NHS IT warnings ignored for 5 years

The Government was warned as far  back as  2004 that immediate action was needed to fix problems in the £12.7 billion programme to revamp NHS IT, but chose not to take the necessary steps.

The scale of the problems now facing the programme in 2009 have been exposed by the publication of 31 Office of Government Commerce (OGC) gateway reviews published between 2002 and 2007.

According to a 2004 strategic assessment, one of the biggest problems was caused by  rolling out systems without satisfactorily engaging with the  staff they were supposed to serve.  "A conscious decision was... taken that, counter to the generally accepted wisdom, the approach for the National Programme would be to procure and deliver the new IT infrastructure and only seek to engage the users who would need to be involved in its implementation when there was something specific to present them with and when delivery dates were firm," the assessement stated.

"The vast majority of the user community have yet to be properly engaged. There is therefore a massive challenge in engaging with this large and diverse community such that they are sufficiently prepared (informed and equipped) to implement the new services when they receive their systems," it continued. “Overall status of the National Programme is Red — to achieve success the programme should take action immediately.”

On top of of the bad feeling that this decision created, technical problems later kicked in, including key suppliers missing deadlines for rollouts of patient administration systems (PAS) and delays in the deployment of the Spine central database, which limited the tasks the PAS could be used for.

Nearly a third of the 31 reviews are so severe that they gave a 'red light' to elements of the programme, which means there was a need for immediate remedial action and serious reconsideration of the NPfIT progresses.

Earlier this year, the parliamentary spending watchdog, the Public Accounts Committee, described the Department of Health's progress on CRS as "very disappointing" and said if the deployment of the scheme did not improve, the department should consider abandoning the planned national implementation of it.

Meanwhile it looks as though Connecting for Health may disappear altogether.  Martin Bellamy, previously head of Connecting for Health (CfH), the NHS agency responsible for NPfIT, is moving to the Cabinet Office to head up the government’s Cloud Computing  strategy.

CfH will now become part of the Department of Health Informatics Directorate which was set up by the Department of Health in March, as part of a reorganisation that saw major IT leadership roles moved from CfH to the Department. CfH was refocused as a delivery arm, with policy and strategy questions decided by a team reporting directly to  CIO Christine Connelly.

It's clearly a time of great pressure for the NHS programme and its future – or lack of future – may soon be determined. Connelly told staff in an e-mail: "The challenges ahead are tough, particularly in the acute sector, but achievable and we are united behind our objectives for the remainder of the year. Collectively we remain absolutely focused on all key deliverables.

"It is important for us to all maintain the momentum of delivery that we have collectively worked hard to establish, and we will continue to enhance our capabilities and our skills to deliver the very best solutions for patients and the NHS. The ultimate outcome - creating the best electronic healthcare systems and services in the world to help save lives and improve the quality of care - is an ambition we can all aspire to and share.

"I know that with change comes uncertainty for employees - and this news probably fuels that uncertainty - but let's not forget the real appetite out in the NHS for quality informatics and the capability we have already shown in delivering an information infrastructure for one of the largest organisations in the world.”