed calls for IT programme overhaul (27 Jan 2009)

Health Service Journal

"The national programme for IT should be called in by government, NHS Confederation policy director Nigel Edwards has said. Instead, local programmes should be allowed to meet national IT standards. Speaking on Radio 4's Today programme this morning Mr Edwards said managers were pessimistic that the programme could improve. He said: "Levels of pessimism are now such that we have reached the point where the government needs to call this in. We can't abandon this programme but have to ask: is this really working? We need local determinations about what is needed to reach a national standard. We need this programme and need to spend the money but this is increasingly looking like it is not the best way of spending it." Mr Edwards' remarks came after a report by MPs said the Department of Health should fund hospitals to buy electronic care records systems outside of the national programme for IT. . ."

U.K. NHS computer system on verge of collapse & implications for the U.S investment in CHIT (27 Jan 2009)

Virtualgryphon blog

"News from yesterday indicates that the project to build an integrated healthcare information system for the U.K. is close to collapse. Reaction to a report from the Public Accounts Committee of the House of Commons indicate that key elements of the £13 billion system are not working now, unlikely to work by the projected end of project in 2015, and may never work. The system, which was supposed to make medical care in the UK "better, safer and faster", is an end-to-end integrated healthcare information system similar to that currently sought by U.S. healthcare leaders. The U.S. system is one of the projects being targeted for a US$60 billion investment by the Congress and the Obama administration. The U.K.'s clinical healthcare information technology (CHIT) system evolution has followed the pathway of other, large, expensive IT system failures. CHIT was proposed as a remedy for many of the problematic features of an essential, expensive, and politically sensitive healthcare delivery system. The benefits of CHIT were optimistic extrapolations from demonstrations. The massive project itself was similarly optimistically planned and budgeted. Ironically, controls intended to avoid cost overruns and project delays acted as as incentives for primary contractors to pull out of the project when problems arose. Progress on relatively easy parts of the system (e.g. incorporation of already working image storage systems, network infrastructure) obscured failure to create and field core functional elements. Fielding of some crippled, partly working components was hailed as "installation" and treated as success despite clear signals that the components made clinical work harder rather than easier. When problems were raised, CHIT proponents classified them as small faults that would be resolved by future software and hardware improvements or even as evidence of "resistance" from clinicians themselves. Over time the goal of making care better, safer, and faster was replaced by the need to simply get the system working irrespective of its impact on care - with a promise to incorporate these features in a future release. The Commons committee report and the associated interviews and press reports are couched in language suggesting that political support for the system is waning. Significantly, the sunk costs (possibly £4 billion), the lost time and momentum are probably unrecoverable. As with other large scale project failures, the U.K. system owners now face Hobson's choices. They can abandon the existing system and give up the grand plan of integrated, national CHIT. Or they can persevere with a system so poorly organized and planned that it may cost so much more and take so much more time to fix that its benefits will never equal its costs. Not surprisingly for such a large project, national prestige and macroeconomic factors may have more to do with the choice than any technical assessment. As Nigel Edwards, the Director of Policy for the NHS Confederation observed "There's a real hazard of doing [with the NPfIT] what we did with Concorde". The experience with the U.K. system gives U.S. observers nightmares. One part of the economic stimulus planned by the Obama administration is a huge investment in U.S. CHIT - by some accounts as much as US$ 60 billion. The claim is that the savings will pay for this investment. If the U.K. experience is any indication, the cost/benefit ratio is not likely to be favorable. More importantly, it is unlikely that the proposed U.S. system can be made to work even for US$ 60 billion. . ."

Secret computer deals that are costing the taxpayer billions (2 Feb 2008)

The Times

"It is costing the taxpayer almost as much as the autumn bank bailout. But the huge amounts being spent by the Government on information technology - £16 billion this financial year - are barely noticed. With no central regulation by one ministry, civil servants enter into contracts worth billions with a few select companies. The details are protected by confidentiality agreements and periodic progress reviews in Whitehall are kept private, despite calls by MPs and anti-privacy campaigners for their disclosure. The cost of most large projects balloons. The Government admits that only about 30 per cent are completed on time and on budget. An investigation by The Times and Computer Weekly shows that the overrun of the largest IT projects totals £18.6 billion. Those include a controversial plan to computerise all NHS patients' records, originally estimated to cost £2.3 billion over three years but the cost of which has grown to £12.7 billion. Two companies have dropped out of the project, which is already four years behind schedule. Hospitals left with obsolete equipment have had to up-grade on their own. Yesterday Whitehall sources told The Times that the NHS programme, which aims to link more than 30,000 GPs to nearly 300 hospitals, would be reviewed. Non-foundation-trust hospitals would be allowed to opt out and buy from smaller providers. . ."

NPfIT software unsuited to mobile use (25 Feb 2009)


"Core National Programme for IT software 'has not been developed for a mobile environment', according to the NHS's chief technology officer. Dr Paul Jones, who works for the National Programme's controller NHS Connecting for Health, said that its applications could be connected and integrated with mobile systems. However, some were not themselves able to run on the mobile devices increasingly used within healthcare. . . "

No NPfIT black box to be found (29 Apr 2009)

Computer Weekly

"If the NHS IT scheme, the NPfIT, were a jumbo jet, its frequent crashes would have putfear-of-flying courses out of business. But because the NPfIT is not an aircraft crash, there is no wreckage. The damage is not visible. The Trust's undiagnosed, sick, or injured patients have been on a hidden waiting list,lost in the systems. As delays in their treatments are below the perception of the general public they don't seem to matter. The disorder we've highlighted this week at Barts and The London NHS Trust, a yearafter it went live with the NPfIT Cerner Millennium Care Records Service, is the most serious problem to afflict the national programme. The trust's managers are uncertain who among their patients have gone untreated within the government's 18-week target. They have been trying to reduce a waiting list of more than 2,100 patients on their 18-week waiting list. Some of the trust's patients have been discovered months after they should have been treated. When patients go untreated they are likely to get worse. Some might now be seriously ill because of the delays. We don't know. Worse, Barts does not know. Fortunately the NPfIT is not an aircraft crash. So there is nothing unsightly for the the TV cameras to broadcast across the world; there is no public clamour for information; no demand for the common causes of all the crashes to be quickly established. What there is, however, is the figure of NPfIT minister Ben Bradshaw, announcing that he and his advisers can see clearly now, and that the national programme is generally doing well. It should rollout more quickly, he says. But every time there is a crash Bradshaw is advised that the lessons have been learned from earlier failures and improvements have been made in the delivery model: trusts will be able to "localise" and "tailor" the Cerner system; and there will be closer working between clinicians and solution providers. He is told that there are always challenges with early adopters of complex IT solutions; they get over them; time heals. He is told that the Royal Free in Hampstead lost some patients on its waiting lists. But the London Acute Programme Board (no names are mentioned) now has confidence in the stability of the systems. But he is unlikely to have been told that doctors at the Royal Free continue to express their concerns to the board about the Care Records Service implementation. The result of ministerial complacency is that accident trouble-shooters now have clearance to drive to the next Care Records Service implementations in Kingston, Bath, Bristol, and to London's Imperial College and St George's. The patients at these hospitals should welcome, and benefit from, the influx of NPfIT experts. But if history counts for anything, they have every reason to fear them. . ."

