When Tony Blair addressed the annual CBI dinner last week he discussed the challenges of modernisation. He also cited the £6bn, 10-year National Programme for NHS IT (NPfIT).
‘The NHS IT strategy is a large and complex programme, but it is having a real impact,’ said the Prime Minister.
Blair’s endorsement runs contrary to the condemnation that has dogged the programme in recent months. A group of academics has described the project as ‘fundamentally flawed’ and there have been continued criticisms of delivery delays, changing specifications, disagreements with clinicians, and financial problems for suppliers.
Worse is yet to come. A National Audit Office report is due, and NHS IT director general Richard Granger faces a tough grilling by the Public Accounts Committee next month.
But Granger, while acknowledging there have been delays and variable supplier performance, says such a revolutionary programme was never going to be easy to implement.
‘We are breaking new ground: some things go well, some things are difficult – and those that are difficult get a disproportionate amount of attention,’ Granger told Computing.
‘People seem to forget that these systems are disruptive and introducing them is disruptive, but we have to hold our nerve,’ he said.
NPfIT includes the development of national electronic bookings, prescriptions and patient records systems relying on a central data ‘spine’, a high-speed network and upgraded Patient Administration Systems (Pas) and clinical software in hospitals across the country.
The challenges facing the programme are on an unprecedented scale, with overall health policy shifts on top of technical and logistical issues. The cultural issues of installing new systems that users are comfortable with are also significant.
‘A large programme has to be a tree, growing into the wind and shaped to take the forces of change, rather than standing rigid like a skyscraper in an earthquake zone,’ said Granger.
He says the perception of NPfIT as a centrist autocracy, in direct contradiction to the wider health service strategy of increasing local independence, is a misunderstanding.
‘I don’t think we have properly communicated what we’ve built: the spine is not a standardisation bulldozer with which to clear away lots of cherished systems, but rather the means by which those systems can be enabled to send information around the NHS,’ said Granger.
‘There is a balance to strikebetween the homogeneity we are accused of and an excessive heterogeneity that leads to an engineering impossibility around integration. History will tell if we have the balance right, but we are aware that we need to strike it,’ he said.
Determining the progress of the programme can be tricky. The official statistics list 71 Pas deployments, for example, but critics argue that even this is misleading because only 13 of them are in acute hospitals at the sharp end of the NHS.
Granger says while progress may be slow in some areas, NPfIT has delivered other systems not included in the original strategy, such as a national email service, digital X-rays and quality management systems.
‘It would be really easy to believe the legend, but what should be looked at are the things we have delivered and the things we will deliver which are already working,’ he said.
Even the problems with the core Pas software do not constitute the classic government information technology disaster. Only three years into a 10-year programme, some difficulties are to be expected, says Granger.
‘People who sit in ivory towers imagining that large programmes don’t have to accommodate significant change have obviously never delivered one,’ he said.
Part of the problem is that trusts are more critical of products bought nationally. Trusts identified 8,000 issues with the iSoft software, but they were all things the 150 trusts already using the system had been happy to put up with, says Granger.
And despite trust concerns that the NPfIT systems will not work as well as they have, sticking with the existing mixture of systems is not viable.
‘There is a complex mosaic of heterogeneous systems that have been knitted together on an institution by institution basis and most are not extendable, and in many cases are becoming critically obsolete,’ said Granger.
‘The core software is a challenge for suppliers and we would like a lot more functionality than is currently available, but most of what is installed across trusts now is not sustainable.
‘If we want an NHS where data can be transferred and clinicians can work in multiple institutions, we need this embracing infrastructure,’ he said.
The latest NHS numbers
* 136 million annual demographic searches took place on the spine.
* 57 per cent of GP practices using Choose & Book, 92 per cent technically enabled.
* 30,000 electronic bookings per week.
* 31 out of 130 digital X-ray Picture Archiving and Communications System (Pacs) installations live.
* 53 per cent of trusts have signed off Pacs business case.
* More than one million prescriptions transferred electronically, expected to rise to two million in the next few months.
* 13 acute patient administration systems installed, 58 community systems.
* 79,000 people using NHS Mail every day, with some 174,000 registered.
* Five spine software releases last year, two this year.
* 28 million digital images stored.
* 100 per cent spine availability in April.
* 224,000 smartcards issued.
* 40 independent software systems accredited to work with the spine.
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