[many thanks to the contributors to NHS IT Info, from which I obtained many references in order to support my claims]
The NHS has a page, entitled NHS Myth Busters, that claims there are common misconceptions about NHS Connecting for Health and the programmes and services it delivers, and it seeks to bust them.
I thought I might look at some myths, the NHS ‘busts’, and comment on where these myths might have come from, and whether or not the myths presented by Connecting for Health are in fact straw men.
A straw man, in case you’re unfamiliar with the term, is a tactic used by an opponent where he sets up an argument (usually weaker than yours) and attacks it as if you made it. So for example you might claim,
staff were inadequately consulted
…but my straw man would be,
it is not true to say that there has been no consultation.
So, on to the first myth:
The cost of the National Programme for IT is spiralling
The National Audit Office’s report in June 2006 confirmed that the National Programme for IT in the NHS is much needed, well managed and on budget.
The overall cost of the National Programme for IT is £12.4 billion over 10 years.
The NAO report was much criticised for being late and apparently being edited a few times under much pressure from the DoH. But even so it doesn’t seem to me as sunny as implied by Myth Busters. And the NAO has been asked to write a new one.
With regard to costs, there have been a number of stories over the years: £2.3bn, £5 bn, £6.2 bn, £12.4 bn, and £20 bn – the last not for the central services themselves, Lord Warner has explained, but for enabling everyone to use them.
Also, the NAO report makes clear that £6.2 bn was just for the fixed price contracts for 2003 and 2004, and later another £1 bn was budgeted for contracts outside the “original scope” of the project. Meaning, they underestimated the budget. Meaning, the costs are rising.
It’s a waste of money
The National Programme for IT, being delivered by NHS Connecting for Health (NHS CFH), is about changing the way the health service works for the benefit of patients.
Far from being a waste of money, it is actually producing savings for the NHS.
Independent analysts Ovum have estimated that £4.4 billion is being saved through central procurement of IT systems by NHS CFH compared with what could have been achieved by individual NHS organisations purchasing the same systems separately.
That may be so but, to be fair, the NAO report says “the realisation of benefits are mainly a matter for the future and it will therefore be some time before it is possible fully to assess the value for money of the Programme”. So we simply don’t know yet whether or not it is a waste of money.
But I think this myth is a straw man. It seems to me that the question most reasonable people are asking is, could it be done better? Not, has any money been saved at all?
Although I don’t see how spending £12.4 bn to return £4.4 bn makes much business sense. But then the CSA spent £12 m a year to recover £8 m before it was axed, so maybe it makes sense to someone in Government.
Electronic patient records will risk patient confidentiality
Strict and robust safeguards will be in place to protect the security and confidentiality of every patient’s health care records.
Security and confidentiality has been discussed in earlier articles, and (better) elsewhere on the web. But it seems telling that (according to the Guardian) “the government was proposing to start uploading patients’ records before the technology for [securing] the information was proved.”
Now, the next ‘myth’ is behind why many critics believe the costs are rising, and why there are delays in the deliveries of the components of the grand scheme.
The centralist model of the National Programme for IT is flawed and unworkable
NHS Connecting for Health has devolved much of the work on the National Programme for IT.
There is no single supplier and, for most purposes, England has been split into five regional ‘clusters’ so NHS CFH staff can have a closer relationship with local NHS organisations.
But at the same time it often makes sense for systems which are to be deployed across England – like the N3 network – to be developed at a national level.
NHS Connecting for Health has devised a structure that puts decision making at the appropriate level.
It seems telling that the Government has yet to allow a truly independent investiation into the scheme, although the Health Committee is to setup an inquiry.
Another straw man, I think:
There has been limited clinical involvement in the development of IT systems
Thousands of NHS staff at all levels, together with professional bodies, are involved in shaping the systems and services being delivered by NHS Connecting for Health.
Some are employed or seconded to the agency, others have taken time out from their normal jobs to provide their expertise or attend consultation meetings, engagement events and roadshows.As a direct result of this feedback, improvements are being made across the range of programmes.
In April 2006 a major upgrade of Choose and Book implemented changes to the look and feel of the system and introduced new features which had been requested. Action taken to improve the Electronic Prescription Service as a result of consultation with clinicians includes changes to terminology used in the system.
A user survey by the NHS-wide email and directory service, NHSmail, received over 11,000 responses. As a result, 13 improvements to the functions available to users have already been made.
