Under Fire

By Baselinemag  |  Posted 2006-11-13 Print this article Print

The British government budgeted close to $12 billion to transform its health-care system with information technology. The result: possibly the biggest and most complex technology project in the world and one that critics, including two Members of Parliame

Under Fire

Despite such setbacks, Granger vigorously asserts that the CfH is creating numerous benefits to the NHS on a timely basis. He points to the many positives detailed in the NAO report as proof of this. In addition, at a recent GC Expo, a U.K. technology conference for the public sector, he enumerated what the CfH delivers in a typical month. On his list:

  • 600 new N3 connections.

  • 3 Patient Administration Systems implemented.

  • 500,000 patient records converted and cleansed; 14,000 smart cards issued, allowing secure access to new systems.

  • 8.5 million X-rays and other images stored.

  • 1.8 million pathology results sent electronically to general practitioners.

    Of course, Granger is far from alone in extolling the benefits of the NPfIT. "Just from standardizing and centralizing the procurement process, the savings have been enormous," Brennan points out. The NAO report claims that deals negotiated by the CfH with Microsoft and other suppliers are expected to save about $1.5 billion.

    Still, the departure of Accenture, by far the CfH's most important contractor, has sparked questions about the CfH's overall approach and its long-term viability.

    Noted Members of Parliament Pugh and Bacon: "The program badly needs to be simplified, and likely future costs need to be brought down. The fundamental error made when setting up the program was to assume that centralized procurement of single systems across the NHS would be more efficient than local decision-making guided by national standards."

    In late August, the British Computer Society expressed a number of worries about the project, stating in a letter run by ComputerWeekly: "Our main concern [is] that a centralized system will not work in the complex organizational structure of the NHS. A distributed architecture would have been more flexible. We also have major problems with the lack of architectural planning about the detailed structure of the Electronic Health Record … this is an entity which does not fit well with other I.T. methodologies and needs considerable thought." A distributed architecture would have been far more flexible, the BCS noted.

    "The availability of key information about patients—both clinical and demographic—at any place where it is needed and at any time is the core value of the approach," the CfH responded to concerns about its centralized approach.

    While some criticism is political and comes from the Tory camp, there is considerable justification for at least some of the concerns about the NPfIT that go beyond cost overruns and schedule slippages. Most serious perhaps is a lack of support shown for the front-line clinicians, an indication that the CfH has fallen well short in its change management efforts.

    Comparing the result of the recent Medix survey of doctors and nurses with a poll the organization conducted three years ago shows a big change in health-care worker attitudes about the project. In the earlier survey, 67% of British general practitioners said they believed the project was an important priority for the NHS. Only 38% feel the same way today, while just 13% believe that the program represents a good use of NHS resources. Only 5% of British MDs say they've been given adequate consultation regarding NPfIT, up 3% from the old Medix survey but still a poor showing.

    Nurses responded in much the same way. Just 5% said they had received fully adequate information about the NPfIT; 35% said they'd been give reasonably adequate information, and 25% said they'd been given no information at all. "That's pretty damning," Brampton says.

    The CfH differs, noting: "We have undertaken a great deal of high-quality stakeholder engagement and change-management work," in an e-mail to Baseline.

    There have also been a number of seismic I.T. shocks recently that may indicate fault lines in the core I.T. services the CfH hopes to provide.

    As an example, in July, mission-critical computer services such as patient administration systems, holding millions of patient records being provided by the CSC alliance across the Northwest and West Midlands region, were disrupted because of a network equipment failure, according to the CfH. As a result, some 80 trusts in the region were unable to access patient records stored at what was supposed to be either a foolproof data center or a disaster recovery facility with a full backup system. Every NPfIT system in the area was down for three days or longer. Service was fully restored and no patient data was lost, the CfH says.

    That was not the first such failure. In fact, in the past five months more than 110 major incident failures having to do with NHS systems and the network have been reported to the CfH, according to ComputerWeekly.

    The CfH responded in an e-mail to Baseline: "It is easy to misinterpret the expression 'major incident.' Some of these could have been, for example, individual users experiencing "slow running." We encourage reporting of incidents, and we are open and transparent about service availability levels, which we publish on our Web site."

    Finally, according to the NAO report, there has been slippage, in some cases substantial, on many key elements of the program. For instance, the National Spine first went live as scheduled in June 2004, but the milestones for building up its functionality have been delayed by up to 10 months.

    Delivery of the first phases of the CRS and the advanced integrated I.T. systems that are central to the long-term vision for the program also are lagging, according to the NAO. Meanwhile, Choose and Book is running well behind schedule, the NAO report notes, in part because of the time needed by suppliers of existing systems to make their systems compliant.

    Still, for every setback, Granger, CfH and Tony Blair's Labour Government announce a step forward. Blair, in fact, is CfH's biggest ally. Addressing some 80 senior doctors earlier this year earlier and, according to The London Times, sweating profusely under the bright lights, Blair said, "The truth is that we have now reached crunch point where the process of transition from the old system to a new way of work in the NHS is taking place. Each reform was in its time opposed. Each is now considered the norm. The lesson, especially at the point of difficulty, is if it's right, do it. In fact, do more of it."

    More recently in September, Blair toured hospitals as an opportunity to defend the NPfIT: "This is going to be a place where people come from all over the world and say: 'This is how health care should be done.'"

    Ironically, with Blair a year from leaving office, the NHS has run short of funds, and recently reported a deficit of almost $1 billion—resulting in huge layoffs, possible closings of hospitals, reductions in services and a mad scramble by Health Secretary Hewitt to bring costs under control.

    "The money is no longer there," says Gartner's Edwards. "There are no funds for implementation or training." Given that by some estimates it will take yet another $15 billion to get the NPfIT initiative fully functioning, that indeed might end up as the NPfIT's epitaph.

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