NPfIT - the good and not so good (13 May 2009)

Computer Weekly - Tony Collins' IT Projects Blog

Glyn Hayes, chairman of the Health Informatics Forum at the British Computer Society, gave a brief but frank assessment of NHS's National Programme for IT [NPfIT] at a Westminster forum this week. Hayes is leading a review of the NPfIT for the Conservative Party. With Guy Hains, President of CSC's European Group, Hayes spoke about the NPfIT to an audience of Parliamentarians, IT specialists, clinicians and others at the Conservative Technology Forum at Portcullis House, Westminster, on Monday evening. . . Hayes' speech in summary:

  • The original vision of the NPfIT "is still ok"
  • There have been many reviews of the NPfIT but no independent external review. That's one reason the * It's too early to judge the work of Christine Connelly, CIO at the Department of Health. There's a danger than when people move into the Department of Health they sometimes get lost.
  • A framework contract called ASCC - Additional Supply Capability and Capacity" - has not been very successful for anybody so far. Smaller suppliers find it too bureaucratic and costly. Larger suppliers complain that the framework allows maverick companies into the national programme.
  • There have been successes for the NPfIT but "I do slightly worry with some of the things they claim to be a success because I know the problems they are still having out there".
  • There may be too much focus on the Summary Care Record which will make an extract of a patient record held by a GP available to the rest of the NHS. Hayes said that CfH is making a "great song and dance about that [the SCR] and yet I know there are a lot of problems with it, and I don't know how well they are being addressed".
  • At the HC2009 Healthcare IT conference at Harrogate last month Martin Bellamy, head of CfH, spoke of learning the lessons from the go-live of the Cerner Millennium Care Records Service at the Royal Free hospital in Hampstead. Hayes said the "fairly disastrous implementation" was caused in part by staff being trained on a generic database. "The first time they saw the real system was when they went live".
  • On the lessons from the Royal Free's implementation being learned, Hayes said: "I hope that's true. I have no knowledge to the contrary. I am worried that there were a couple of people from the Royal Free there [at Harrogate] who were saying that they still haven't learnt the lessons from the Royal Free. It's not all hunky-dory. In the end no doubt they will get there".
  • The one system that will really benefit patients is e-prescribing, which some hospitals are installing. It will reduce medication errors which he said are killing hundreds of patients every year in the UK. "One of my pleas would be: let's not wait another four years for the roll-out [of e-prescribing]. We need electronic prescribing now. This IT is there to help patient care."

BMA leader calls for NPfIT to be scrapped (3 Jun 2009)

e-Health Insider

One of the leaders of the British Medical Association has described the NHS IT programme as "the worst case of planning blight across the NHS" and called for it to be ended. Speaking at the BMA's Consultants Conference, Dr Jonathan Fielden, chair of the BMA's Consultants Committee also said it was time for the health service to wean itself off failed, expensive government policies, commercial contracts and management consultants. "When MPs regain probity, regain trust, then perhaps they can join our crusade to further improve healthcare; until then don't stand in our way," said Dr Fielden. Earlier this week, the BMA launched a campaign to "save" the NHS from "commercialisation", saying it should remain "publicly funded, publicly provided, and publicly accountable." The campaign includes a website on which NHS staff can sign up to the campaign and contribute examples of market reforms that they feel have cost the NHS money or harmed patient care. At the Consultant's Conference, Dr Fielden said hugely wasteful Private Finance Initiative and Independent Sector Treatment Centre (ISTC) deals should be scrapped. He also that private management consultants should be "ditched" and that the health service would do much better to rely on the experience and expertise of its 1.2m staff. "Ditch the management consultants - when we have to tell them how primary care works, when we see them flogging our ideas there is immense frustration that we are not utilising the great talents across the NHS. We have 40,000 hospital consultants, 1.3 million employees, 250 'top leaders' - surely we can utilise the talent we have?" Dr Fielden said the value of electronic patient records had been established, but that the National Programme for IT in the NHS was taking too long to deliver them. "At what stage do we cut loose from this spiralling disaster?" he asked. "It is thwarting local chances to move forward; the worst case of planning blight across the NHS. Let's free hospitals to move forward. Keep the 'national electronic super-highway' but free trusts to go their own way. It will be faster; it will deliver for patients, meet the needs of clinicians and produce another massive saving." Dr Fielden also argued that the BMA's Look After our NHS campaign was vital given the growing public sector funding crisis that is set to trigger cuts and savings in the health service. "For the first time in working memory, we may see real cuts in health spending," he said. "This will provoke some stark choices: what is kept, what is cut, what can the NHS afford? Let's ensure that it's doctors making those difficult decisions in partnership with our patients and healthcare colleagues, not faceless bureaucrats, accountants, and those out to fleece the taxpayer."

Tories plan localised NHS IT (9 Jun 2009)


A Conservative government would allow trusts to choose their own IT systems, according to Stephen O'Brien, the shadow health minister. O'Brien, speaking at Smart Healthcare Live on 9 June 2009, said centralised procurement in the NHS was at its most damaging when it came to IT. "Since its inception in 2002, the National Programme for IT has stalled time and time again as a result of its centralised procurement strategy," he told attendees. "The National Programme for IT embodies the price to be paid for careless procurement," he added, both in its financial cost and in "the opportunity cost of lost lives, improved healthcare and well-being [which] is literally countless". O'Brien added that NPfIT systems are often inappropriate for specific trusts. "It cannot be right, for example, that a teaching hospital is expected to use the same system as a district hospital," he said. "In contrast to this one-size fits all strategy, a localised approach to NHS IT can enable trusts to be given a choice of information systems," he said. "Local choice can equip trusts to meet the needs of their patients and staff." O'Brien said the independent report he had commissioned on NHS IT has been delivered, and this will be published over the summer. He said it will be used by the Conservative Party in forming its policies on NHS IT, and he hoped other parties would also draw on it. "I can assure you that it is a rigorous, extensive and authoritative document that will address many of the issues we are discussing today, and propose alternative solutions to the current set up of the National Programme for IT," he said, although declining to provide any details. In response to a question, O'Brien said that there would be a need for national standards for NHS data, but said it made most sense for datasets to be controlled locally by those responsible for providing care to patients.

NPfIT failed nine Gateway Reviews (19 Jun 2009)


Nearly one third of the National Programme for IT's Gateway Reviews until 2007 produced a red status demand for immediate remedial action. Of 31 reviews produced by the Treasury's Office of Government Commerce and released under the Freedom of Information Act on 18 June 2009, nine had a red status, meaning "To achieve success the project should take action immediately." NHS Connecting for Health said the reviews, which have previously been confidential, comprise all of those prepared between 2002-07. One red review, a 'gateway 0' strategic assessment of the whole National Programme released in November 2004, recorded great progress on procurement, which it credited to a large extent to then head Richard Granger. But it warned of "suspicion and cynicism of the National Programme" urgently requiring a more open approach. It concluded: "Despite the good progress on procurement, the current lack of engagement with the hearts and minds of the staff within the NHS at all levels, the lack of a coherent benefits realisation strategy and the absence of clarity regarding the organisational structure that will address these problems means that the overall status of the National Programme is red." The reviews released include 19 with an amber status, denoting the project in question should proceed but take notice of the OGC's recommendations. Just two reviews had a green status, showing the OGC felt the project was on target to succeed, both covering the N3 network. One, a strategic review of the whole programme dating from 2002, did not allocate a traffic light status. The red rated reviews covered two areas of the programme twice: Choose & Book, in 2002 and 2005, which received amber reviews in 2003 and 2004, and the state of the programme in London, in 2004 and 2005. The OGC also issued red reviews of the Southern region in 2004, the North-West in 2005, the Care Records Service in 2002 and Electronic Transmission of Prescriptions in 2004. In a statement, NHS Connecting for Health said that the reviews had taken place to highlight problems, and "were therefore deliberately critical and focused on problems," although they also found positive aspects. "We welcomed the report from the Public Accounts Committee in January this year and its acknowledgment of what has been successfully delivered," it said, adding that the delays in some areas are regrettable, while pointing out that this has also delayed payments to suppliers. "The Department of Health's Director General for Informatics has recently made clear that if significant progress is not achieved by the end of November 2009, a new approach may need to be adopted," it added, referring to Christine Connolly's speech at HC2009 in May.

