That was then…

The first leader of the National Programme for IT in the NHS was the man who introduced the congestion charge to London, Richard Granger.

The programme’s failings have been well-publicised, and the scheme has often been described as a car-crash. Yet it did have some successes.

PACS was good

Paul Curley, clinical director for IT and a consultant surgeon at Mid Yorkshire Hospitals NHS Trust, believes that while it was “too ambitious” overall, it had considerable success with e-prescribing and picture archiving and communications systems.

“This is an area where NPfIT and NHS Connecting for Health [the agency set up to run the programme] have done some really useful work. This includes reviews of available systems and detailing the pros and cons – the ‘Which’ guide of pharmacy systems,” he says.

“PACS was undoubtedly an application that clinicians have embraced and value highly.

"Instant availability after distant acquisition of diagnostic examinations, collaboration with colleagues who are working across hospital sites but who are able to view the same images simultaneously are real steps forward in high quality, 21st century healthcare.”

As close students of NPfIT will recall, PACS was an addition to the programme. While Christine Walters, director of IM&T at Pennine Acute Hospitals NHS Trust, agrees that it was valuable, she is also keen to trumpet the delivery of the N3 network.

This was both a core part of the programme, and a service that has delivered fast, broadband networking services to the NHS.

“For smaller trusts, PACS wouldn’t have happened [without the programme],” she says. “Radiology information systems for local health economies have made a huge difference in sharing images around trusts and, again, I don’t think that would have happened without NPfIT.

“But the major accomplishment was putting the N3 network in place, as that opened up the ability to share information securely throughout the NHS.”

A CSC spokesperson also argued that that NPfIT’s work to raise the profile of IT should not be forgotten, and that: “Having a central body has helped create the infrastructure, standards and national services and a focus on clinical safety that would not exist otherwise.

"Much of this has informed the latest information strategy and will underpin future developments.”

EPR not so much so

Even so, most observers believe that the high profile failures of the programme outweigh its successes. In particular, they point its failure to deliver ‘strategic’ IT systems to NHS trusts.

To date, CSC, the local service provider for the North, Midlands and East since Accenture pulled out of two of these regions back in 2006, has managed to deploy Lorenzo to just four significant ‘early adopters’ – a community service, two acute trusts, and a mental health trust that went live at the end of May.

In London, BT has deployed Cerner Millennium to far fewer trusts than was originally envisaged, while in the South it is supporting seven trusts that went ‘live’ with Cerner Millennium before Fujitsu quit as LSP in 2008 and deployed the system to a further three ‘greenfield’ sites.

Tola Sargeant, director of TechMarketView, cites the lack of deployment of the EPR systems as the “biggest failure” of the national programme, and says a lack of clinical engagement in the design process was key factor.

“Ten years on, well after all the EPR systems were supposed to be up and running, it’s depressing to see how little progress has really been made towards the vision of a joined-up, digital NHS,” she says.

“BT is plugging away with the rollout of Cerner software in London and selected sites in the South of England, but CSC’s work on the programme has all but ground to a halt as contract negotiations with the DH drag on” (the latest standstill agreement between the company and the DH will run out at the end of August).

Jonathan Edwards, a long-term observer of NPfIT, who is now a director of The Advisory Group, says there was a “lack of understanding of how to purchase and deploy software” and that the LSPs were at fault for agreeing to “unworkable contracts.”

“The insistence on ‘rip and replace’ with no attention to the turmoil it causes, no acknowledgement of existing systems and their value, inserting LSPs and NPfIT between the trust and the software vendor so that every request for a change went through a bureaucratic legalistic process, were the core reasons the programme failed,” he says.

“The pushing of a dumbed-down, standardised solution on a diverse set of organisations showed a lack of understanding to the NHS.”

Still supporting the vision

However, there is support for this aspect of the programme from a surprising quarter; University Hospitals of Morecambe Bay NHS Foundation Trust, which was the first acute and most high-profile adopter of Lorenzo.

The trust gave the system a ‘soft landing’ back in 2008, and has since worked through significant problems. It put the system live in A&E this week.

Patrick McGahon, the trust’s director of service and commercial development says the EPR vision, which was the “fundamental tenet of the original goal of NPfIT” is still key to improving safety and driving better and more secure treatment.

“It was an uncomfortable ride at times,” he admits. “However, we have remained committed to the principles of the NPfIT because we believe its vision is worth fighting for.

“That is why, despite all the inevitable controversy that has dogged the NPfIT over the years, there remains a basic requirement for an integrated IT system, capable of communicating with other systems to manage all patient activities.”

On with the Power of Information

The NHS now has a new information strategy – the ‘Power of Information: putting us all in control of the health and social care information we need.’ The strategy sets out a “vision” for the use of information in the health service, but makes almost no mention of the NPfIT legacy, and is virtually silent on the organisations that might support its vision, or how it might be funded.

While Edwards can understand the strategy’s reluctance to be prescriptive, he thinks this will be a problem. He also thinks that without a national approach, some trusts are likely to make far more progress than others.

“Some trusts have the money for advanced EPR systems. Most, however, are pursuing clinical portals and ‘health information exchange’ approaches as a lower-cost way of providing some value to clinicians and to help share patient data across care settings,” he says.

However, the director of healthcare at Northgate Public Services, Andy Gordon-Jones, believes the strategy has tacitly learned from the programme and that it focuses on the right things by stressing “the appropriate use of data to inform decisions by clinicians” and the need to put patients in control of information and their own records.

“The original iteration of the NPfIT took a single product approach, which hampered innovation, but we are increasingly seeing signs of broader innovation coming back in to the area,” he says.

“With greater clarity on the future direction of the programme, there is more incentive for organisations from both the public and commercial sector to innovate and invest in R&D.”

Curley also remains positive, although he emphasises that clinicians need to take it upon themselves to continue the “resourcefulness and enthusiasm of clinician colleagues” who were involved with CfH.

“They were the trailblazers and we – the next generation – owe it to them to continue to innovate and successfully argue for the development and deployment of systems,” he says. “We need to get them working to standard that will allow efficient high quality healthcare to flourish in the new era of healthcare budget austerity.”