The £6bn, 10-year National Programme for NHS IT (NPfIT) is ‘like pushing water uphill’, says health service IT director general Richard Granger.

It has certainly been a difficult year. As well as ongoing issues over the Choose
& Book electronic appointments system, there have been delays installing the upgraded hospital systems needed to access the programme’s national applications, and problems with clinician buy-in and supplier performance.

But Granger remains upbeat.

‘This is a multi-year programme so there is no point at which the job will be finished, but we are coming to the end of a tough year in which we have put some of the
cornerstones in place,’ he told Computing.

Both the NHS itself and the scope of the programme have changed significantly since the specification was written in 2003, says Granger.

Radical changes such as the new GP contract, the creation of foundation trusts and better private sector delivery have increased the organisational complexity facing the NPfIT team.

And technical additions include the national Picture Archiving and Communications Systems (Pacs), which replace X-ray films with digital images, and the development of a directory and smartcard security system for the hundreds of thousands of NHS staff.

‘We have ended up doing a vast quantity of work we didn’t think we would have to do, against the background of the end user community going through big changes,’ says Granger.

One of the areas where Granger feels that criticism is particularly unfair is the
perceived lack of end user engagement. Until the NHS Modernisation Agency was closed earlier this year, clinician liaison has not been a responsibility of the NPfIT, he says.

2005 has also been a slow year for the National Programme.

The major software applications may all have been delivered on time, but implementation of the next-generation hospital systems required to make the most of them is still running about six months late.

Supplier BT has come under particular fire for problems in London, and Granger has been vocal in his condemnation of under-performance in the capital.

‘BT is on report and being closely monitored, and it is staying behind to make sure its homework is done,’ he says.

But the programme may be about to turn a corner, if the first two major patient administration systems in London and the South go live before Christmas as planned.

Issues of supplier performance should not come as a surprise, says Granger.

‘If you take an environment in which there has been very little investment, and suddenly start spending significant amounts of money, the supplier community takes a while to scale up,’ he says.

‘The regional implementation problems are a resource issue. These are challenging targets, on a massive scale, in an immature sector within an immature industry.’

The beginning was always going to be difficult because the programme is breaking new ground, he says. But as early implementations bed in, and further installations become ‘like shelling peas’, progress should become easier.

‘The problem is that there is a set of complex requirements that need to be built into existing products and then “ruggedised”, so they are installable
rapidly on a repeatable basis,’ he says.

Some aspects of the programme are already gathering pace. ‘When we start connecting the major pharmacy networks to the prescription software, we will have
thousands of outlets connected up very quickly,’ he says.

‘And Pacs was not in the original specification, but now every few weeks another hospital becomes filmless.’

The coming year will see a massive increase in transaction volumes, and increasing innovation by local users, says Granger.

‘There is an obsession with patient administration systems and labels about targets, but what we are seeing is a massive increase in digital information flowing around the NHS,’ he says.

‘People will use it in all sorts of ways we haven’t thought of yet.’

The National Programme for NHS IT: where are we now?
THE £6bn National Programme for NHS IT (NPfIT) has four core components: central ebookings, eprescriptions, electronic patient records applications, and the N3 broadband infrastructure.

N3 network
The target is for the infrastructure to be installed in all 18,000 NHS locations by March 2007. There have been some installation quality problems with supplier BT, but the implementation is about to deliver its 12,000th connection and is about 2,500 ahead of schedule, says NHS IT director general Richard Granger.

‘During this calendar year we have rolled out what is already the largest virtual private network in this country, and one of the largest in the world, ahead of schedule and under budget,’ he says.

Choose & Book (C&B)
Despite a target of 205,000 electronic bookings by December 2004, fewer than 18,000 have been made so far. NHS chief executive Sir Nigel Crisp acknowledged last week that C&B implementation is 12 months behind schedule.

But Granger maintains that the delays are NHS-wide issues outside the NPfIT remit and beyond his control.

The central application was delivered in July 2004, and all upgrade and service availability targets have been met, says Granger.

The issues causing the delays are twofold, he says. Some are logistical, such as the upgrading of hospital-end systems by local NHS trusts. Others are more political, such as take-up, because many GPs are not sold on the patient choice policy that C&B allows.

‘The core application is there, does what it was asked to do and was delivered on time,’ says Granger.

‘There have been some configuration problems, some service availability issues and a series of user requirements which emerged subsequent to the launch that we have had to deliver, but low usage is not something I can do anything about.’

Electronic transfer of prescriptions
The target is for paper prescriptions to be all but eliminated by 2007. The central software has been developed on time and most pharmacy systems are now compliant, says Granger.

So far, 72 GP practices and six pharmacies are live on the system and about 70,000 electronic scripts had been processed by the end of October.

‘We are on the verge of being able to connect some of the large pharmacy networks, so we expect exponential growth,’ says Granger.

‘There will be a huge jump in the near future because something like 80 per cent of the 330 million scripts a year go through just seven networks.’

Electronic patient records
The heart of the NPfIT is an electronic patient records system created around a national ‘spine’ of basic data. As well as the central application, local systems need to be upgraded to access the spine.

The core software is in place and will be completed by the end of the year, says Granger. And GP-to-GP electronic records transfer, which is useful when patients change surgery, is up and running in half a dozen surgeries.

But the hospital end of the programme has hit problems and continues to run about six months behind schedule. The next couple of months will be critical, as the first
two patient administration systems are due to go live in hospitals in London and the South.