Scrap big government IT: think tank (30 Jun 2009)

e-Health Insider

"A right-wing think tank has called for more open standards and open source development in IT, arguing this could lead to savings of 50% on government IT expenditure. A paper published by the Centre for Policy Studies - It's ours. Why we, not the government own our data ('s%20ours.pdf) - dismisses the government's Transformational Government strategy as disappointing, staggeringly unsuccessful and completely at odds with what citizens need. It argues that instead of continuing with its centralised and "failing" IT projects, government should hand control of personal information back to individuals, so they can use it on a voluntary basis to transact with public services. . . It argues that individuals could use services such as Microsoft HealthVault or Google Health to store their health records and to communicate with their GP or Hospital, eliminating the need for "the NHS database". It states: "If services such as HealthVault had already existed, there would be no need whatsoever for the UK government to spend anything like £12 billion building its own centralised medical system." Apart from being intrusive, the paper argues that the government's approach has made it reliant on a "handful of IT suppliers". It describes this as "peculiar" and "dangerous" and asserts that 60% of spending is in the hands of just nine companies. The suppliers listed include the two remaining local service providers to the National Programme for IT in the NHS, CSC and BT. "One of the many dangers of awarding these sizes of contract is that when things go wrong, they can drag on for years, at great expense," the report says. As an alternative to large suppliers, the think-tank promotes cloud computing as a simple and effective platform for users to access the computing services they need. "Cloud computing systems, provided by third parties other than government will enable us to choose where to store our personal information, such as medical records," it argues. "All government departments will no longer need to procure and own all IT infrastructures itself, or to pay an outsourced company to do so. The market is now providing the IT systems needed for government systems, which are better centred on the needs of public service users rather than in government as a fumbling middleman." The paper calculates that the government's IT provision of £16.5 billion this year is the equivalent to £700 for every house hold across the country. Yet it calculates that of all the IT projects that the government invests in, only 30% succeed."

Docs call for clinical review of NPfIT (3 Jul 2009)

e-Health Insider Primary Care

Doctors have voted for a clinically-led review of the National Programme for IT in the NHS and called on the British Medical Association to campaign for local IT solutions. The BMA's annual representative meeting in Liverpool supported calls for an independent review, for NHS Connecting for Health to release money for local clinical system purchase and for it to concentrate on developing specialty professional standard clinical datasets. Dr Gordon Matthews, a consultant orthopaedic surgeon at Buckinghamshire Hospitals NHS Trust, told the ARM that doctors at his trust were still having difficulties with Cerner's Millenium system three years after its installation. He added: "Since the NCRS went live our trust has been unable to collect electronic data on surgical complications or outcomes other than death; and I'm informed it's not possible to re-programme Cerner Millenium. We are now struggling to install a piecemeal system to run in parallel with CRS to provide some clinically useful data." He said a review led by clinicians was essential to ensure the NHS got the clinical solutions it needed. Dr Paul Flynn from the BMA's Central Consultants and Specialists Committee said he had been brought in to help doctors at the Royal Free Hospital in London following the implementation of Cerner Millenium.nHe told the meeting: "I saw doctors who were enthusiasts for IT turning to complete despair. I have seen doctors almost in tears because of how frustrated they are at being prevented from doing their jobs by the IT system." Dr Deidre Hine, chair of the BMA's Working Party on IT, told the meeting that the BMA was already insisting on a clinically led review in its discussions with the Department of Health. In a debate on data sharing and confidentiality, representatives backed calls from GPs for an opt-in approach to the transfer of patient identifiable data. They also condemned the government for its failed attempts to make data sharing easier through clause 152 of the Coroners and Justice Bill, which was eventually dropped by justice secretary Jack Straw. Dr Gill Beck from the Buckinghamshire division congratulated the BMA for its part in stopping the move but said the BMA needed to continue to fight to protect patient confidentiality. "This potential access to 50m medical records remains extraordinarily tempting for the surveillance-obsessed UK government that we have got, and they have a proven track record for reneging on their promises," she added. Dr Grant Ingrams, co-chair of the Joint IT Committee of the Royal College of GPs and the BMA's GP committee, told the conference he was being asked for advice from GPs on almost a daily basis about request for access to patient data. "Sometimes these requests are legitimate but more often than not the proposed extraction is unlawful and totally inappropriate," he said. However, professor Michael Rees from the BMA's Medical Academics Staff Committee, warned an opt-in might have a detrimental effect on legitimate research. He said: "If we are going to go for a full opt-in system, then we have to be in a position to discuss the issues with patients. If we haven't got the time to do that and patients automatically opt out of research then we will be doing a great disservice to our patients." However, Dr Ingrams said he did not believe an opt-in approach was inconsistent with research. He also disagreed with an A&E consultant who said an opt-in might lead patients to withhold vital information, while unconscious patients would not be able to give their consent. Dr Ingrams added: "Patients should have the right to make poor decisions and just because you're unconscious doesn't mean you shouldn't still have a right to privacy." . . .

End the vanity projects (5 Aug 2009)

