It’s not working and it’s not going to work. It – of course – is the NHS National Programme for IT (NPfIT). This time the condemnation comes from a source that ought to know what it is talking about – one of the prime contractors.
Specifically it is the doom-laden assessment of Andrew Rollerson, healthcare consultancy practice lead at Fujitsu, which is on course to mop up £896 million – so far – as the prime contractor for the south England region.
He warned a recent NHS conference that the way things are going at the moment, the end result would be “a camel and not the racehorse that we might try to produce”.
He criticised the thinking behind the project, arguing that it lacks vision. “There is a belief that the National Programme is somehow going to propel transformation in the NHS simply by delivering an IT system,” he said. Nothing could be further from the truth. A vacuum, a chasm, is opening up.
“We are desperate to get something in and make it work, versus what the programme really ought to be trying to achieve. The more pressure we come under, both as suppliers and on the NHS side, the more we are reverting to very narrowly focused IT-oriented behaviour. This is not a good sign for the programme.”
His basic argument is that the wrong approach is being taken to the rollout. “What we are trying to do is run an enormous programme with the techniques that we are familiar with for running small projects,” he says.
“And it isn’t working. And it isn’t going to work. Unless we do some serious thinking about that – about the challenges of scale and how we scale up to an appropriate size – then I think we are out on a limb.”
It may yet come to pass that his speech will turn out to be the most commonsense words surrounding the project in recent months. Certainly it sounds like a sensible idea – to focus on getting the current situation sorted out and on track – rather than the bizarre notion that the coffers should be topped up from the public purse for yet another expansion of the project’s scope.
The NPfIT as it was envisaged was scoped to join up disparate systems across the NHS, from trusts through individual hospitals to GP surgeries and local pharmacies. Now it is being floated as a notion that the computerisation of the NHS should extend into citizens’ homes.
Of course, this was not planned for to begin with so it is going to cost extra. As well as the basic technology – which remarkably enough Microsoft seems happy to assist with and get into your homes – any new telehealth systems would have to be tested for interoperability with the national Spine electronic records network which will also bump up both the cost and the complexity of the entire project.
This could only happen in the public sector. Here we have a project that is under-investigation by the House of Commons; under fire from all sides, including those who are expected to use and benefit from it; that has failed to deliver on almost every expectation levelled at it; and whose final taxpayer funded price-tag is the subject of constant evasion by the people spending the money. And the response from the powers-that-be? Let’s spend more money on something untested, potentially unworkable and almost certainly unwanted.
But then this is the NHS 2007 – a Kafka-esque nightmare in which the Secretary of State for Health can claim with a straight face, and not be told to clear her desk, that hospitals closing beds clearly means that fewer people are sick. Compared to the high cant of Patricia Hewitt, the NHS National Programme for IT looks like a philosophical masterpiece.
The house of commons Health Committee is to hold an inquiry into the electronic patient records system at the heart of the £6 billion NPfIT. According to terms of reference published in February, MPs will focus on patient data issues such as where information will be held, who will have access to it and how confidentiality can be protected.
The committee will also consider implementation issues affecting the programme, which is about two years behind schedule. The inquiry is one of a series of reviews of the Programme in the past 12 months.
In June, public spending watchdog, the National Audit Office, published a report on the progress and since the appointment of NHS chief executive David Nicholson in July, there have been at least two further internal reviews, according to health service insiders. Nicholson has reiterated his support for NPfIT and, while acknowledging the need for more engagement with NHS users, he rebutted calls for an independent review.
Progress on the NPfIT is patchy. The N3 broadband network is now fully rolled out, more than two months ahead of schedule and implementation of electronic X-ray systems is considered broadly successful. But installation of the complex hospital administration software has all but ground to a halt and NHS staff buy-in issues are still not resolved.
One result of Nicholson’s reviews is December’s creation of the NPfIT Local Ownership Programme (Nlop), which aims to give local health communities a greater role in the technology programme. But NHS IT staff are not convinced the plan will go far enough. “If it actually happened, Nlop would be helpful but it seems there is not going to be any money or contract management – and supplier discussions are to remain central – so it just looks like responsibility without authority,” said a senior source.