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  This article appeared in The Daily Telegraph on 17 April 2007

The sickening 12 billion NHS fiasco


 

As civil servants prepare for a new government after the departure of Tony Blair, they could do worse than put signs above the door of every minister's office: “Beware the grand projet!” Never would this advice have been more apt than for the most expensive health technology project in history, the national programme for IT in the NHS.

In this case, hyperbole is appropriate. The project is costing more than 12 billion, enough to pay for 60,000 nurses for 10 years, or for Britain's participation in Iraq and Afghanistan twice over.

Run by an agency called Connecting for Health, the vision (are you nervous yet?) is to link up the entire NHS for the electronic age. Patient records are to be available electronically to all clinicians, while appointments and admissions will be booked online and drugs prescribed electronically. The blueprint was a document published in 2002 called Delivering 21st Century IT Support for the NHS. Any senior mandarin who was awake should have started worrying then, since the published version of this document strangely omitted both the high risk scoring and the costs estimate included in the draft - then a mere 5 billion, although the latest figure has more than doubled.

By now, almost every hospital in England is supposed to have key administrative software deployed as the essential first step in introducing the shiny new electronic patient record. They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.

This is a truly grim tale. More than 2 billion has been spent, and although there is no detailed record of overall expenditure on the programme, estimates of its total cost have ranged from 6.2 billion up to 20 billion. There have been six bosses in five years. Timetables are fictitious and the programme is now years behind.

Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke. And three fifths of the programme is dependent on a software supplier called iSoft, which is currently under investigation by the Financial Services Authority and whose flagship software product, “Lorenzo”, does not exist yet (even though the company said it was available three years ago). In the meantime, iSoft has been merrily selling old software that pre-dates the national programme.  

Today, Parliament’s spending watchdog publishes a report on this multi-billion-pound fiasco, which concludes: “At the present rate of progress, it is unlikely that significant clinical benefits will be delivered by the end of the contract period”. The whole project has been an object lesson in how not do it. There are some basic rules of thumb that apply to successful IT projects: start small, do it in stages, learn from your mistakes, resist the grand vision thing, scale up only when you know what you are doing, and - above all - talk to the people who will use it.

Instead, the NHS started with a series of enormous contracts, about 1 billion each, which were let with indecent haste, before talking to clinicians and without knowing what they wanted. One expert told our committee: “It was like being in a juggernaut lorry going up the M1 and it did not really matter where you went as long as you arrived somewhere on time. Then, when you had arrived somewhere, you would go out and buy a product, but you were not quite sure what you wanted to buy. To be honest, I do not think the people selling it knew what we needed”.

The result was a set of contracts that were signed before the Government knew what it wanted to buy and before the suppliers knew what it was they were expected to supply. Subsequently, we have a project that is costing a fortune, that most people in the health service don't want and that doesn't work.  

If Connecting for Health had been created by one of this country's enemies with the specific task of wasting as much money as possible while causing maximum anger and resentment among doctors, nurses and hospital managers, it could hardly have done a better job. Having been given responsibility for the largest sum of money ever allocated to a health IT programme anywhere in the world, at least 12.4 billion, which incidentally dwarfs the entire NHS deficit, it has failed to deliver.  

This disastrous agency should be put out of its misery, but most of its budget - 10 billion is still unspent - and its purchasing functions should be handed over to local hospital bosses. Any remaining functions could be handled by the Department of Health directly. IT has a tremendous role to play in healthcare and it saves lives.  

One size does not fit all. The obvious solution is something similar to that which worked very well for GPs in the mid-1990s. Hospitals should be allowed to choose the systems they want, provided that those systems meet national standards. The role of the centre should be confined to setting those standards and allocating budgets. Hospital chief executives should have the freedom to buy what they want for their hospital, in consultation with their own clinicians and also be given contractual responsibility for delivering it.  

This approach would not only deliver more products more quickly - it would also save a fortune, which the next prime minister will wish to note well.  

Richard Bacon is Tory MP for South Norfolk and a member of the Public Accounts Committee.  


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