Smart Healthcare

We would replace white elephant national schemes with targeted work to improve the patient-doctor relationship. The NHS IT programme has come to symbolise all that is wrong with the way that Labour has dealt with the NHS. Billions of pounds have been spent on building a shiny, high-tech and highly centralised system with little time devoted to thinking about what the aims of the project were. The result is a system which is over-budget, behind schedule and below specification. The 2006 National Audit Office report into progress in the NHS National IT hit the nail on the head: the government seems to have failed on nearly every count when it comes to building the IT system the NHS needs. It failed to negotiate effectively with suppliers, engage with NHS organisations and win the support of staff and the public. This has helped create a system which not only doesn't work but isn't really wanted by anyone except a small group of mandarins in Whitehall. Changing this state of affairs is going to require a radical rethink. I believe that one of the first things we need to do is banish the idea of huge national schemes. Successive governments have fallen for the charms of smooth talking management consultants and IT salesmen who have waxed lyrical about the potential savings and efficiencies of bespoke software packages and complex databases. Time and time again the British public have ended up paying for overly complex vanity projects which habitually under-deliver at greatly inflated prices. The great shame of the NHS IT programme is that instead of learning from past mistakes, the government seems to have set out to raise the bar when it comes to wasteful expenditure. Instead of thinking about how national programmes can transform the NHS, we need to be much more realistic about what we are trying to achieve. IT has revolutionised how we work and when it works well in the NHS it has an excellent track record of improving patient care and workplace efficiency. All too often though the various sections of the National Programme for IT have failed to do this - either because the goals were not well thought out or because nobody really knew what they were being asked to do. A great example of this is 'Choose and Book' - or 'Confuse and Book' as one of my colleagues christened it. What started out as an attempt to develop a simple booking tool has morphed into a system which regularly denies people the choices which it was meant to give them. . . We need to engage clinicians from the commissioning stage onwards rather than trying to engage them after the system has already been commissioned - doctors I know who are trying to implement the new NHS IT system have complained that they are now trying to tailor the system to their needs rather than having a system designed to service them. Given that clinicians are the ones who will work with these programs every day, we need to listen to what they have to say. The proposals that the Conservatives have hinted at, about a localised system of IT commissioning, are a positive beginning and I welcome their belated conversion to the concept of localism. However, I believe that both Labour and the Conservatives are missing the point about what IT can do for the NHS and the role it should play. As a Liberal I believe that one of the key criteria for measuring the success of a programme can be found in measuring how it improves interaction with the system. In its current monolithic form, the National Programme for IT is having a negative impact on patients and the NHS. It has led to restricted access to appointments, exposed confidential patient data to abuse and diverted resources away from frontline care into white elephant schemes. When we look at developing IT schemes in the future, we should not be looking at ways to build the NHS around an IT system, we should be looking at how IT can help improve patient care and improve the efficiency of the system. . .

Conservatives to 'dismantle' NPfIT (10 Aug 2009)

e-Health Insider

The Conservatives have promised to "dismantle Labour's central NHS IT infrastructure" and instead move to a choice of local accredited patient record and clinical systems. Following the publication of an independent review of NHS IT the Conservative party pledged to abolish the NHS national database of electronic patient records, but then say firms - including Google and Microsoft - be allowed to host patient controlled records accessed online. As a first step they promise to "Halt and renegotiate the contracts Labour have signed for IT service providers to prevent further inefficiencies." The commitment raises the prospect of an incoming Tory government becoming embroiled in legal disputes with BT and CSC, the two main IT firms that hold local service provider (LSP) contracts. The government has been locked in legal dispute with Fujitsu since terminating its LSP contract in April 2008. The Conservatives say the NHS National Programme for IT has proved bureaucratic and been plagued with delays and cost overruns and proved hugely disruptive to the NHS. They promise reform focused on local choice of systems, and pledge they will deliver cost savings from the £12.7 billion IT project. The Conservatives say that in Government they would "stop imposing central IT systems on the NHS" and instead "allow healthcare providers to use and develop the IT they have already purchased and developed, within a rigorous framework of interoperability". As part of a new approach use of open source across the public sector will be given a new priority. Taken together the Conservatives say the measures "will deliver huge cost savings and ensure that NHS IT is geared towards the needs and wishes of patients". Dr Glyn Hayes, chair of the review, said: "The review makes clear that NHS IT will only succeed in improving patient care if information is held locally and centred on the patient." Speaking on Sunday Shadow Health Secretary Andrew Lansley outlined new proposals to allow NHS patients access to their records online would give people "greater control over their own health care". Firms such as Google or Microsoft, both of which are developing personal health records, could host such patient controlled records, enabling users could update their medical records with information like blood pressure and cholesterol levels, he added. Patient records should be stored locally rather than on a national database, with the capability of transferring the information when necessary. The Tories say that buying such PHR systems "off the shelf" instead of developing them at taxpayers' expense would mean that personalised records system could be delivered at "little or no cost to the taxpayer".

NHS computerisation: lessons from what the bosses never learned (12 Aug 2009)

The Guardian

As the song goes, a man hears what he wants to hear and disregards the rest. Of all the indictments in the Conservative-sponsored independent review of the NHS's £12bn computerisation programme, the most damning may be its account of the way that the programme's originators wilfully disregarded painfully acquired wisdom. The new study, led by the healthcare informatics veteran Dr Glyn Hayes, observes that the National Programme for IT followed closely on the heels of two important reports. The first was on a series of IT pilot projects at 19 NHS demonstrator sites between 2000 and 2003. That programme, called ERDIP, tested the technical and ethical boundaries of creating community-scale electronic health records. You would have expected the national programme to absorb and build on this work, rather as the Apollo moon programme learned from the Gemini programme about manoeuvring spacecraft in orbit. Instead, ERDIP was airbrushed from history. The independent review finds it "extraordinary that the ERDIP recommendations were largely ignored". The reason, of course, was that the ERDIP findings were inconvenient. The evaluations stressed the need for closely involving system users - and patients - in the design of electronic records, and for introducing IT as part of improvements to patient care, not as an end in itself. This implied that the national programme's massive scale and gung-ho timetable were unrealistic. To return to the space example, it's as if the Gemini programme had concluded that many more years of work was needed before spacecraft docking became a realistic proposition. Even in the go-go 1960s, Nasa would have paused for thought. The NHS could dismiss inconvenient criticisms and, in the national programme's early years, it was doing its best to control the flow of information about its IT projects. Executives deployed "commercial confidentiality", misleading press releases (including one covertly modified after publication) and even the threat of legal action to deter critics. Which leads me to the second fount of wisdom ignored by the NHS chiefs. Hayes's review calls attention to a study called The Challenges of Complex IT Projects, published in April 2004 by the Royal Academy of Engineering and the British Computer Society. This identified a series of reasons why large-scale public sector IT projects tend to go wrong, and suggested steps to mitigate the risks. Again, it stressed the need for closely involving users in development, rather than foisting systems upon them. Again, the findings were ignored: the NHS tried to impose remotely procured standard systems. Hayes's review says that "in an ideal world", the ERDIP and Complex IT Projects reports would already have been heeded. However, "since they have been largely neglected, it is important that they play their part in this review and, where there is still scope for redirection, shape future developments". I can go one better than that. Almost unnoticed outside the specialist press, the institutions behind the Complex IT Projects report published a follow-up last month, calling for the adoption of engineering values in IT. Predictably, this means putting a professional engineer in charge. But it also means building large systems in incremental steps from firm foundations, without tolerating the level of software error that is the norm in many commercial products. Most significantly, the report notes a distinguishing characteristic of engineering: that, "when a major failure occurs, the root causes are investigated, and the lessons are learned by the whole profession". However inconvenient those lessons may be. If we take only one message from the spate of investigations into the NHS's foray into large-scale computerisation, let it be that one.

