Radical Steps highlights serious concerns about NPfIT

These serious concerns, each potentially a threat to the successful delivery of the national programme, are set out in ‘Radical Steps’, a new consultation paper from the Health Informatics Committee of the British Computer Society (BCS). 

The paper also states that the “perception" of what will be delivered by NPfIT, ‘has been downsized by a factor of ten’.

The paper, the third in the Radical Steps series, reflects the collective expert comments from BCS members, many of them working in the field.  Overall the paper is very supportive of the aims of NHS IT modernisation, but commenting on previous advice offered to NPfIT it states: “There is disquiet that previous good advice, described in published literature and expert commentary, has not (yet) been responded to or indeed acted on."

Jean Roberts from the British Computer Society, who authored the paper, told E-Health Insider. “Very few people appear to have an overview, or helicopter view, both of the system specifications and contracts. The perceptions we are getting through people in the field is that people can’t find out where different bits of the programme join together."

Roberts pointed to the consultation on Care Records Services (CRS) in the past two months as a prime example of a “limited consultation” on a key component of the national programme looked at in isolation.  “It seems fragmented and not totally open… The CRS specification appears to be a moving feast you can’t quantify." 

Key concerns raised by Radical Steps include the lack of detailed information on what is to be delivered nationally by the NPfIT and what is required locally. The paper expresses alarm that the “total cost of local ownership of new operational solutions has yet to be worked up (including management of change, capacity increases and capability enhancements)."

It states that the local costs of the NPfIT appear to be mushrooming. “The eventual level appears to those in the field to be escalating rapidly over and above previous perceptions."

In addition it warns that feedback from BCS members strongly indicates the scope of the systems to be delivered by NPfIT have already been dramatically scaled back, without this being adequately consulted on or communicated.  “Perception is rife that the scope of the first phase of procurement has been downsized by a factor of ten – this must be convincingly repudiated or faced up to."  

Roberts said: “In the early days the national programme was going to address everything for everyone.  It does seem to have been rowed back a bit."  She pointed to electronic prescriptions in hospital and the amount of end-user equipment hospitals will have to buy as examples.

The previous Radical Steps papers estimated that the true costs of fully implementing the national programme, as opposed to procuring systems, had been under-estimated by a factor of up to eight.  “When NPfIT was bidding for £2.3 billion from Treasury our people in the field said that that left a shortfall of 4-8 times the figure to deliver everything, doing the maths made clear that was impossible. That sort of cash is not swilling around."

Speaking about people’s perceptions about what the national programme originally indicated it would deliver, as opposed to what it now looks likely to deliver, Roberts said: “The lines have been drawn in very different places from what the initial perspective was."

She added: “If the national programme says everyone’s perspective is wrong I’d say that was down to their communications, or lack of them."  Roberts added that the national programme had been very reticent about publishing details of what and when it will deliver.

Although extremely supportive of the goals of the NPfIT the paper sets out a series of related perceived threats to the success of the programme, particularly around the approach to communications and partnership.  It states: “NHS staff are willing to engage positively with national initiatives like NPfIT, if they fully understand them and are involved in their development and deployment".

Calling for far greater partnership and meaningful detailed consultation the paper states. “Whilst consultation is now improving, the core specification appears immutable”. Specific concerns highlighted include: “superficial operational clinical involvement to date”; lack of nursing involvement – “substantial nursing involvement will not be included until 2008"; and lack of engagement with health records staff.

The document warns though that the national programme represents an additional major demand on already stretched NHS staff.  “The NHS is under-resourced in human terms to cope with the day-to-day and emergency situations it works within.  Overlaying a major change programme onto such situations is challenging."

Radical Steps also voices concern that the tight target timescales may not allow time for partnerships between the NHS and supplier consortia to develop. “This places enormous pressure on the organisations, raises the issue of corporate over-stretching and increases the risk to successful application delivery and operation."

“If provision is to deliver operational tools that are fit for purpose, partnership must cover design, development and deployment of full functionality not just the generic front-end."