Intended for healthcare professionals


Implementing the NHS information technology programme: qualitative study of progress in acute trusts

BMJ 2007; 334 doi: (Published 28 June 2007) Cite this as: BMJ 2007;334:1360
  1. Jane Hendy, research fellow1,
  2. Naomi Fulop, professor of health and health policy2,
  3. Barnaby C Reeves, reader in epidemiology3,
  4. Andrew Hutchings, lecturer4,
  5. Simon Collin, research associate5
  1. 1Innovation Studies Centre, Imperial College, London SW7 2AZ
  2. 2School of Social Science and Public Policy, King's College, London
  3. 3Bristol Heart Institute, University of Bristol, Bristol
  4. 4Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
  5. 5Department of Social Medicine, University of Bristol, Bristol
  1. Correspondence to: J Hendy j.hendy{at}
  • Accepted 17 April 2007


Objectives To describe progress and perceived challenges in implementing the NHS information and technology (IT) programme in England.

Design Case studies and in-depth interviews, with themes identified using a framework developed from grounded theory. We interviewed personnel who had been interviewed 18 months earlier, or new personnel in the same posts.

Setting Four NHS acute hospital trusts in England.

Participants Senior trust managers and clinicians, including chief executives, directors of IT, medical directors, and directors of nursing.

Results Interviewees unreservedly supported the goals of the programme but had several serious concerns. As before, implementation is hampered by local financial deficits, delays in implementing patient administration systems that are compliant with the programme, and poor communication between Connecting for Health (the agency responsible for the programme) and local managers. New issues were raised. Local managers cannot prioritise implementing the programme because of competing financial priorities and uncertainties about the programme. They perceive a growing risk to patients' safety associated with delays and a loss of integration of components of the programme, and are discontented with Choose and Book (electronic booking for referrals from primary care).

Conclusions We recommend that the programme sets realistic timetables for individual trusts and advises managers about interim IT systems they have to purchase because of delays outside their control. Advice needs to be mindful of the need for trusts to ensure longer term compatibility with the programme and value for money. Trusts need assistance in prioritising modernisation of IT by, for example, including implementation of the programme in the performance management framework. Even with Connecting for Health adopting a different approach of setting central standards with local implementation, these issues will still need to be addressed. Lessons learnt in the NHS have wider relevance as healthcare systems, such as in France and Australia, look to realise the potential of large scale IT modernisation.


  • We thank participating trusts, individual interviewees for their time and interest, and members of the steering group for their continuing support.

  • Contributors: JH took part in conducting, planning, and reporting the work. NF took part in planning and reporting and is guarantor. BCR and AH took part in planning and reporting. SC took part in conducting and reporting.

  • Funding: NHS Service Delivery and Organisation R&D Programme (ref. SDO/44/2003).

  • Competing interests: None declared.

  • Ethical approval: NHS Trent multicentre research ethics committee and NHS trust local research ethics committees.

  • Accepted 17 April 2007
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