The national IT programme has failed to achieve and responsibility over the longer run ultimately must lie with the senior management community at every level

One of the more worrying aspects of the fierce debate on progress with the national IT strategy is the possibility that the debate is only 'fierce' in the closed world of NHS IT professionals and enthusiasts.

The acid test of how far the NHS has come over the last decade (in relation to clinical enthusiasm for the benefits of IT) is the extent to which the problems of the national IT programme are a lively topic of conversation in staff rooms up and down the country.

It is a worrying possibility that much of the clinical community remains largely indifferent to the slow pace at which they are acquiring access to functionally rich clinical IT. And who can blame them, given the poor track record the NHS has for delivering real clinical IT systems?

For their part, senior NHS managers are still likely to be more focused on what they regard as more pressing operational priorities. Many will be happy to leave the IT agenda and its associated costs on the backburner for as long as they can.

This is all very sad. The serious delays with the national programme mean that for the third time in a decade or so a major national programme to accelerate the deployment of clinically rich IT functionality in the NHS has failed to deliver the original timetable or brief.

Like HISS and Information for Health before it, the national programme has failed to achieve and sustain the necessary momentum for the delivery and implementation of the complex clinical systems the NHS needs.

The blame for this situation lies not just with the national programme - the IT malady in the NHS predates it by many years. Responsibility over the longer run ultimately must lie with the senior management community at every level, who have been slow to understand the clinical and business benefits of clinical IT.

The national programme exists because the chief executive community in the NHS declined to take responsibility for progressing the local implementation model at the heart of IfH and actively campaigned for a more centralised approach. How ironic that many are now complaining the process is too prescriptive and increasing numbers are trying to 'go it alone'.

Big decision, right decision

Richard Bacon, a member of the public accounts committee, has called for a major change of direction involving reinstatement of the local implementation approach advocated in IfH.

One thing is clear: any change of direction should follow a full, open and honest debate about whether the programme will ever deliver the state-of-the-art patient management and decision-support systems that could do so much to improve care and the working lives of clinical staff. If there is a big decision about the future of the national programme it needs to be the right decision. Neither the national nor the local option can proceed until usable and useful clinical systems are actually in place across all care settings. In some parts of the country even this simple step appears to be years off.

The really important thing about any decision on the future of the programme is that it can only be properly made by the senior management community across the NHS working with and on behalf of their clinical colleagues and based on sound practical advice from experienced technical staff.

There are enough people with the experience, knowledge, common sense and necessary goodwill both within and outside the programme to put together a consensus on the way forward. David Nicholson needs to get such a group together urgently.

IT is a basic and uncontroversial utility in many industries; the clinical and business benefits of IT in the NHS are now in the 'no brainer' category of decisions.

The fact that progress has been so slow for so long should not simply be laid at the door of the national programme - the problem reflects the collective failure of generations of NHS managers from the top to the bottom of the NHS to give this agenda the priority it deserves.

It's time somebody got a grip.

Frank Burns is former chief executive of Wirral Hospital trust and author of the Information for Health strategy.