2020health’s report on “Fixing NHS IT” is published today
and featured in the Financial Times and on smarthealthcare.com. In it we detail how incoming government could save at least £1 billion
by realigning the troubled NHS computer programme and boosting its performance. We have compiled an unprecedented dossier gleaned from extensive
interviews with key participants of what has worked, what should be stopped and
what next.
Our detailed rescue plan for
the £12 billion National Programme for Information Technology (NPfIT), which was launched
with a great fanfare by Tony Blair in 2002 but now mired in cost over-runs and
a four-year delay, is, we argue, essential for the future of UK healthcare.The NPfIT was supposed to link 30,000 GPs to nearly 300
hospitals across England,
providing NHS staff with instant access to the medical notes of patients at
every stage of diagnosis, treatment and discharge. It consisted of national
infrastructure, an NHS Spine, integrated with local care records services.
MPs on the Commons Public Accounts Committee warned last
year that key parts of the programme –
the biggest civilian IT project in the world –
were on the brink of failure and that the revised completion date of 2014-15
(four years behind schedule) looked over-optimistic.Our study, conducted by 2020health.org and written by NHS
IT expert John Cruickshank, warns that a hiatus for NHS IT after the
election expected in May would be hugely detrimental to patient care. We based our findings on confidential interviews with NHS
officials and the private contractors tasked with upgrading NHS IT.
The report’s starting point is to state that getting NHS IT
right is critical for a new government. IT-enabled new ways of working are
essential to enable the NHS to meet ever-growing health demands whilst also
achieving its productivity targets and improved outcomes.The study then does a
rigorous analysis of NPfIT, and dispassionately considers its successes and
failures. It argues that the perception that the problem can be fixed simply by
axing the Programme and localising everything will only makes things worse.
Instead, the approach it recommends is to accelerate the
benefits from exploiting the new NHS infrastructure, while halting or
redirecting failing parts of the programme. It puts forward 30 detailed
recommendations for action, all to be executed within 12 months of a new
government taking office.
The report is highly critical of the way in which the
current government established the programme which attempted to do too much, too quickly, with a limited focus on early
winners to gain credibility and acceptance with the NHS. Furthermore, the current government has not adequately taken
into account the cost and complexity of IT investment that its policies have
created, before launching policy initiative after policy initiative (e.g.
Choose & Book, 18 week wait).
The key report’s key recommendations include the following:
•
Future national IT approaches should only be done in limited circumstances.
Trusts should be free to set their own direction to meet local clinical
priorities, provided nationally agreed standards are met.
• A
course of national action and investment is needed in areas where IT is
currently under-exploited in the NHS, notably telemedicine and collaborative
technology, which are a focus in other countries such as in Scandinavia
•
Those elements of NPfIT which are a valuable platform for the future should be
developed. These include N3 (the NHS broadband network), PACS (the capture and
communication of radiological and other images) and the Electronic Prescription
Service.
•
Action should be concentrated on addressing the care records service in acute
hospitals where the failings are greatest. A series of tests are proposed and a
plan of action should the model fail those tests.
• The
roll-out of the controversial Summary Care Records project (part of the NHS
Spine) should be halted and subjected to review.
• A
radical reorientation and downsizing of the central IT organisation is needed
for it to become more transparent and accountable to the NHS, in combination
with a consolidation and strengthening of IT provision at the local level.
Ultimately we musn't forget that IT is not a goal - it's an enabler - and 21st century healthcare and improved patient outcomes can't be delivered without it. We hope that our implementation plan will ensure that this is a ball that isn't dropped on May 7th.
