The strategy that dare not speak its name gets a new champion
History will probably be much kinder about the national programme for IT than current sentiment. The recognition the NHS was lagging behind in the adoption of technology and needed significant investment to catch up quickly was the right decision, at the right time.
NPfIT did not fully deliver on that promise, although it did provide more than is normally acknowledged, and as a result the default mode of describing it as another government IT disaster has held sway.
One of the most negative consequences of this attitude is that politicians (of all colours) have shied away from championing the NHS’s need to employ new technology or from pointing out that the gap identified by Derek Wanless in 2002 still yawns. Jeremy Hunt should be congratulated for putting the issue back on the agenda.
‘Hunt is aware other sectors have transformed their efficiency through greater use of IT and asks why the NHS is not moving faster’
The health secretary cannot endorse a top-down approach like that taken through NPfIT − it would run contrary to the devolution of responsibility inherent in the reforms. He also, of course, has no money.
It is that funding pressure which lies behind Mr Hunt’s enthusiasm for technology. Yes, he wants a modern NHS − but he would like a financially stable one even more.
Technological step change
HSJ understands the health secretary is convinced the NHS can only deliver the efficiency savings it requires by pushing through a step change in the use of technology.
Mr Hunt is aware that other sectors have transformed their efficiency through greater use of IT and asks why the NHS is not moving faster in that direction.
He is also likely to argue that greater use of technology can help tackle health inequalities. Rather than opening up a digital divide, IT can provide more cost-effective services for many, leaving more resources for those without access to the web.
Given all this, the health secretary will be concerned that HSJ’s latest analysis shows how technology is integral to very few QIPP plans. He is unlikely to be content to let this situation continue.
Expect to see a range of incentives and penalties introduced to “encourage” healthcare providers to increase their pace of technology adoption.
It would not be surprising, for example, to see the automatic updating of electronic patient records after treatment made a requirement for all providers of NHS services before the next election.
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Readers' comments (17)
John Church | 29-Nov-2012 10:40 am
There is no doubt that the NHS needs to up its game plan on the use of IT to introduce efficiencies and funding needs to be found to make it happen at every level of the NHS.
As a patient I see so many manumatic ways of handling information where IT can eliminate so much time being wasted. Business plans should reflect investment in IT to help transform services and reduce burdensome manumatic processes.
This all fits with putting the patient at the centre of what we do.
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Patrick Newman | 29-Nov-2012 12:02 pm
The £12bn did not get all spent so there must be something lying around. Yes it was top down but also serious privatisation that failed with many WW1 like casualties. CfH aka NPfIT was not so much an ICT strategy but more like a central procurement programme. Is there an NHS APB for Richard Granger yet!
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Anonymous | 29-Nov-2012 1:47 pm
Alastair, normally you are spot on but on this you are miles off.
History will not be kind to the national programme for IT. The idea that it’s not really the omnishambles painted by the media is bunk given the vast sums poured into it.
Also, the NHS has never been short of IT 'champions'. The current SoS like almost all others before him rightly sees technology as a way of improving things for patients and the service. The trouble is it is not ‘champions’ that we are short of. When it comes to technology, vision and enthusiasm are no substitute for expertise, a track record of quantifiable delivery and an unremitting focus on the detail. Cheerleading is not good enough; that is the lesson of the Npfit.
Here are a few basic questions that every senior official on the NHCB and DH should know the answers to in ballpark terms. Those involved in technology should have the detail at their finger tips. They frame what is possible now and what the system has to work with. How many would pass the test?
1/ what proportion of GP practices have the ability to share patient records on-line and what proportion have turned those systems on?
2/ What proportion of hospital visits are booked via Choose and Book?
3/ how many people visit the main nhs website each month, what are they doing there and what is the average cost per visit?
4/ how many people call 111/NHS Direct each month and what is the cost per visit?
5/ is the projected cost of the new friends and family test 5, 50 or £399m?
6/ how much space, functionality and security does NHS mail allow per user compared to Gmail and what are the differences in costs per user?
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Anonymous | 29-Nov-2012 2:48 pm
Anon 1:47 - Sorry I am with Alistair on this. You are revealing a bias against the adoption of technology in the NHS by laying waste to every technology related idea that it has tried/is trying to implement. While you were at it, you should have mentioned N3/4, an expensive, poor performing, and pointless network.