Hospital CIOs find local remedies for IT headaches (3 Sep 2009)


Health service IT leaders are finding their own solutions to shortcomings in the NHS National Programme for IT. One of the common criticisms of the £12.7bn NHS National Programme for IT (NPfIT) has been that its centralised nature stifles innovation and creativity among IT leaders in the health service. The top-down approach to the UK's biggest IT project has angered many within the NHS. Hospital and health authority chief information officers (CIOs) felt they were being told how to do their job by Whitehall bureaucrats with little coalface experience. Some experts felt the solutions being imposed were so inadequate as to jeopardise the reputation of the whole programme. CIOs were being told what software to buy, how to implement it, and how to train staff, leading to many being alienated by the programme. But in recent years, NHS IT leaders have found ways to work around these challenges. Computing met with several of them at a roundtable organised by health vendor Simpl last month. Great Ormond Street has looked to introduce non-health-specific IT systems that would centre care around patient participation, according to David Bowen, programme manager at the world-famous children's hospital. "We're looking at business process management and enterprise communication platforms. That's the sort of thing that can open up our systems to effective teamwork where your role is dictated on your competencies, not what your systems are closing you off from on an architectural level," he said. "Part of the problem with the National Programme is that it is database focused, it's not about process." The sharing of health records is a problem for NPfIT and it has been slow in developing policy, sometimes leaving NHS trusts to take the lead. Though sharing is beneficial, many clinicians only want to see relevant information, complicating any central sharing model. According to Ian Herbert, until recently a senior consultant working for the NHS on NPfIT, Liverpool Primary Care Trust could not wait for central guidance and took matters into its own hands. "The trust worked with [suppliers] EMIS and Vision 360 and together they made electronic records, with the patient's consent, available in all unscheduled care situations," he said. "They also use it in the medical admissions unit and two other places in the hospital. It's crude in the sense that you see the lot but the evidence is it has been well received by clinical staff and patients alike." The model is successful because it has been built from the bottom up with the consent of all involved, and NPfIT would do well to take note, said Herbert. . .

Special Report: Andy Burnham's unhealthy diagnosis for NHS IT (14 Dec 2009)

It's entirely typical of the NHS National Programme for IT (NPfIT) that even the prospects of scaling it back should end in confusion, disarray and a rather meaningless gesture. Once proudly spoken of by Prime Minister Tony Blair as the biggest civil IT project in the world, NPfIT has come to represent all that is wrong with public sector computing. The errors and mistakes pile up one by one: from the dark days of former CIO Richard Granger taunting suppliers to metaphorically 'come and have a go if you think you're hard enough' through the shocking fact that the Lorenzo care records have only 174 regular users to the Kafka-esque defence from Whitehall that the project is well under its £12.7 billion budget, but only because it's so far behind schedule that payments haven't had to be made to suppliers! Last weekend it seemed as though the death knell might finally be sounding as Chancellor Alistair Darling popped up on The Andrew Marr Show to call for cuts to the project, declaring that it is not a front line priority at this time. Well, maybe not from the point of view of the Treasury which sees the NHS programme as a cost encumbrance that would be a politically useful item to cut back on. But the Department of Health clearly has other ideas. After all, this is its flagship IT project, the biggest civil IT project in etc etc etc. So it's going to take more than Alistair Darling pre-announcing cutbacks to put a stop to that. When Health Secretary Andy Durham made a statement to the House of Commons he made that perfectly clear when he ignored Darling's assertion that the Programme was not front line critical and proceeded to sing its praises while lightly scarping £600 million from the (current) budget over four years. So what's going on? Is it a turf war? Will the DoH hang on in there until a possible Conservative administration slams the brakes on? Or will Darling's Treasury team manage to wrest sufficient control away from the DoH to make some significant cut backs that will actually made a serious impact? For his part, Burnham leaves little room for hope of any compromise. He began his statement with a fulsome backing of the Programme. "I want to begin by challenging the myth put around that the NHS IT Programme has been a waste," he declared. "The programme has changed the way in which the Government pay for IT by creating a contract whereby we pay for what we get from suppliers only when it is fully delivered. Indeed, we have been praised by the National Audit Office for creating such a contract." This is entirely correct. But it conveniently overlooks other damning reports on the progress (or lack of) and the (mis) management of the scheme from other bodies, including the Parliamentary Accounts Committee. And the praise from the NAO is more about the fact that the contract terms mean that less money has been wasted so far than might otherwise have been – hardly the universal and unconditional approval that Burnham implies. But he ploughed on regardless. "To put it simply, the Programme is a key part of delivering modern, safe, joined-up health care. It is supporting the ongoing reform of the NHS by giving choice and convenience to patients. The NHS could not function without it," he claimed – although it seems to have gone about the business of looking after the sick and poorly relatively well for over 50 years without a grandiose IT scheme to help it. This is a misrepresentation of what the Programme was set up to do which was to do better all the things the NHS needs IT for, not to enable them. For example, being able to share medical records via the Spine network is laudable in ambition, but it was already possible just by using basic email! . . . The overall suspicion has to be that the DoH is now so committed to a mess of its own making that it can't back out. It was Tony Blair who was so carried away by the "modernity" of it all that he kicked off the idea of the National Programme, but nothing was commissioned back then without the Chancellor's sign-off. That was Gordon Brown so the chances of there being any admission of error there is non-existent. The only way that the NHS scheme is likely to be seriously overhauled now will be as a result of a change of government – with both the Tories and Liberal Democrats committed to either substantial changes or outright cancellation. But it won't be happening on Andy Burnham's watch where this sickest of all government IT projects is still being given a healthy prognosis despite its terminal condition. . .

Electronic records are less efficient than paper, finds DH research lead (14 Dec 2009)


A leading academic has dealt a major blow to the Government's embattled electronic patient record rollout, after publishing a major global study claiming systems of its kind hamper rather than improve clinical care. Professor Trisha Greenhalgh, professor of primary healthcare at University College London, led a review of hundreds of previous studies from all over the world, which found that large systems such as that being developed by Connecting for Health, are less efficient than locally-based systems and often less useful than paper records. Professor Greenhalgh's research will come as a particular body blow as she is heading up the ongoing UCL study commissioned by the DH into the effectiveness of the patient electronic care record rollout. The study, which began in 2007, is published today and is the second major blow to the project in the past few months. The Government has pledged to slash £5bn from its budget by 2012-13 by measures including cutting back the NHS IT Programme and Tories are already planning to contract a string of NHS IT systems out to private providers. Despite this, the patient electronic care record rollout is about to embark on its next big phase in January, when millions of patients across London will be given three months to opt out, or have records automatically created. But the study published today, in the US journal Milbank Quarterly, identifies what the researchers claim are 'fundamental' problems with the design of such systems, finding that:

  • While secondary work like audit and billing may be made more efficient by electronic patient records, primary clinical work can be made less efficient;
  • Paper, far from being technologically obsolete, can offer greater flexibility for many aspects of clinical work than the types of electronic record currently available;
  • Smaller, more local EPR systems appear to be more efficient and effective than larger ones in many situations and settings;
  • Seamless integration between different EPR systems is unlikely ever to happen.

Professor Greenhalgh said: 'EPRs are often depicted as the cornerstone of a modern health service. According to many policy documents and political speeches, they will make healthcare better, safer, cheaper and more integrated. Implementing them will make lost records, duplication of effort, mistaken identity and drug administration errors a thing of the past. Yet clinicians and managers the world over struggle to implement EPR systems. Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of EPR projects fail - and the larger the project, the more likely it is to fail. Our results suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world.' An interim report in September from Professor Greenhalgh's ongoing study for the DH already found next to no evidence the record had produced any improvement in care in the areas in which it had been rolled. It found the record was likely to make a limited contribution to A&E care, was plagued by IT problems and often failed to work in out-of-hours care.

