Life after the NHS National Programme for IT revealed

Plans to hand control for the future adoption of healthcare technology to individual NHS bodies have been called into question as critics fear yet more money will be spent on systems that fail to bring any benefit to patients or clinicians.

Ministers speaking at the Health Informatics Congress 2012 in London last week admitted the NHS National Programme for IT (NPfIT) had largely been a failure, arguing that the way forward was ‘not top-down, but bottom-up’.

The programme forced doctors and nurses to bend over backwards to meet the needs of the systems. The result was that IT became the enemy, innovation was stifled, enthusiasm was sapped, and real progress was delayed

Earl Howe, the Parliamentary Undersecretary of State for Quality, told delegates: “We have learned from the national programme that the top-down approach does not work. The programme forced doctors and nurses to bend over backwards to meet the needs of the systems. The result was that IT became the enemy, innovation was stifled, enthusiasm was sapped, and real progress was delayed. What we failed to do was to involve users and clinicians early enough and it fell flat on its face.”

Both he and Jim Easton, the NHS national director for improvement and efficiency, hinted that the landscape post NPfIT would put much more emphasis on local decision-making and there would be no more major national procurements. This is an approach that has attracted fresh criticism as NHS Scotland recently saved hundreds of thousands of pounds procuring a national single sign-on solution for all its health boards. England, in contrast, looks set to move to a more locally-led system, which could see repetition of effort and fail to take full advantage of economies of scale. Ultimately, critics fear, it could also scupper the success of the overall plan to ensure patient information is available at the point of care, wherever patients are in the country.

Broadcaster, Nick Ross, who moderated at the conference, told ministers at the event: “We have seen the failure of the national programme and that has scared a whole generation of politicians from making any decisions at all. There is no national strategy for IT and no clear accountability.

“It is a classic case of unintended consequences. Everyone is scared of making decisions, so they are saying ‘you make them’. Whether they say ‘you can make a decision until something happens and we get our behinds slapped and then we will say you can’t do it’ is yet to be seen.

”Are we in the grip of a political pendulum where we are swinging from national programme to make and mend? Are we designing for yesterday’s processes and not for today? And how, if we allow innovative people to do their own thing, are we going to be able to read each other’s information?

“I was at the launch of the national programme and alarm bells were ringing then, but no one wanted to raise them because it was a new dawn. Is that where we are going again now? Are we heading towards a system that in five or 10 years’ time we will be scratching our heads and asking whether we got it right?”

I was at the launch of the national programme and alarm bells were ringing then. Are we heading towards a system that in five or 10 years’ time we will be scratching our heads and asking whether we got it right?

Easton said the Government had learnt from the failures of the national programme, arguing that handing over control to individual trusts was the only way to promote innovation and ensure clinical staff and patients buy into the need for an ‘information revolution’.

He added: “What I am most excited about is the sense that informatics is about to move from a critical-but-backroom service to a frontline service.

“There are clinicians who want to drive care faster and better, but think the way we structure healthcare inhibits the technology. The problem is in the way we constrain revolution rather than unleash it.

“NPFit, for all the controversy, has done some remarkable things, but we should have a national infrastructure that acts as a carrier. Innovation and change needs to come locally and we need to have the arrangements in place for that.

“There’s no doubt that setting a clear direction at government level makes a difference, but it cannot bring orthopaedic waiting times down. It’s about the people in hospital departments having discussions. What we got from feedback on the national programme was that while it got results, it was not sustainable and it hacked people off.”

What we got from feedback on the national programme was that while it got results, it was not sustainable and it hacked people off

Earl Howe said the national programme had enjoyed some success, with the roll out of Choose and Book, digital X-ray technology and the secure N3 broadband network, adding: “It is important to understand what has come before so good work can be preserved while mistakes do not happen again.

“We benefited from some elements and these will stay. There is no sense culling them, but the programme overall has not reaped the rewards expected for the time and money invested and it was spectacularly overtaken by the revolution in technology.

what we are striving for in the wider reforms process is not a choice between top-down or bottom-up, but to try to achieve a mature relationship between both of these things

“We now have a situation where doctors can talk to other doctors overseas, but they have to wait for paper records on their patients. Then there’s the case where a three-year-old patient can come into the surgery and he can already use an iPad, but his mother can only book his appointment over the phone.

“It is right that we make the leap and shift power to the frontline so that clinicians are in the driving seat, but supported by national systems and services where necessary. Political pressure alone, however well meaning, cannot make this happen. The role of Government should be to support clinicians, to empower, not to tell them what to do. Frontline clinicians know what will make their jobs easier and services better for patients. The Government is there to provide support, but we have got to trust the frontline professionals to lead locally and act in the best interests of patients and service users.”

Easton added: “Moving forward, are we going to do everything from the top down or are we going to keep things local and hope for the best? The answer is ‘yes’. The mature answer is that what we are striving for in the wider reforms process is not a choice between top-down or bottom-up, but to try to achieve a mature relationship between both of these things. What we need to look at is how we join them up.

“When everything was done locally we had many examples of failure. We are not saying ‘we will do standards you do innovation’; it’s about joining that up. That is the future for the NHS.”