Written evidence from K2 Advisory|
In the UK, we can pretty much all see the wisdom
of having a digital care record system which means that when we
or our friends and family are taken ill and are rushed to hospital
in an emergency, the medical profession has immediate access to
our medical records. So, one question is whether it is possible
to achieve this outcome and the other question is which scapegoat
to charge with the blame for us spending £2.7 billion to
date on a system that does not yet work?
If we were starting the Detailed Care Record system
today we would begin by finding out whether any software existed
that could help us deliver such a system. In fact although ISVs
such as iSoft have made efforts to develop their software to deliver
what is required, none yet really have what is required. This
goes some way to explaining why not one of the 250 hospitals in
England yet has a full electronic record.
But, even today there are surprisingly few Detailed
Care Record systems in operation anywhere in the world and certainly
none on a national scale.
It was clear from the outset of the NPfIT that it
was a very ambitious project to stage a revolution, and was also
approved without due diligence being paid to some basic considerations,
such as the availability of the software on which to build the
systems. Indeed, this type of risk was left entirely up to the
Local Service Providers to shoulder. Given the size of the investment
from the public purse that was definitely not a wise decision.
It is now not reasonable to expect this system to
emerge as envisaged particularly given the proposed re-organisation
of the NHS. So the best course may well be to move to a more evolutionary
roll-out by establishing a catalogue of suppliers working to agreed
data exchange and payment standards and let the hospitals adopt
what they want, when they want.
Furthermore, as Google Health matures, along with
the Web generations that have grown up with online presence, individuals
will increasingly elect to manage their own medical information.
By a combination of these two approaches we will gradually get
a more modern Digital Care Record system, but the current Big
Bang project is too expensive too continue given our budget deficit.
We cannot afford to spend several more billion pounds on this.
And, what of the existing contracts? The solutions
and their ongoing development should form part of the catalogue
of services available for medical practitioners to use. The contracts
themselves need to be renegotiated to fit a pared down, decentralised
A commonly held opinion both among suppliers and
buyers is that much of the fault lies with Richard Granger (the
Director General for IT for the NHS 2002-08). He set up a top-down,
centralised approach to programme development along with a survival
of the fittest approach to managing the four main IT suppliers
for NPfIT. Some think his mis-management was of treasonable proportions.
Others blame the then Prime Minister Tony Blair for pushing programme
approval through too quickly.
However, neither Granger nor Blair is around to take
the flack. In their absence the fallguys are CSC, for being American
while missing deadline after deadline, and Christine Connolly
and the DoH for attempting to defend the project. BT is not targeted
nearly so much for its failings, partly because two of its national
projects N3 and The Spine have been successfully delivered, and
also I think because it is a British supplier.