[The full report is currently freely available at]

Tories suggest new NHS IT approach (5 Jan 2010)

The Conservatives have proposed an "information revolution" in the NHS, giving patients more control over their own personal data and a greater access to performance data. Publishing its draft manifesto for the NHS, the Conservatives said if elected they would make much more detailed data available for patients to make more informed choices. Detailed data about the performance of trusts, hospitals, GPs, doctors and other staff will be made available to the public online, the manifesto said, so the public can surmise who is providing a good or bad service. Following this, the party said it would create an NHS where patients "are in the driving seat". In terms of the National Programme for IT (NPfIT), which the Tories have promised to change on a huge scale, the manifesto said patients would be put in charge of their own health records. This new power over their personal data would allow patients to choose which providers they share it with, the party said. Writing the foreword for the manifesto, Conservative leader David Cameron said it was time for "massive change". "In the post-bureaucratic age people expect to be in control of their lives, not have their lives controlled for them by distant politicians and bureaucrats. We need a shift in power from the political elite to the man and woman in the street, through decentralising power, introducing a strong line of democratic accountability, and bringing in a new era of transparency to government," he said.

Lib Dems to take the axe to the NPfIT (4 Feb 2010)

A Liberal Democrat policy blueprint on the NHS has proposed severe cuts to the National Programme for IT (NPfIT). The policy document, published by the party's shadow health spokesman Norman Lamb, has proposed scrapping the Care Records Service (CRS), reducing the scope of the troubled Choose and Book scheme and shutting down Connecting for Health (CfH) – the organisation overseeing the NPfIT's implementation. Its proposals in general all point towards removing central control over IT systems. More specifically, the document called for CRS's abandonment as it is four years late, has encountered enormous technical challenges and has raised serious concerns over the confidentiality of patient records. "Most fundamentally, the clinical and business case has still not been satisfactorily made for establishing a national database," the document said. Turning its attention to the Choose and Book service, the document said it should be scaled back after the government's late changes caused serious technical difficulties. "The Choose and Book programme has caused enormous frustration for doctors and patients. It was originally designed as an electronic appointments booking system but was later converted into a central element of the government's commitment to offering patients a choice of hospital – in theory enabling the GP and patient to book an appointment online choosing from a list of hospitals. The introduction of this system fatally lacked clinical engagement and, like the CRS, has been blighted by technical problems," the document said. Reaffirming its commitment to removing the central control of IT, the document added that CfH must also be scrapped. Remaining responsibilities would then presumably be shared between local trusts and the Department of Health. "The strategy for the future should be based on local connectivity between primary and secondary health care and social care," the document said. Citing a recent report, the document highlighted the case for building from the bottom up and engaging with both clinicians and patients. This approach would make managers and clinicians accountable and engaged in the development of IT, it said, and would encourage small and medium-sized IT companies to contribute.

Minister to sign new NPfIT deals before General Election? (2 Mar 2010)

Computer Weekly

Health officials are seeking urgently to sign deals with the two main suppliers to the NHS scheme, which would commit the next government to about £3bn of spending on the troubled National Programme for IT, Computer Weekly has learned. New deals could frustrate plans by the Conservatives, if they win the coming general election, to halt and renegotiate contracts with the two NPfIT local service providers CSC and BT. Whitehall officials aim to sign a memorandum of understanding with CSC and BT by the end of this month, which would commit the next government to a new schedule of NPfIT software deliveries and electronic patient record installations at NHS sites. A legally-binding memorandum of understanding with each supplier would keep the NPfIT alive, after the Chancellor Alistair Darling told the BBC's Andrew Marr programme in December 2009 that the NHS IT scheme was not essential to the frontline. New deals would also refresh the NPfIT contracts, large parts of which are no longer relevant. Delays in the delivery of software, and changes in the NHS, mean that the original contract's timetables and schedules for software functionality are obsolescent. The NPfIT minister Mike O'Brien has confirmed to BBC R4's File on Four programme - in a broadcast this evening - that his officials aim to sign new deals by the end of March. O'Brien said: "We are certainly looking for a memorandum of understanding by the end of March if we can get that." O'Brien said he could not suspend negotiations and stop the work of government just because there is a general election approaching. The minister said his officials are in negotiation with suppliers to save £600m from the costs of the NPfIT. When asked by File on 4 whether he was trying to sew up a deal by the end of March to tie the hands of the next government by giving new contracts, O'Brien said: "No. What we are seeking to do is negotiate with the industry to achieve savings of £600m. Now these savings would be over the lifetime of the programme, up to 2016." The BBC put it to O'Brien that the Conservatives are worried that a new deal would commit them to contracts they may wish to cancel. O'Brien said: "No. What they are right to want to do is ensure that the savings that we promise are actually delivered, and we are discussing that with the various companies concerned we want to focus on the core elements of the programme that have been identified as critical by clinicians you know there's a sort of party political knock-about around this to some extent. "We need to get beyond that I'm certainly not going to get into a situation where because we're approaching a general election that the whole of government stops and we can't make any contracts with suppliers of key NHS equipment. That would be complete nonsense." O'Brien - and the Conservative Shadow health minister Stephen O'Brien - have said that NHS trusts will have a choice of systems within the framework of the local service provider contracts. This could mean that Cerner and iSoft lose their status as the main software offerings to NHS trusts in England.

What the next Government should do about the NPfIT (3 Mar 2010)

Computer Weekly - Tony Collins' IT Projects Blog

Tom Brooks, who spoke about NHS IT on last night's BBC R4 File on 4 broadcast, has let me have his suggestions on what the next government should do about the NPfIT. Brooks, a much-respected figure in health IT, writes:
The next Secretary of State for Health would be well advised to apply what is often known as the Harvard TEAMS test.
T - Is the proposal Technically sound or even feasible?
There have been major technical doubts expressed since the scheme's inception. The new Minister should pick up the phone to Martyn Thomas and request him to form a professorial team to report on the technical issues. The rejection by Ministers and the Parliamentary Select Committee of his offer a few years ago to conduct such a study is felt by many to have cost the taxpayer as much as a £1bn
E - Does the scheme make Economic sense?
The Treasury spokesman, Mr Mortimer, told the Public Accounts Committee that the Treasury did not believe there should be an overall business for the NHS IT programme. The Treasury got it wrong. In November 1999, the NHS National programme was five years away and was going to cost £1bn.Now, for the same objective, it is still five years away and is going to cost £12bn. The new Minister should require a national NHS IT business case to be produced and published as a matter of urgency.
A - Is Accountability aligned with responsibility?
Currently, very few Trusts have direct contracts of consequence with the Local Service Providers (LSPs). Contracts are held centrally, and suppliers are accountable to the Secretary of State. But the cost of poor implementations is felt locally by the Trusts. The new Minister should first suspend all new work under the contracts, and then announce a termination date for all contracts that are not for genuine national purposes, such as N3 and Choose & Book. Trusts that wish to continue to use LSP services can contract for them locally and ensure that they provide value for money.
M - Are the Management arrangements sound and has the Management deployed been competent?
There are many areas of deficiency and even more questions. One perhaps is the anomaly disclosed in recent Parliamentary Questions. Why, in the three northern LSP areas, had less than £500,000 been paid to the LSP on Lorenzo deployment (set-up) activity and service charge (running cost) payments, while the total payment to the LSP in the Northern three areas had already exceeded £780m? What has the management in the centre and the northern SHAs spent the £780m on if not on Lorenzo? The new Minister should transfer to local Trust posts at least half of all central and SHA IT management, thereby slimming down the expensive centralised bureaucracy, whose achievement record is suspect.
S - Are the arrangements Statutorily compliant?
The Opposition believes that the present Government policies for NHS IT are flawed. Severe doubts exist over the arrangements for patient privacy and data protection, over responsibility for inaccurate patient data and the liability for errors arising from reliance upon it. Questions are asked about Monitor's apparent failure to vigorously defend the freedom of foundation trusts from SHA 'interference' and its role in the present sorry national NHS IT state of affairs. Views have been expressed recommending that the Darzi 'Five' requirements for implementation by April 2010, but whose delivery has not been achieved by most Trusts, should now be put on a statutory duty basis. Policy is unclear. The new Minister should abandon the national centralised patient data objective for NPfIT and would be well advised to adopt the principal Obama objective of "replacing all paper records by electronic ones for each practitioner" as a sufficient challenge for NHS IT during this decade, with its expectation of tight financial constraints and over-stretched NHS management and clinical staff.

