The NHS programme for information technology
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38889.569201.DE (Published 29 June 2006) Cite this as: BMJ 2006;333:3All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Prof Keen suggests that the NHS IT program has only been running for
4 years. In fact the Information for Health program was set up in 1998 (8
yrs ago) and was supposed to have been completed by 2005 with only an
additional expenditure of 1 Billion pounds.
The BMJ published a largely positive editorial about the program at
the time and I note that Justin Keen contributed to that. (BMJ, Oct 1998;
317: 900).
Many IT literate consultants suspected that there was no way that the
NHS would be able to deliver on the more complex parts of the strategy
within budget and on time.
That’s proved to be the case. OK the NHS has changed the name of the
program to NPfIT (National Programme for IT), but it’s basically still the
old 1998 strategy. I suspect the change of name was partly to disguise the
fact that they got their original sums and timescales hopelessly wrong.
Lets hope they get there in the end.
Martin Briscoe
Competing interests:
None declared
Competing interests: No competing interests
Opt out of failure, Opt into success.
The case made by Nigel Watson for the national care records to have a
patient opt out is compelling (1) . There is however one crucial point in
the Hampshire and Isle of Wight’s successful records service that is not
made clear in the paper.
The key feature is the use of computer integration software ( XML
Graphnet) which provided a confidentiality breakthrough. This links
diverse and unrelated GP, Hospital and Ambulance/Out of hours systems
together and has safety features.
The alternative method of trying to achieve this level of joint
working is to scrap all the existing systems and force all these services
to use exactly the same system. This approach was tested in Dorset as part
of a NHS pilot scheme in 2001-3 run by the Information Authority, at the
same time as Hampshire. This method hit massive problems with data
migration, confidentiality and a GP revolt against the imposition of new
software which did not work as well as their advanced surgery systems.
This is the route chosen by Connecting for Health. The Dorset site
recorded the same delays and escalating costs before abandoning rigid
centralisation and adopting the same integration technology as Hampshire.
In Dorset we can confirm the commentary of Jan Wilkinson asking
“What’s all the fuss about ?” (2) as when we asked patients contacting the
out of hours service permission to look at their integrated record they
universally agreed and were surprised that we could not already do this
across the whole NHS.
This concept of integration fits perfectly with the arguments made by
Justin Keen (3) which foresees the benefits that could accrue to the
National Care Records Service by emulating the dynamic and innovative
market system that brought such progress to GP systems in the 1990s, using
a regulatory framework to accredit, steer and fund progress. Integration
technology allows diverse enterprise whilst allowing a central record to
be built behind the scenes. GP practices retain their Caldicott Guardian
roles with their locally based records and can monitor, edit and correct
the entries that are replicated to the spine.
Lord Warner recently announced a review following the National Audit
Office report (4) and proposed a visit to look at the Veteran’s
Association system in the USA then pilot sites in 2007. The lessons are
already there. Hampshire and Dorset have provided pilot sites for two
methods of building the National System. Integration technology is the key
to rapid progress. It is cost effective, rapidly reproducible and it
works.
1 BMJ volume 222, 1 July page 39
2 BMJ volume 222, 1 July page 42
3 BMJ volume 222, 1 July page 3
4 National Audit Office The National Programme for IT in the NHS
16/06/2006
Competing interests:
2003 employed Graphnet solution. No commercial interest now.
Competing interests: No competing interests
Role of doctors in NHS programme for information technology
In the editorial written by professor J Keen an extended role of
doctors have been suggested as one of the best way forward for the
development of NHS IT services. He has also suggested that the doctors
need to judge the probable outcomes of the NHS IT programmes.
Looking at the present circumstances of the NHS IT programme, involvement
of Doctors to influence on decision making looks a good approach but it is
an advice which came very late.
There is no actual involvement of doctors so far in this programme. Poor
promotion of the front line clinical staff involvement (including doctors)
in this programme leading to poor awareness and enthusiasm about the
programme.1, 2
Doctors along with other front line clinical staff acquiring role in
shaping IT services may be ideal (as they are the front line clinical
staff using these services) but ideally their involvement should have been
there from the very beginning.
In the current structure of the management in NHS there is a very little
role of involvement of doctors in planning and administration. Under this
background it is difficult to say how far is this advice of Prof. Keen is
going to go.
References:
1. Ipsos MORI survey of NHS staff on behalf of NHS connecting for health;
Jan.-Feb. 2006: Pg 9.
2. Medix UK plc survey (Q850) of doctors’ views about the National
Programme for IT (NPfIT) – January 2006.
Competing interests:
None declared
Competing interests: No competing interests