Leaked report criticises NPfIT implementation

According to a report in today’s Financial Times, in a March report Professor Peter Hutton, who resigned as head of the National Clinical Advisory Board (NCAB) last week, said: “There is no key clear time frame setting out when key interdependent items of the programme will take effect”. 

The report is said to express the view that e-booking, due to begin in June, cannot work properly until all patients have a unique identifying number.

E-Health Insider broke the news of Hutton’s abrupt resignation last week. In an email on 21 April he explained that the move was needed to clarify arrangements for clinical input into the NPfIT, “in the light of recent developments” – taken to mean the March appointment of Professor Aidan Halligan, deputy chief medical officer, as joint senior responsible officer for the NPfIT.

Halligan has been charged with heading up the task of selling the programme to clinicians, an area previously seen as resting with Hutton.   According to the FT report Hutton had been frozen out since Halligan’s appointment and his warnings have been unwelcome within the programme itself. 

His March report is said to reveal frustration that NCAB was "instructed" to cancel a series of planned spring road shows to inform clinicians about the programme, and states that the board “continues to be concerned about the engagement of clinicians”.

This concern is further underlined by minutes of a 16 March meeting of NCAB, which are said to express concern that communication between the central part of the programme and the local clusters was “inadequate”.   

The concerns about insufficient clinician involvement were backed by Dr John Powell, chairman of the BMA’s IT Committee who told E-Health Insider: "The BMA would agree that there has been a lack of clinician engagement with NPfIT.  The level of clinician engagement has not been sufficient."

Dr Powell said "Its about involving the average clinician in the average hospital, that’s the sort of person who has not been consulted." 

Powell added that the appointment of Aidan Halligan was good news: "I hope its not too late for Professor Halligan, who is a highly respected figure, to turn this around."

The report, as quoted in the FT, goes on to warn that there is a lack of clarity about what is to be delivered nationally through the NHS care record service and what is being developed locally.  “Much of the care record is being developed nationally, but local development is being allowed for some parts – for example maternity, emergency care and ambulance services.

"What is required is a recognisably national set of applications," Professor Hutton is quoted as saying.  He goes on to warn that local variations would raise “major safety and training implications”, threatening the continuity of care.

Hutton says that the aspiration of uniform systems, with standard screens and functionality may be lost "in the multiplicity of suppliers now working at local level". He says that companies delivering the national programme “are unclear about how uniformity will be achieved”.

Chairman of the British Computer Society’s primary care special interest group, Ewan Davis questioned whether the type of monolithic system as described by Hutton was actually desirable or achievable, but said it was imperative for the national programme to be absolutely clear what would be delivered centrally.  “I would dearly like to know what the national programme will provide to each local health community from central budgets; it remains extremely difficult to get clarity on that.”

Part of the problem, said Davis, is that despite its public statements the national programme did not yet have all the answers.  “We’d have much more progress if we could have an honest debate about what is needed.  Unfortunately the national programme hides behind commercial confidentiality and other forms of secrecy rather than say ‘we haven’t worked that one out yet’.” 

Dr Grant Kelly, a GP and healthcare IT expert who advised some of the bidders for the national programme contracts, said “He [Professor Hutton] made the mistake of criticising, didn’t he?”

Referring to the problems surrounding the engagement of clinical staff, he said: “This is the problem about implementation which I pointed out to the national programme last July.  Unless you had the implementation planned, the procurement was pointless.”

Kelly said Halligan was now faced with selling a programme that had already been decided.  “That’s not how you sell things to clinicians,” he said.

He said the points Hutton was reported to have raised about the lack of a clear time frame underlined his point about devising an implementation plan before a procurement.  Kelly said that last year, when he was commenting on the national programme’s OBS to companies taking part in the contract bidding round, he had seen that some it was unworkable.

But Kelly’s greatest criticism was reserved for politicians pressing for results ahead of the general election due next year. “This is not driven by clinical need, it’s driven by politics.”