The National Programme for IT in the NHS: an update on the delivery of detailed care records systems - Public Accounts Committee Contents


Written evidence from Public Technology

As a technology journalist and consultant, I've been following and writing about the National Programme for IT since its inception. On PublicTechnology.net - a public sector news and analysis community with 115,000 subscribers across the UK public sector with half a million page impressions per month, - we've just published an NHS IT special report as part of which we listed what we see as the four possible next steps for NPFIT.

We offer these up to you for consideration following the PAC meeting on Monday last:

OPTION 1

Scenario: The Prime Minister closes the whole project down and says "not a penny more on my watch".

Pros: This aligns with the government's "waste and efficiency" ideology. It could be presented, with not that much PR genius, as proof of the Coalition's commitment to the NHS and be a healing balm, perhaps, against all the resistance NHS reforms are experiencing - look, we're putting £4 billion back into "frontline service delivery".

Cons: Very regrettably, the original NPFIT CIO Richard Granger's attitude to supplier contracts has come back to haunt us badly, despite years of telling he was doing the opposite ("We have punched the bottom out of pricing arrangements that have previously been suffered by the NHS and the wider public sector… We have seen big cuts in the prices for electronic patient records, for servers and for other infrastructure. We now need to see the same for picture archiving systems. If we don't get that, we will subject the suppliers to radical surgery," 2004 interview with the Financial Times).

Essentially UK HMG basically can't afford to can the Programme. If we did, you're talking literally years of punishing litigation that will only make lawyers and the contractors richer. Indeed, the most likely outcome would be that CSC and BT would walk away with some reputational damage perhaps, but probably, pound for pound, as much as they'd got anyway (CSC maybe more, given that we've been trying for two years to recalibrate the deal).

The outcome would be that no British government would commit any big money to NHS informatics for a generation - sort of like an AI Winter, only longer.

OPTION 2 - DO NOTHING: THE PLACEBO EFFECT

Scenario: Apart from some really rather tough words in the House or a Committee report or two, we leave things in situ. BT and CSC continue the cheque-trousering, NPfIT limps on until 2015, when as a nation we shrug our collective shoulders and put it down to experience.

Pros: This makes both political and arguably "medical" sense. Sorting out this would require a lot of legal, contract management, communications and strategic vision talent - and we're using all of that to try and work out WTF we do to reorganize the rest of the NHS. Medically, doctors since Classical times have been told they must first, "Do No Harm". Sometimes left alone is best. So, again, accept that money and opportunity have been wasted, but push ahead with the thousand flowers bloom/localism agenda. Look to the planned Information Strategy to reconcile the work done so far and emphasis that as a way to unify NHS ICT. Thus you avoid the law courts, you keep the peace with two central government suppliers (important at a time of massive change and dislocation in the wider NHS).

Cons: Er, what the hell is the Information Strategy? It's certainly not a professor of computer science's idea of a unifying taxonomic framework. At the moment, it's Tory-LibDem personal freedom ideology in press release form. Who's driving it? Is there coherence? Do we really expect it to provide the kind of overall intellectual architecture to unify what our friend Granger himself called in 2006, "a massive, diverse, heterogeneous organisation that is itself changing while this is being implemented".

Er...quite. If we try this we face real danger in the sense of systemic drift - nothing happens, expensively, for a long time and suddenly it's 2015 and it's all been a total waste of time, energy and ideas. Oh, and enough money to build God knows how many proper new hospitals - or 10% of a PFI one, maybe.

OPTION 3 - KEYHOLE SURGERY

Scenario: Stop the most flagrant waste. Look to the new Major Projects Authority that Maude, Healey and Watmore have schemed up to step in and sort out the mess and get what value can be had from the suppliers. Accept it won't be all we want (as we drew up the contracts ourselves as the national customer, or rather let Granger, we can't say "deserve"), but this time put some structure and commercially sensible benchmarks back in. Re-focus the Information Strategy work to be as useful as possible. Provide support to the newly structured, post-Lansley shake up (if there is one, bien sur) NHS to make the most of what's out there, and where appropriate, go commodity for new NHS ICT.

Pros: Government, suppliers and CfH save face - again. This is not a particularly attractive element given ten years of wasted opportunity, but important if you've built a career or a sales pipeline out of all this. Saving face will be a consideration at key points in the decision tree, believe you me. Done well, you get (some) reform and minimal "disruption".

Cons: This option needs sure political and project management skills to dance our way with something still worthwhile out of the wreckage. Is NHS CIO Christine Connelly the right woman to do this? What about NHS supremo David Nicholson? We have our own thoughts on that - cemented by their performances under questioning from the PAC - but we'll keep our powder dry for now - as they say they are doing in their negotiations with suppliers.

OPTION 4 - HEART AND LUNG TRANSPLANT

Scenario: A radical version of the latter with a bit of option 1. This one's not for the faint hearted. You dump the whole thing and have the cojones to face down the suppliers, probably paying the price of some compensation, but suggest to them that they'd not work in Whitehall ever again if they play dirty pool. Then you use the balance of the rest of the money in the NPFIT account to do an NHS Cloud, stripped down, commodity-based, not-invented-here version. Think universal, cheap, open source - you choose what works for you.

Pros: By mandating that Trusts only use simple, proven technology, you get quite a few wins for free here. It aligns with the G-Cloud message, App Store and New Model Army Government ICT Strategy approach (all that "agility", right?). You make the suppliers and indeed the market do the bulk of the development as you just rent what works. Cloud is the future, so this could actually last a bit longer and do more useful work than what we face when we walk over the cliff in 2015 when the nightmare, sorry, the Programme, ends.

Cons: If you give the NHS to Google this time, not Microsoft as Blair did, you'll have a new PR problem of your very own. If you give my patient record to someone who will store it in India but work on it in Budapest, the first time The Daily Mail finds out we'll have the whole offshoring row of the last decade all over again, only this time with your mum's X-ray data being sold, not your current account. It's also, to be frank, probably too radical and imaginative for DoH to even consider.

May 2011


 
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Prepared 3 August 2011