Whatever else people may think about the NHS IT Programme’s progress – or lack thereof – there is one person who still believes it is working: Director General Richard Granger.
“Despite what you might read, we have had successes,” he insists. “How many people have a copy of their medical records? How many believe that the next person in the chain of care knows pretty much what the previous person knew? The presumption is that it is somehow magically passed on to the next person. In fact, there was a complete lack of assured information – which is what I’ve spent the past four joy filled years trying to fix.”
Granger says there is a major cultural and power shift going on under the auspices of the NHS project. “Most people have used the NHS in the past year or experienced it through their family or friends,” he says. “In its first five decades, the NHS tried to focus on doing the best for patients but the risk was never transferred from the patient to the organisation. The organisation was not centred on patients’ needs. The NHS is finding it quite traumatic to make that shift towards carrying the risk. The unions and the suppliers are expressing their ‘disgusted of Tunbridge Wells’ routine at the transfer of the risk from patients to them.”
Granger makes the reasonable point that the way the NHS conducted itself before was not acceptable or efficient.
“GP surgeries used to buy their systems themselves,” he points out. “That was good for suppliers as the GP surgeries only did it once every 10 years, so were not as experienced as the suppliers were. As a result, the systems they bought were incompatible. By March 2001, only 6 trusts had Electronic Patient Record systems. Some 99 per cent of GP surgeries had been computerised but they had no interoperability with other GPs or hospitals,” he says.
“We took a new approach to procurements. In January 2003, we published a set of procurement principles. We were trying to set up more effective supply chain or ecosystems in the NHS. We decided that some organisations that used to supply us directly would now have to work with third-parties,” says Granger.
“There were third-party software firms that just weren’t mature enough for us to deal with. For example, IDX decided that they wanted to do cookie cutter software, not complex medical software as the market wasn’t big enough for it. But we had a mitigation plan in place to cope with the risk. These principles were published before we got into the procurement itself. They are still good things for the NHS.”
But what about things like Accenture’s walking out on the project? “The ‘Accenture event’ was one such risk that we predicted,” insists Granger. “I know I have the model wrong if I didn’t have a queue of people ready to carry on the work if needed.”
But not far beneath the surface is the bubbling resentment of critics. Granger cites an evaluation of the project by the National Outsourcing Association. “That assessment didn’t fit with the requirements of the press, so it was largely ignored,” he claims. “We are not spending $12 billion on IT services. If you are a friend of [outspoken critic of the NHS programme] Richard Bacon MP, then sorry, we’re not spending £50 billion. “You see all those amazing numbers circulating about what we’re doing as though we’re squandering billions of pounds that could be spent on doctors and nurses,” he complains. “We’re doing 5 billion electronic transactions that cost 3 pence each that would have cost 12 pence under the previous approach.”
“Anyone who thinks the NHS is a downwardly managed organisation hasn’t encountered it,” says Granger.
“It’s a series of independent entities each choosing to do their own thing on occasion. So we have to produce products that are seductive enough to get used. There has to be an element of organisational buy in and end user takeup which is quite challenging. Choose and Book is being used but there is significant organisational resistance. But the IT system works. It gets incorrectly portrayed as not working.
“The resistance to electronic transmission of prescriptions is quite interesting. There is a lot of money involved in the pharmaceutical industry. It’s remarkable how difficult it has been for chains of chemists to deliver systems of similar compatibility. The bricks and mortar chemists businesses are scared of what will happen when you can fill out your prescription at home. But there is an Amazon style market change coming to the high street chemists.” He claims: “Up to 100 bodies are piled up in the mortuaries due to transcription errors every month but you don’t get an outcry about that!”
So how does Granger propose to break down that resistance? Not his problem, it seems. “I was appointed to run a procurement process and set up an IT services programme,” he explains. “I was not appointed to manage the end user environment. That’s the job of the chief medical officer.”