You are also completely wrong about the reasons for the failure of NPfIT. It was not an "omnishambles". It failed because its scope was unachievable. It tried to implement a joined up clinical/administration system for an entire nation without appreciating that the NHS' requirements are impossibly diverse. The aim of "Ruthless Standardisation" was an impossible one to achieve. I have a lot of sympathy with some NPfIT suppliers who were expected to deliver an ever-changing specification that was so far removed from the original requirement.
I feel still that a "top down" requirement will still be necessary to make the NHS adopt any form of standardisation. Hoping that local organisations will work with each other simply will not work.
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Anonymous | 29-Nov-2012 4:03 pm
Small note of order:
A crap system put onto a computer becomes an even worse computer system!
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Anonymous | 29-Nov-2012 4:43 pm
Anon 2.48
"revealing a bias against the adoption of technology in the NHS by laying waste to every technology related idea that it has tried/is trying to implement"....
what are you on about?
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Anonymous | 29-Nov-2012 6:22 pm
Anon 1:47 - Sorry I am with Alistair on this. You are revealing a bias against the adoption of technology in the NHS by laying waste to every technology related idea that it has tried/is trying to implement. While you were at it, you should have mentioned N3/4, an expensive, poor performing, and pointless network.
You are also completely wrong about the reasons for the failure of NPfIT. It was not an "omnishambles". It failed because its scope was unachievable. It tried to implement a joined up clinical/administration system for an entire nation without appreciating that the NHS' requirements are impossibly diverse. The aim of "Ruthless Standardisation" was an impossible one to achieve. I have a lot of sympathy with some NPfIT suppliers who were expected to deliver an ever-changing specification that was so far removed from the original requirement.
I feel still that a "top down" requirement will still be necessary to make the NHS adopt any form of standardisation. Hoping that local organisations will work with each other simply will not work.
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Anonymous | 29-Nov-2012 6:29 pm
An6n 4-43 to clarify my statement.
When I read the 6 questions that are put forward in Anon 1.47 post, all relating to various NHS technology projects, they are all phrased in such a way that indicates that the answer points to a wasteful outcome in each case.
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Anonymous | 29-Nov-2012 7:14 pm
I'm with 1:47. Hoping for an IT miracle that will save the NHS billions is just as ridiculous, though not quite as expensive as the waste of public money presided over by CfH. (Yes, it may have not have been an unqualified disaster, but it was still a shambles.) Alistair trips lightly over the "no money" issue, but like the NHS just because much of today's IT is free at the point of use, it still costs money to deploy. We need experts and they need to be working to a plan whether they are working on local or national projects. Nothing will come of nothing and hoping for an IT Fairy Godmother to appear, even this close to the panto season, is hopelessly naive.
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Anonymous | 29-Nov-2012 7:18 pm
PS Apologies on behalf of all of us that have misspelt Alastair.
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Anonymous | 29-Nov-2012 8:35 pm
It always seemed to me that if Trusts had been given the requisite share of the money spent on NPfIT there would be a lot more IT systems in place today.
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Anonymous | 30-Nov-2012 1:47 pm
For an interesting alternative take on the subject, see the NHS Networks editor's blog http://www.networks.nhs.uk/editors-blog/the-new-wonder-drug
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Anonymous | 30-Nov-2012 6:04 pm
What are the answers to those questions? Anyone here know?
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Anonymous | 30-Nov-2012 6:06 pm
Anon at 6.29
no, some of those projects have done amazingly well. Trouble is you, like most people in NHS IT, have no idea which is which
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Anonymous | 3-Dec-2012 10:32 am
"While you were at it, you should have mentioned N3/4, an expensive, poor performing, and pointless network.".
Sorry 2:48, but you are wrong. You're clearly from an Acute trust with a single (or small number of) large sites where I agree the benefits are limited.
N3 has however been extremely succesful in providing connectivity for GP Practices and Community sites (where the future of the NHS lies we are told). Can you imagine providing protection against DoS attacks/intrusion prevention/etc. seperately at a local level for all GP practices - there are at least 10,000 of these alone.
N3 has pretty much been the only NPfIT project which actually delivered what it originally set out to do within its original agreed timescales.
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Anonymous | 4-Dec-2012 12:23 pm
Anyone know those answers?
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Alineh Haidery | 4-Dec-2012 2:21 pm
What are your thoughts on the need to adopt patient flow solutions to save costs and increase efficiency in hospitals?
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