Delays with £12.7bn NHS software program bring it close to collapse (21 Mar 2010)

The Guardian

The government's ailing £12.7bn IT programme to overhaul paper-based NHS patient records in England is close to imploding, potentially triggering a deluge of legal claims against the taxpayer running into billions of pounds, which could start to emerge weeks before a general election. The Guardian has discovered that mounting chaos and delays in installing core care records systems across the country is reaching a tipping point, with intense political pressure from Whitehall now falling on Morecambe Bay NHS Trust and a software "go-live" deadline set for the end of this month. Morecambe Bay is intended to be the first acute trust to take a new patient administration software package called Lorenzo, which has been delayed for four years. After a string of missed deadlines, the Department of Health set a deadline of March 2010 for Lorenzo last April. "If we don't see significant progress... then we will move to a new plan for delivering infomatics in healthcare," Christine Connelly, the Department of Health's director general of IT, said at the time. Preparatory testing at Morecambe Bay is believed to have failed some weeks ago, though iSoft, the firm behind Lorenzo, last week insisted testing was "on track" and dismissed as "media speculation" suggestions that the deadline was in jeopardy. If Lorenzo is not running smoothly at Morecambe Bay in the next two weeks it will send financial shockwaves throughout Labour's National Programme for IT, potentially forcing profits warnings from iSoft and others. It will also be devastating for the Department of Health, which is locked in frantic contract renegotiations with contractors to keep the project alive. . . Failure at Morecambe Bay could see the largest regional contractor on the 10-year programme, US outsourcing firm Computer Sciences Corporation (CSC), come under renewed pressure to book heavy provisions against the value of three £1bn NHS contracts - a move likely to send the group's share price tumbling. It would also be bad news for iSoft, the Australian firm formerly called IBA Health, which in 2007 acquired crisis-stricken iSoft plc, the British firm behind Lorenzo, and took its name. It has told investors: "iSoft expects the milestone at Morecambe Bay to be met according to the timetable agreed between its partner CSC and the NHS, and expects this achievement to trigger a cash payment to the company." A Morecambe Bay delay could also push mounting tensions between the Department of Health and CSC into the hands of lawyers, as a squabble breaks out over who should foot the bill for seven years of underperformance since the National Programme contracts were signed in 2003. The government is already facing a reported £700m legal dispute with CSC's fellow regional contractor Fujitsu after the Japanese consultancy firm walked away from a £1bn contract to supply and install IT systems at NHS trusts across the South of England and the West Country three years ago. If CSC, an $11bn (£7.3bn) Virginia-based group listed on the New York stock exchange, were to enter into a parallel legal battle, it would leave 80% of care records IT contracts - the heart of the National Programme - in the hands of lawyers. After the departure of Fujitsu, and Accenture a year earlier, the only remaining regional contractor aside from CSC is BT, responsible for the London area. It was forced last year to wipe between half and 70% from the value of its £1bn contract with NHS London because of delays and software failings. . . As the National Programme moves into its seventh year, the Department of Health and regional contractors are trying to thrash out a back-room compromise over how to apportion the bill for an army of IT workers who have failed to deliver - particularly on patient administration systems such as Lorenzo at acute hospitals, the most costly element of the National Programme. The government has offered to slash the functionality requirements for Lorenzo as well as reduce the number of acute trusts into which CSC must install the software. . .

Rotherham: NPfIT has put us back 10 yrs (28 Apr 2010)

E-Health Insider

The chief executive of The Rotherham NHS Foundation Trust has said the National Programme for IT in the NHS has "put back the contribution of IT in the NHS by more than ten years." In a controversial speech at the Health Informatics Congress 2010 in Birmingham, Brian James renamed the programme "NFFPIT - Not Fit for Purpose IT." He also said it had "not only impacted on systems within healthcare but also on the skills of the IT profession to scope and manage projects." Last year, The Rotherham became one of the first NHS trusts to go outside the national programme for an electronic patient record programme. It rejected iSoft's Lorenzo system from CSC and instead decided to implement a £40m Meditech v6.0 system from FileTek. Speaking about the implementation, James said the trust had encountered a serious lack of skills. He said it had taken more than a year to recruit the correct people for the implementation. He said: "The lack of skills in this area, which has been caused by the delays to NPfIT, has meant that we found it really difficult to find the right people for the project. My concern is that as we go forward there is going to be a rush for these systems. Where are the skills going to come from? And how are we going to deliver this agenda, whether that's through the national programme or whatever comes after it?" He added that he hoped that trusts were starting to think about the next steps in their IT strategy because "NPfiT may be dead." He echoed concerns first raised at E-Health Insider Live last year, when he said trusts were being forced to pay penalties for opting out of the programme. He said: "What we did was put a good business case together. We showed that by implementing this EPR, we expect to reduce our operating costs by a minimum of 5% - which is £10m pounds per annum. And that's our downside scenario - the upside is closer to 10%. We also managed to get through the hoops around penalties by saying that it is an interim solution - a 15 year interim solution." In an interview with EHI after the speech, James said that the Meditech implementation is going well. He said trust has been working for a year to anglicise the product ready for it to go-live in November this year. "I'd say that we are around four weeks behind where we should be, but we should still go live in November. However, we will take a view on that in the summer, because the quality of the product is key." James also said the trust had decided to change its go-live strategy to a two-phase big bang rather than a single one. "In November we will go-live and switch over 14 systems, then the second phase will happen within three months with an additional 12 systems."

