Richard Barker on why the IT programme is never going to come right

Just who is going to accept responsibility for the fiasco that is the national programme for IT? The government's much-vaunted technology led overhaul of the NHS is in chaos, with Accenture, the biggest and most successful lead contractor, responsible for two of the five regional programmes having recently withdrawn from the project.

Deadlines have been repeatedly missed and projects undelivered. Yet prime minister Tony Blair has now announced that further funding, on top of the recent revelation by the National Audit Office that the expected cost had doubled to£12.4bn, will be made available if necessary to get NPfIT back on track.

In the meantime, leading academics and industry commentators continue to predict that escalating project costs will see the final figure anywhere between£20bn and£40bn.

NPfIT will never get back on track; it was never on track in the first place. It breaks every rule of project management - from scoping to delivery - and is patently failing to take into account the actual requirements of clinicians across the NHS.

NPfIT has achieved one thing over the past few years: it has kept the IT industry solvent although one key supplier is testing even that assumption, in what otherwise would have been difficult financial times.

In the meantime, those at the front line have been denied the IT solutions they desired and requested to actually transform the effectiveness and efficiency of NHS hospitals.

Misinformation

The manifest failure of NPfIT to have any impact on the problems facing those at the front line of patient delivery is a disgrace. For five years the NHS has endured a technology moratorium as those tasked with NPfIT have thrown money at over-complex network infrastructures yet failed to address the pressing issues facing clinicians. In hospitals, the only real change is the requirement for 1.2 million NHS employees to handle their own human resources and payroll online - a move that hardly releases more time for patient care.

And, occasionally, when prompted by the media, the government has made a flurry of announcements relating to specific patient led issues that will - apparently - be addressed by NPfIT. Just when they will be addressed is, of course, not clear.

This government's sudden concern about the misadministration of drugs, for example, is hardly credible, given that MPs and hospitals raised the issue with the prime minister's office as far back as 2001. According to chief medical officer for England Sir Liam Donaldson, it is estimated that 40,000 deaths a year in the UK are caused by 'breakdowns in patient safety'. These include machine failures and hospital acquired infections, but the majority are caused by medical errors.

While much of the media focus is on infections such as MRSA, an issue that hospitals are working hard to address, the problems caused by misprescription and misadministration of drugs continue.

Viable solution

Yet over five years ago Southend Hospital piloted a system that not only ensured drugs were administered to the right patient at the right time and in the right quantity, but also provided doctors with immediate information (and warning) on possible contra-indications associated with the prescription of multiple drugs.

At the time the system was independently reviewed by the Royal Pharmaceutical Society of Great Britain. Its report concluded that it was not only vital to improving patient care - and hence well-being and recovery rates - but also reducing high levels of drug wastage and releasing the hospital pharmacist to undertake more patient treatment discussions with doctors.

Critically it provided, for the first time, an exact audit trail of drug use from pharmacy to patient - at individual treatment level. This could provide pharmaceutical companies with unprecedented insight into actual drug performance in real patients as well as vital information into the issues raised by the prescription of multiple drugs.

Despite pleas from doctors, nurses and pharmacists, the government could not find the money for the system and the project was abandoned.

Misplaced investment

Instead it has committed, originally,£6bn on NPfIT, and acknowledged that it will spend another£6bn with little chance of delivering a prescription administration system that provides any of the benefits that could have been available five years ago.

And this system is just one of many that could have been in place years ago if the NPfIT fiasco had been avoided. Legions of highly experienced technology suppliers to the NHS, the majority of whom had in-depth knowledge and understanding of the issues, have been forced out of the market by the five-fold NPfIT monopoly. The fact that five have now become three following the withdrawal of two vendors from the project is, of course, a further nail in the NPfIT coffin.

Together these trusted, embedded organisations had the technology and experience to deliver quantifiable improvements in patient care, in efficiency and accountability using the intuitive, integrated technology now available. Instead, mistakenly believing that reducing the number of suppliers to the NHS would reduce costs and improve accountability, the government introduced NPfIT and hospitals are now languishing with aging technologies that are consistently failing patients and staff alike.

Worst of all, there was no need for either the excessive investment or constraint of local innovation. Yes, the concept of an electronic patient record is great and to be applauded. But with today's highly integrated technology it is neither necessary nor reasonable to impose identical technology across every aspect of the NHS. The NHS is treating individual, idiosyncratic patients - not a nation of identikits. Indeed, no experienced project manager in the world would opt to deploy systems on a National basis like this. It makes no sense. And it will never be delivered.

Culpable

Of course, the IT industry has been culpable; in the face of the cash cow, few have been able to resist. But it is beyond belief that so many people across government, the civil service, senior NHS managers and the NPfIT providers could be allowed to waste taxpayers' money in this way with no accountability and no call to justify their actions.

How can it cost another£20bn to deliver NPfIT? And how can the government justify the lives that will be lost, the wastage and extended hospital stays caused by poor drug administration when a solution was available and in use, for a tiny fraction of the NPfIT investment, so long ago?

The NPfIT concept may have been created with the best intentions, but before more valuable investment is thrown at organisations that have yet to prove their competency in this area, isn't it time for some answers?

Richard Barker is managing director of Sovereign the software provider to the NHS before the introduction of the NPfIT. Sovereign was too small to bid for NpfIT contracts, but was among those to whom the successful contractors outsourced their roles.