Stephen O'Brien MP: The latest NHS IT shambles
In September 2003, Patricia Hewitt said:
“The principle, the civil liberties and the practicalities of great big IT projects and databases have a horrible habit of going wrong.”
Yesterday it transpired that the Government are terminating the contract with Fujitsu to deliver the NHS IT programme to the South East and South West of England. It seems that in the Government’s attempt to ‘reset’ the contract (code for ‘pouring more taxpayers’ money in’), Fujitsu have decided that they cannot deliver what is asked at the price given to them, and they intend to cut their losses, after what will no doubt be an ugly legal scuffle.
The question before us is, does this put in jeopardy the whole ‘supercomputer’ programme - the core of which is to create a national electronic patient record database, to enable hospital appointments to be booked electronically, and prescriptions to be created and administered electronically - and how much of a problem is that?
Despite New Labour embracing an internal market in the NHS, and welcoming the private sector ‘at a local level’ (i.e. imposing it from above) after the (more) disastrous early years, the NHS IT programme remains a monolithic, soviet-style mechanisation project (which is why, no doubt, it has survived Mr Brown’s purges). What is more, getting to the truth of any matter is near impossible, as tractor production figures remain the order of the day. In fact, so obfuscating is the quango that runs it, ‘Connecting for Health’, that it was recently criticised in a Government sponsored report for a “defensive and controlling approach to the release of information”. Even the Labour-dominated Health Select Committee had to deal with “vague and inconsistent” officials when they reported on the electronic patient record.
So, for example, Connecting for Health routinely tells us that “x” million bookings have been made to date, whereas against the target that matters (i.e. 90% of GP referrals to first consultant-led outpatient services should be made through Choose and Book by 31 March 2007), the Government are running at 44%.
Or on electronic prescriptions – the target is that 100% of all sites should be capable of issuing Electronic prescriptions by 31 December 2007: the Government are doing better against this target: 64.1% of sites are able to issue Electronic prescriptions. However, EPS is being used for only 1% of daily prescription messages, and only about 0.05% of prescriptions are actually dispensed electronically (assuming 773 million prescription items per annum). Furthermore it is submitted in parallel with a paper prescription, neutralising any anti-bureaucratic benefits.
The Care Records Service itself was supposed to be, albeit tentatively, ready by December 2007. Under this system everyone in the country will have their demographic data held on a central database accessible across the NHS, in a ‘summary care record’. Those of us who do not opt out will also have details of allergies and prescriptions added, and whenever an individual is treated, that information will be added to the record with their consent. This will complement ‘detailed care records’ held locally by the providers who treat us. Aside from the security concerns, progress is slow - the first pilots only went live in March 2007, and we are still awaiting a timetable for full roll out. At March 2008 153,188 Summary Care Records had been uploaded to the Spine in the pilot areas, circa 0.24% of UK medical records.
Last week the National Audit Office confirmed that:
“Current indications are that it is likely to take some four years more than planned – until 2014-15 – before every NHS Trust has fully deployed the care records systems.”
Today’s exit by Fujitsu follows Accenture’s departure in September 2006, after they had written down $450m losses against the programme. Serious questions loom – with only two of the original four suppliers left in the market, will either take on Fujitsu’s contract at the original price? Furthermore, on the one hand the duopoly increases the negotiating power of the suppliers, and on the other if these suppliers fail, the Government will be forced to sacrifice either the project, or swathes of taxpayers’ money. But that two suppliers have now quit brings in to question whether the programme can ever be delivered.
Make no mistake, Information Technology could be bringing huge benefits to patient care, frontline healthcare professionals and informing patient choice. Tony Blair was right when he said in 1998 that ‘The challenge for the NHS is to harness the information revolution and use it to benefit patients’. The mistake he made was to try and meet that challenge from his sofa, rather than allowing the hardworking staff and knowledgeable users of the NHS to solve it themselves. Information Technology should be used to meet local need, and tailored to local geo- and demo-graphic situations – the State should step back, support local innovation, and enable diverse systems to talk to one another, not build a one-size-fits-all structure from Whitehall – but with a ‘control freak’ Prime Minister, is that likely to happen?