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 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 adoption approach.

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.

May 2011


 
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© Parliamentary copyright 2011
Prepared 3 August 2011