National Programme for IT faces an uncertain future (17 May 2010)

The coalition government has laid out a clear agenda to scrap many of Labour's ideas for public databases and central IT agendas, such as the ID Card project and the ContactPoint database, but plans for the NHS and the National Programme for IT (NPfIT) remain uncertain. Pre-election estimates were that the NHS needed to achieve efficiency savings of up to £20bn by 2014. Labour had indicated that these would come mainly through improving management and productivity. However, the reality is that such a high sum will warrant a government taking tough action on many NHS back-office functions. Any spending is likely to be concentrated on the frontline in order to maintain the popular vote. The Conservative Party said in its manifesto that new IT projects would be put on hold, and discussed dismantling the NPfIT as decision-making is moved to a local level. The Liberal Democrats have been largely supportive of the Conservative view. The NPfIT underlies what had been Labour's agenda for creating an Integrated Care Records Service, also known as the NHS Spine. The NHS Spine is used by clinicians to collect patient data and share it with other healthcare professionals. However, the centralised system has often been seen as a failure owing to continued installation setbacks, rising costs and data management problems. The original cost of the system was supposed to be £2.3bn, but has now risen to around £12.4bn. The new government has been open about its cuts to the NPfIT, but it has left many important questions unanswered, such as how deep the cuts will be, whether the NPfIT will ever go ahead or whether the project of establishing a centralised records service should be seen as a failure. UK healthcare organisations and commentators still hold out hope that the NPfIT will be finalised one day, but analysts have argued that the programme has come to its end, and that this would have been the case even if the Labour party had remained in government. Considering that the Tories set forth their own NHS agenda, outlining plans for patients to control their own data and choose the online providers with which they store their health records, the latter argument seems the more likely outcome. Ovum analyst Mike Davis suggested that the government is unlikely to move ahead with a radical NHS IT project because of cost pressures, but will move ahead with its localisation plans. Healthcare providers will become autonomous Foundation trusts under the Tory proposals. . . The local NHS way of working will potentially require more rather than fewer IT services, according to Davis, and the greater choice for trusts between suppliers will open up new opportunities for vendors to engage with the NHS, especially those that were formerly excluded from such deals. Davis added that it is important for local trusts to communicate and share data even though they will be autonomous, and that this vision should have been the essence of the NPfIT. . . However, Alan Maryon-Davis, chairman and president of the Faculty for Public Health, has an altogether different view and believes that cuts to the NHS Spine will be detrimental to public health. "We feel that the sharing of data records is a good thing providing that the right security checks are in place and there is not this awful business of notes going missing," he said. "Perhaps most importantly the central system would have allowed health professionals to look at anonymised data right across the system to generate public health data statistics without intruding on privacy. "It will be a shame if this process does not happen, although I do expect it will be slowed due to a lack of money." . . . Meanwhile, Cambridge University researcher Ian Dent said that the new government's calls to localise NHS IT is clever rhetoric but simply reflects a process that was already happening under Labour. "Although the Conservatives say they will move the NHS to a regional basis, this was the way it was going under Labour anyway, like Child Agencies and the Skills Funding Agency. It also is the way Europe is heading," he said. Dent was pessimistic about the idea of an NHS Spine, holding a similar belief to many digital rights enthusiasts that the UK government and its European Union counterparts are eroding civil liberties in their rush towards an information society. "I do believe the NHS database could create better healthcare for patients, but the danger is that the government can extract data for outside purposes," he said. "The NHS central database has a similar function to the ContactPoint database, which is used to track children to adulthood. In the 1960s, the government knew where people were because people stayed where they were, people voted and there were electricity boards. "Now the public is more invisible to the government and that is why it has set up so many central IT databases."

Summary Care Records - too big to fail? (26 May 2010)

Computer Weekly Tony Collins IT Projects Blog

Emma Byrne is one of the authors of a confidential draft report on the Summary Care Records scheme. She'd worked on the report with a team from University College London. The latest report of her team was completed in March 2010 but hasn't been published, perhaps because some of its findings were not greeted warmly by the Department of Health. The Department and NHS Connecting for Health commissioned the SCR report from University College London. Now Byrne has written an article for the Open Rights Group on NHS IT, the NPfIT and particularly the SCR scheme. She is on the ORG's board. She says in the article: " ... The problems are made far worse by the way NPfIT runs its key projects. When a project simultaneously manages to be 'not much use' and 'too big to fail' you have a recipe for perverse incentives and disastrous privacy consequences. The biggest project in the NHS, the Summary Care Record (SCR), is a clear example of this. The political pressure for the SCR to be seen as a success has always been immense: it was announced in 1997 as a personally favoured project of the then Prime Minister, Tony Blair. But this was never a vision shared by the doctors and nurses working in the NHS. When we studied the way health care professionals felt about the SCR in 2008, most of them said that they didn't really see the point of it: if you have an accident they would much rather get the information from you directly, either by examining you or by talking to you or your carer. Given that it's not particularly effective at improving health care, the project has to be seen to be a success in some other way. As a result, the reported "benefits" of the SCR consist of things like "the growth in number of patient records on the system," and "the number of times that SCRs have been accessed..."

Highlights of confidential UCL report on summary care records (15 Jun 2010)

Computer Weekly Tony Collins IT Projects Blog

A report by University College London on the summary care record scheme is expected to be published on Thursday. Today this blog publishes highlights from a draft of the UCL SCR report. It'll be interesting to compare the draft and final reports to see whether the Department of Health has softened any of the already-nuanced messages in the draft report. . . The UCL draft report concludes: "Overall the evidence that the SCR programme had so far achieved the benefits set out was limited." Specifically: (i) There was evidence of improved quality in some consultations, particularly those which involved medication decisions, (ii) There was no direct evidence of safer care but findings were consistent with the conclusion that the SCR may reduce rare but important medication errors, (iii) There was no consistent evidence that the SCR made consultations quicker , (iv) There was evidence that the SCR was particularly useful in patients unable to communicate or advocate for themselves, (v) There was no evidence of a reduction in onward referral, (vi) The impact of the SCR on the satisfaction of patients was impossible to assess. . .

Decision day arrives for CfH and NPfIT (5 Aug 2010)

e-Health Insider Primary Care

The National Programme for IT in the NHS is set to end in its current guise, with plans tabled for further deep cuts, and the name NHS Connecting for Health to be dropped. E-Health Insider understands that a far-reaching review of the National Programme and Connecting for Health was completed by the coalition government last week, as part of a wider review of all public sector IT major projects. The recommendations of the review was due to be evaluated today by a panel chaired by government chief information officer John Suffolk. Assuming it is approved, a ministerial announcement expected to follow within the next two weeks. Sources indicate that the binding nature of the LSP deals with CSC and BT mean they will not be axed, but instead allowed to run down or expire. In the case of CSC - expected to be pushed hard to deliver further savings - its current contract runs until 2016. Savings beyond the £600m required by the previous government - which included an agreed £100m from the BT London contract, and a yet to be agreed £300m cut from CSCs three LSP deals - are expected to be announced. EHI has been told that further cuts will come from CSC and perhaps London, together with the unspent monies in the south. One source told EHI that the situation was still in flux, with it not being clear where final decisions would be taken. The drive for savings, however, is being led by the Cabinet Office, with the DH said to be playing second fiddle. Cabinet Office minister Francis Maude is said to have begun negotiations with CSC by demanding 30% savings from CSC's £3 billion NHS IT contracts, or up to £900m. EHI has been told that CfH will disappear as a brand and the already much reduced agency will be dramatically scaled back. Over the past month an exercise described as "hold and let go" has been going on to identify what core responsibilities the DH Informatics Directorate should retain and relinquish. Far more emphasis will instead be placed on local decision making, interoperability, shared records, clinical portals, and best of breed. "The national programme will become 'a' programme, rather than 'the' national programme," said one source. In effect trusts are being given greater choice, though with little central funding to help them exercise it. An indication of the swinging nature of cuts to come has already been provided in the last month's termination of the Microsoft NHS enterprise licensing deal. One EHI reader described the end of the Microsoft deal as: "Dumping cost out from the centre", pointing out that trusts had already set budgets "and now is certainly not the time to get new local funding". Many of the responsibilities of CfH are expected to be taken on the Department of Health Informatics Directorate, particularly its Technology Office. This will focus on standards and interoperability, together with ongoing management of contracts.

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