Again, that may be so. But many NHS staff have been dissatisfied with the level of consultation – only 5% of GPs (370 Kb PDF) for example, have said they felt it was adequate, and a couple of years ago only 2% felt it was adequate. The BMA said of the care records service specifically,
Whilst the BMA supports the sharing of information to improve patient care, we are disappointed that the architecture of a system, which will have huge implications to the delivery of healthcare, was commissioned and built prior to stakeholder consultation.
The NAO said of a survey (978 Kb) relating to Choose and Book specifically,
An overwhelming majority of respondents [GPs] felt that the consultation on the implementation of Choose and Book was inadequate – 93% felt this.
The Chairman of the BMA said that
“another year has been wasted” in efforts to implement the National Programme for IT.
In his keynote address to the BMA’s annual representative meeting (ARM) Mr James Johnson claimed that doctors were being marginalised in all aspects of system reform and that Connecting for Health was the obvious example of that.
He added: “Last year at the ARM, I criticised the failure to engage with clinicians. There are some very good doctors involved with the project now, but overall I would have to say that another year has been wasted because doctors are still not at the heart of determining how the systems should work.”
There is lots more on the NHS IT Info page relating to User Surveys and Consultations.
Back to the Myth Busters:
The NHS does not want the National Programme for IT
A second Ipos MORI survey [452 Kb PDF, not sure why Myth Busters didn't link to it] was undertaken in January and February 2006. It was designed to explore levels of awareness, understanding of, and support for the National Programme for IT in the NHS.
This latest survey shows that NHS staff continue to have high levels of support for the National Programme for IT, despite recognising the challenges involved in its delivery.
More staff are favourable to the National Programme for IT than unfavourable.
Well of course they want the scheme to work! I’d be very surprised if they didn’t.
But do they want the scheme to work at the expense of ‘medical care’? The survey says that more Managers, IT Managers, and Administrators, are more likely to agree that “the cost of the programme is high at the expense of medical care”.
Note that the survey also says that some staff (Managers and IT Managers, for example) have become less favourable about the scheme in general, and others (such as Nurses) have become less favourable about specific services (such as Choose and Book). It really isn’t as simple and rosy as Myth Busters seems to imply.
The taxpayer will bear the brunt of problems with the National Programme for IT
Suppliers are only paid when they deliver, so the public purse is protected.
Sure, but when suppliers go under (such as iSoft) or abandon the project (such as Accenture) does that not impact on the taxpayer – i.e. the end user? And don’t these delays and additions ‘outside the scope’ of the project add to the costs to the taxpayer? For example, the rise from £6.2bn to £12.4bn.
Someone has got to pay for it, surely?
The National Programme for IT is yet another botched government IT project
The National Programme for IT is delivering what it was set up to do.
It is making good progress, as the National Audit Office recognised in its report.
No parts of the National Programme have had to be abandoned after implementation. Suppliers are paid only after the successful delivery of systems.
Tony Blair and Palestinian President Mahmoud Abbas have both praised Lord Levy, the prime minister’s Middle East envoy and chief fundraiser.
Speaking at a joint news conference, Mr Blair said Lord Levy was carrying out “a perfectly excellent job as my envoy in very difficult circumstances”.
Detectives investigating alleged corruption in BAe’s dealings with Saudi Arabia believe that the probe was being bugged, The Independent on Sunday has been told. A source close to the investigation made the remarkable claim as Tony Blair’s defence for stopping it on the grounds of national interest began to unravel.
The head of the Serious Fraud Office (SFO) disputed the official claim that the investigation was unlikely to result in charges. Robert Wardle said he had a “different view” from Lord Goldsmith. The Attorney General told Parliament on Thursday that he had agreed to close the case after he had “obtained the views of the Prime Minister and the Foreign and Defence Secretaries” on the effect the probe was having on Anglo-Saudi relations.
But in fact Tony Blair personally took charge of efforts to pressure the Attorney General to drop the probe. He ordered supportive assessments from the Ministry of Defence and the Foreign Office. These were then presented to the head of the SFO and formed part of Lord Goldsmith’s “public interest” justification for calling off the probe.
See also Brian Barder’s blog.
Downing Street aides and Labour officials involved in the cash-for-honours inquiry are being investigated on suspicion of perverting the course of justice, The Times has learnt.
On Thursday Mr Blair became the first serving Prime Minister to be interviewed by police undertaking a criminal inquiry. He was not questioned under caution. This newspaper revealed on Saturday that his evidence contradicted that of his close friend, Lord Levy, who will now be interviewed again.