UK government topples the dinosaur

Whilst the UK’s massive National Health Service’s NPfIT programme saw some healthy successes – already delivered and integrated into the service are applications such as Choose and Book, electronic Prescription Service and PACS -- through the near decade of the existence of this mammoth project, involving a still evolving science, there have been unhealthy delays, overspending, cancelled contracts, and too much else. For example, although the plan aimed for every patient to have an electronic care record by 2010, systems ordered by the Department of Health (DoH) from suppliers British Telecom (BT) and the US firm CSC are not all are likely to be in place until 2015-16, and reservations have been aired about that completion period.

In addition, among 4,715 NHS organisations in England expecting to receive a new IT system, over 3,000 are still outstanding. Up to recently, around £6.4 billion has been spent on the programme and £5 billion more was earmarked for investment. In September 2010, following a review of the NPfIT programme, the DoH concluded that ‘a centralised, national approach is no longer required, and a more locallyled plural system of procurement should operate, whilst continuing with national applications already procured.’

This February, the death knell sounded louder following the release of a report from the National Audit Office (NAO) that revealed the state of the NPfIT, nine years after its launch. In a statement in May 2011, Amyas Morse, head of the NAO said: ‘The original vision for the National Programme for IT in the NHS will not be realised. The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme. ‘The Department of Health needs to admit that it is now in damagelimitation mode’, he continued. ‘I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help to prevent further loss of public value from future expenditure on the Programme,’ he concluded.

In July a government white paper announced its radical re-organisation of the health service. In August, a Commons’ Public Accounts Committee report called for the entire NPfIT, including plans for EPRs, to be dropped and, backed vociferously by Members of Parliament, criticised IT suppliers – BT and CSC -- for failing to deliver what was guaranteed in their contracts. The DoH has been negotiating with CSC for over a year, and is reported to have said that it might be more expensive to terminate the contract than to complete it. (According to CSC’s annual report in June, the DoH paid the firm £200m in April, as part of an advance payment. There is a provision: that the firm, which is responsible for the implementation of iSoft’s Lorenzo software in three UK healthcare regions, will repay the sum upon NHS demand in September ‘if the parties are not progressing satisfactorily toward completion of the expected contract amendment’.

BT, also accused of being unable to deliver according to its original contract, is additionally accused of demanding over four times the market rate for its services – it receives £9 million for systems in each NHS site, ‘even though the same systems have been purchased for under £2m by NHS organisations outside the NPfIT’. Before mid-August, the UK Coalition Government (Conservative and Liberal Democrat) acted. It now intends to replace the world’s most ambitious healthcare IT programme with a form of decentralisation that might at least save £700 million. Health Minister Simon Burns said: ‘We will allow hospitals to use and develop the IT they already have and add to their environment either by integrating systems purchased through the existing national contracts or elsewhere.’ The NHS now has matured applications that no longer need to be managed as projects; they can be controlled by the NHS itself. According to a DoH statement, NHS local organisations now can themselves ‘introduce smaller, more manageable change, in line with their business requirements and capacity.

NHS services will be the customers of a more plural system of IT embodying the core assumption of “connect all”, rather than “replace all” systems. This reflects the coalition government’s commitment to ending top-down government and enabling localised decision-making.’ Until a review report expected to be aired in September and focusing on the NPfIT’s Summary Care Records system (aiming to implement a national electronic patient records application), no one knows whether this will also face further cuts. A decade is a long time in information technology. Since the NPfIT began, electronic communication has advanced so rapidly that perhaps the UK’s elephantine healthcare IT project became more of a dinosaur, doomed from the start from a technology climate change.

Certainly much has been learned and progress made, but the ultimate lesson appears to be that small has more chance of survival, and in that smallness it has to be the people ‘on the ground’, in this case healthcare IT users, who control their individual institutions communication needs, though still able to use a larger communications infrastructure as needed. The decentralisation of government IT should prove faster to implement as well as enjoy standardised, interconnected systems – becoming nothing too big to survive.

31.08.2011

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