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.

“If you do things on a national scale and too fast, you hit the rocks harder. If you do things on a smaller scale, personal contact counts for a lot,” he said.

Some of the IT managers agreed that the NPfIT had encouraged a box-ticking approach and in some cases led them to deliberately hide innovations in case they were reprimanded for not following the plan. Others were more keen to share.

University Hospitals Birmingham NHS Trust has developed a home-grown solution to improve drug prescribing, according to ICT director Stephen Chilton.

“You can put intelligent rules in about how drug therapy is applied to a patient to ensure you’re giving someone the appropriate drug at the appropriate times in the appropriate dosage. It means that the patient can go home earlier,” he said.

Such innovations need to be publicised, said Chilton. “There is a lot of redundancy in the work we all do to achieve the same goals,” he said.

“We need to work out how we improve our ability to share innovation and creativity. As IT folk, we haven’t yet learned to articulate to others.”

What the NHS experts say

Why security of patient records is suddenly an issue when paper records have littered doctors’ floors for years:
“It’s quicker and easier to search data centrally than in piles. It’s one key to a very big cupboard.”
Niall Poole, Heart of England NHS Foundation Trust

Why there isn’t more in-house IT expertise in the NHS:
“The big argument is that the NHS is not a software developer – it’s about delivering patient care.”
Paul McQuaid, programme manager, NHS Manchester

On Conservative Party proposals to get rid of a central database of patient records:
“There are some clunky things about the NHS Spine and the way it operates. But if we didn’t have one, we would build one.”
Ian Herbert, former NPfIT consultant